Clinical Review

Management of retinal detachment: a guide for non-ophthalmologists

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39581.525532.47 (Published 29 May 2008) Cite this as: BMJ 2008;336:1235
  1. Hyong Kwon Kang, vitreoretinal consultant,
  2. A J Luff, vitreoretinal consultant
  1. 1Eye Unit, Southampton University Hospital NHS Trust, Southampton SO16 6YD
  1. Correspondence to: H K Kang, 3 Colleen Close, Cherrybrook, NSW 2126, Australia kwonkang{at}ozemail.com.au

    Patients with retinal detachment often present to their general practitioner, emergency department, or optometrist after central vision has been compromised. This delay is unfortunate because early repair results in little or no visual loss. Once the detachment extends across the fovea (the central macula), permanent visual impairment is almost inevitable. Thorough examination of the retina needs equipment that is rarely available to non-ophthalmologists. Recognition of symptoms and awareness of the risk factors for retinal detachment may help in making speedy referrals and saving vision.

    Methods

    For an overview in the current management of retinal detachment we consulted textbooks and proceedings of meetings in the field of retinal surgery. We searched Medline and Cochrane Review databases for “retinal detachment”, “retinal break”, “retinal tear”, “retinal hole”, “vitreous detachment”, “lattice”, “retinal tuft”, “vitrectomy”, “scleral buckle”, and “retinopexy”, and we searched the internet for reviews and perspectives on retinal detachment.

    What is retinal detachment?

    Retinal detachment is separation of the neurosensory retina from the underlying retinal pigment epithelium (fig 1). In health, the potential “subretinal space” between these two layers is closed by the retinal pigment epithelium actively pumping fluid across the retina and into the choroid.1 Cellular interdigitation and extracellular matrix provide additional adhesion. Retinal detachment occurs when the forces of retinal attachment are overcome and fluid accumulates in the subretinal space.

    Fig 1 The retina lines the internal surface of the posterior two thirds of the globe. It is thickest around the optic nerve and ends at the ora serrata, 5-7 mm behind the limbus. The macula lies temporal to the optic nerve, bordered by the vascular arcades; the fovea is a depression at its centre that provides fine visual acuity. The outermost layer of the retina contains photoreceptors (rods and cones), loosely attached to the retinal pigment epithelium; they depend on the retinal …

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