• Ophthalmology
  • Clinicals

Retinal detachment

  • 2 minutes, 12 seconds
  • Ophthalmology
  • 2022-02-08 00:00:00

Estimated read time is 2 minutes, 12 seconds

Article Details

Retinal detachment is the separation of the sensory retina from the underlying pigment epithelium with fluid accumulation. Clients experiencing retinal detachment may report a gradual, curtain-like loss of the visual field. 

 It can be a result of spontaneous atrophic retinal breaks or acute trauma. 

Common symptoms include a painless loss of vision "like a curtain" coming across the field of vision, light flashes, or a gnat/hairnet appearance in the vision field.

This report needs emergent evaluation.  Untreated symptomatic retinal detachment usually leads to blindness in that eye.  In addition, this is the only presentation that is acute: the rule for prioritization is acute before chronic.

Blunt-force trauma to the head is associated with potentially severe complications (eg, brain damage and herniation, retinal detachment, seizures).  Prompt recognition of potential complications is essential to prevent irreversible changes to the client's neurological status and level of function.

Retinal detachment is a separation of the retina from the posterior wall of the eye that may occur following head trauma. 

This is an ocular emergency as permanent blindness may result without intervention.  Signs of retinal detachment include perception of lightning flashes or floaters and a curtain-like or gnats/hairnet/cobweb effect throughout the visual field 

Traumatic retinal detachment may also result in abrupt vision loss. 

Retinal detachment requires emergency surgery to attempt to restore vision. 

Surgical repair involves rebinding the choroid and retina.  After repair, interventions focus on promoting retinal reattachment. 

Postoperative teaching should include:

Avoiding activities that increase intraocular pressure (eg, rubbing the eye, straining) 

Reporting sudden pain, flashes of light, vision loss, or bleeding, which may indicate detachment or infection, to the health care provider

Avoiding focused activities (eg, reading, writing, sewing), that can cause rapid eye movements and increase the risk for detachment 

Wearing an eye patch or shield as directed to prevent rubbing/scratching of the eye and minimize eye movement

Ensuring appropriate positioning as instructed by the surgeon because clients may receive intravitreal oil or gas, which holds the retina in a specific position to allow healing

Signs of retinal detachment include floaters, sudden flashes of light, and loss of vision.  If signs of detachment occur, the surgeon should be notified immediately.

Chronic hyperglycemia can cause microvascular damage in the retina, leading to diabetic retinopathy, the most common cause of new blindness in adults.

A retinal detachment requiring emergency management. 

A partial retinal detachment may be painless and cause symptoms such as a curtain blocking part of the visual field, floaters or lines, and sudden flashes of light.  An unrepaired complete retinal detachment can cause blindness.

References
    Saunders NCLEX RN Review

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