• Occurs as a result of the separation of the outer retinal pigmented epithelium from the inner neurosensory retina. 

• Usually painless and can present with flashes of light, floaters and a feeling of dots, cobwebs or a curtain passing over the eye. Patients may describe a grey area within their vision. Visual loss can be sudden or gradual depending on the degree and site of detachment. More common in short-sighted individuals (myopes), aged ≥ 60 years, and in diabetes.

Assessment

• There can be loss of the red reflex.  Fundoscopy may be normal in the early stages of the condition or reveal a pale, opaque retina often with wrinkling and loss of the usual choroidal patten. Proper slit lamp examination should be performed by an ophthalmologist. 

Differential diagnosis

• Macular degeneration affects the central vision and usually presents with blurry or distorted vision. 

• Amaurosis fugax is usually a painless transient loss of vision

• Uveitis would cause a painful red eye with worsening vision.

• Glaucoma would not cause these symptoms.

Management

• If suspected, should be treated as an emergency with immediate referral as progression and non treatment can lead to blindness.Commonly used surgical interventions for retinal detachment include scleral buckling, pneumatic retinopexy and vitrectomy. Patient may experience some bruising and discomfort after the operation as well as blurry vision. However, headaches, nausea, acute eye pain and worsening of vision are unusual so warrant a clinical review.

Resources

• Retinal detachment (CKS)