4. Retinal Detachment
• A Retinal Detachment (RD) describes the
separation of the neurosensory retina (NSR)
from the retinal pigment epithelium (RPE).
This results in the accumulation of subretinal
fluid (SRF) in the potential space between the
NSR and RPE.
5. • pulled away from the underlying choroid
• small areas of the retina torn =>
retinal tears or retinal breaks
• retinal cells deprived of oxygen
• if not promptly treated => permanent vision
loss
6. Types
1. Rhegmatogenous (rhegma – break), occurs
secondarily to a full-thickness defect in the
sensory retina, which permits fluid derived
from vitreous to gain access to the subretinal
space.
2. Tractional in which the NSR is pulled away
from the RPE by contracting vitreoretinal
membranes in the absence of a retinal break.
7. 3. Exudative (serous, secondary) RD is caused
neither by a break nor traction; the SRF is
derived from fluid in the vessels of the NSR or
choroid, or both.
4. Combined tractional-rhegmatogenous, is the
result of a combination of a retinal break and
retinal traction. The retinal break is caused by
traction from an adjacent area of fibrovascular
proliferation and is most commonly seen in
advanced proliferative diabetic retinopathy.
8. Can occur as a result of:
• trauma
• advanced diabetes
• an inflammatory disorder, such as
sarcoidosis
• shrinkage of the jelly-like vitreous that fills
the inside of the eye
10. Causes in non rhegmatogenous
detachment
1. The retina being pushed away from its bed
• Accumulation of fluid. Eg- blood (choroidal
haemorrhage) or exudates
• Neoplasm
2. The retina being pulled away from its bed
• The contraction of fibrous tissue bands in the
vitreous
11. Factors that may increase risk of
retinal detachment:
• aging - more common in people older than 40
• previous retinal detachment in one eye
• family history of retinal detachment
• extreme nearsightedness
• previous eye surgery
• previous severe eye injury or trauma
12. • vitreous liquid leaks through retinal tear and
accumulates underneath retina
• retina can peel away from underlying layer of
blood vessels
13. SYMPTOMS
• floaters
• light flashes (photopsia)
• shadow or curtain over a portion of visual
field
• blur in vision
14. SYMPTOMS
• floaters - bits of debris in field of vision that
look like spots, hairs or strings
15.
16. Signs
• Plane mirror examination- defective or no red
glow seen
Fundus examination
• The detached retina looks greyish- white and
raised above the surface
• The retinal vessels are dark with no central
light reflex
• Detached retina is thrown into multiple folds
which oscillate with the movement of the eye
• Holes or tear can seen
17. • Visual fields – scotomas are present
• Electroretinography- it is subnormal
• Ultrasonography confirms the diagnosis
18. Complications
• Total detachment of the retina
• Complicated cataract is seen in the posterior
cortex
• Chronic uveitis and phthisis
21. CRYOPEXY- is done to seal the retinal breaks by
causing tissue necrosis
22. PNEUMATIC RETINOPEXY
It is another method of repairing a retinal
detachment in which a gas bubble is injected
into the eye after which laser or freezing
treatment is applied to the retinal hole.
24. Scleral buckling
• Scleral buckle surgery is an established
treatment in which the eye surgeon sews one
or more silicone bands to the sclera. The
bands push the wall of the eye inward against
the retinal hole, closing the break or reducing
fluid flow through it and reducing the effect of
vitreous traction thereby allowing the retina
to re-attach.
26. vitrectomy
• It breaks the tractional band in the vitreous
thus releasing the pull on the retina in cases of
tractional retinal detachment
• Drainage of subretinal fluid is required in long
standing cases
28. Nursing diagnoses for Retinal
Detachment
• Disturbed sensory perception (visual).
• Anxiety.
• Risk for injury.
29. Implementation
• Asses visual status and functional vision in the
unaffected eye to determine self care needs.
• Prepare the client for surgery by explaining
possible surgical interventions and technique
to alleviate some of the client's anxiety.
• Discourage straining during defecation,
bending down and hard coughing, sneezing or
vomiting to avoid activities that increase
intraocular pressure.
30. • Assist with ambulation, as needed, to help the
client remain independent.
• Approach the clients from the unaffected side
to avoid startling him.
• Provide assistance with activities of daily living
to minimize frustation and strain.
• Orient the client to his environment to reduce
the risk of injury.
• Postoperatively instruct the client to lie on his
back or on his unoperated side to reduce
intraocular pressure in the affected area.
