Vitreous Detachment or Retinal Detachment?

15 Aug
•Vitreous and retinal detachment have similar symptoms but very different prognosis and treatment. One is an emergency and one seems to be no big deal. How can you comfortably rule out retinal detachment in the ED? Is US helpful?

Both can present with increasing or new flashers and floaters.
  • Sudden onset of one large circular floater in the center of the visual axis indicates a PVD
  • Hundreds of tiny black specks appearing before the eye, followed several hours later by the appearance of cobwebs, is pathognomonic for vitreous hemorrhage
  • New onset floaters with flashers should be considered a retinal tear until proven otherwise
•12% of posterior vitreous detachments have an associated peripheral retinal tear

With retinal detachment, the affected eye may have an IOP 4-5mmg Hg less than the opposite eye

•In an observational study of bedside ultrasound to evaluate for retinal detachment, no cases of retinal detachment were missed by emergency physicians using bedside ultrasound. Sensitivity was 100%, specificity was 83% (5 cases of vitreous hemorrhage were incorrectly diagnosed as retinal detachment).

•Both are indications for ophthalmology consultation

Submitted by M. Smith.

Reference(s): Yoonessi R, Hussain A, Jang TB. Bedside ocular ultrasound for the detection of retinal detachment in the emergency department. Acad Emerg Med. Sep 2010;17(9):913-7; picture

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