Someone who has suddenly lost their vision or is experiencing a severe deterioration associated with retinal detachment, may become distressed and go to the emergency department or call an ambulance. Retinal detachment is a medical emergency and would require treatment immediately in the hospital.
The patient may be experiencing floaters, that may be accompanied by flashes of light in their peripheral vision (Yorston, 2018). Dots or lines in the vision are defined as ‘floaters’, and may rapidly increase in number (NHS, 2017). While detachment worsens, there may be a corresponding visual field defect, and when the macula detaches itself, the patient will experience symptoms of sudden and severe loss of vision, usually to less than 6/60 (Yorston, 2018).
To fully assess the eye, a trained specialist will be required to examine using an opthalmoscope. Some paramedics are trained to this level, but if they are unavailable, the patient will need to be examined and diagnosed in the emergency department.
Using the opthalmoscope, the detachment needs to be visualised, and will be visible as a grey, mobile membrane inside the eye (Yorston, 2018). This is presented as the blue area on this month's illustration. The intraocular pressure may also be reduced, and the red reflex is usually pale or grey, rather than the normal orange colour (Yorston, 2018). Further, examining the eye with a slit lamp would show pigment cells in the vitreous (Yorston, 2018).
Of course it is also important to always check that the opthalmoscope works and that spare batteries and bulbs are available. If the retinal detachment is confirmed upon examination, emergency surgery will be required, or the patient's sight may be lost completely.
Retinal detachments can occur as a result of scarring of the vitreous and retina, the cause being tractional of origin, resulting from chronic traction from scars on the surface of the retina and across the vitreous cavity (Kang and Luff, 2008). The detachment may be exudative, whereby there has been leakage of fluid into the subretinal space, but this is less common. The majority of retinal breaks occur when the vitreous separates from the retina as part of the normal ageing process. This is known as posterior vitreous detachment, which is the result of degenerative and liquefaction, as well as shrinkage of the vitreous over the course of a lifetime (Kang and Luff, 2008). The breaks allow fluid to enter the subretinal space, which is a form of detachment known as rhegmatogenous in nature. Most cases are benign but about 10–15%, go on to experience retinal detachment requiring treatment (Kang and Luff, 2008).
The most common risk factors for retinal detachment are age (commonly 50–70 years), gender (mostly in men), history of cataract surgery, particularly if it was complicated by vitreous loss, and myopia (more common in longer-sighted eyes) (NHS, 2017; Yorston, 2018).