Retinal Detachment

Michelle A. Macawile3A2

Introduction... It is a disorder of the eye in which

the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness.

Types of Retinal Detachment: Rhegmatogenous retinal detachment –

occurs due to a hole, tear, or break in the retina that allows fluid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium.

Exudative, serous, or secondary retinal detachment – occurs due to inflammation, injury or vascular abnormalities that results in fluid accumulating underneath the retina without the presence of a hole, tear, or break.

Tractional retinal detachment –occurs when fibrovascular tissue, caused by an injury, inflammation or neovascularization, pulls the sensory retina from the retinal pigment epithelium.

Types of retinal detachment:

Rhegmatogenous Most common

type, a tear in the retina allows fluid to get under the retina and separates it from the retinal pigment epithelium

Types of retinal detachment:Tractional Scar tissue on

the retina’s surface contracts and causes the retina to separate from the retinal pigment epithelium

Types of retinal detachment:

Serous/Exudative

Fluid leaks into the area underneath the retina, but there are no tear or breaks in the retina

Risk Factors:

COMMON: Aging Cataract Surgery Myopia Trauma Affects men more

than women

LESS COMMON: Congenital eye

diseases Diabetic

retinopathy Family history of

retinal detachment

Signs and Symptoms

Light Flashes (photopsia) Wavy or watery vision

(metamorphopsia) Veil or curtain obstructing

vision Shower of floaters Sudden decrease of vision

Pathophysiology

Diagnostic Exams...

Opthalmoscopy- uses bright light and powerful lens that allow the doctor to view the inside of the eye in detail and in 3D. To be able to see a retinal hole, tear or detachment. (the retina is gray)

Ultrasonography- sends sounds waves through the eyes to bounce off the retina. The returning sound waves create an image of the retina and other eye structures.

Eye chart- test the visual acuity

Direct Funduscopy- detect hemorrhage and detachment of the posterior pole

Slit lamp biomicroscopy- facilitates an examination of the anterior segment, or frontal structures and posterior segment of the human eye.

Medications...

Surgery is the only effective therapy for a retinal tear or detachment.

Surgical management... Cryotherapy and Laser

photocoagulation – used alone to wall off a small area of retinal detachment so that the detachment does not spread.

Scleral buckling –sewing one or more silicone bands to the sclera. It compresses the sclera to indent the scleral wall from the outside of the eye and bring the two retinal layers in contact with each other.

Pneumatic Retinopexy- a gas bubble (SF 6 or C3F8 gas) is injected into the eye after which laser or freezing treatment is applied to the retinal hole.

Vitrectomy- involves the removal of the vitreous gel and is usually combined with filling the eye with either a gas bubble or silicone e oil. There is no myopic shift.

Electrodiathermy- tiny hole in the sclera is made to drain subretinal fluid allowing the RPE to adhere to the retina

Nursing management...

1.Pre-op Instruct the patient to remain quiet in

prescribed (dependent) position, to keep the detached area of the retina in dependent position.

Patch both eyes. Wash the patient’s face with antibacterial

solution. Instruct the patient not to touch the eyes to

avoid contamination. Administer preoperative medications as

ordered.

2.Preventing post-op complications.. Caution the patient to avoid bumping

head. Encourage the patient no to cough or

sneeze or to perform other strain-inducing activities that will increase intraocular pressure.

3. Encourage ambulation and independence as tolerated.

4. Administer medication for pain, nausea, and vomiting as directed.

5. Provide quiet diversional activities, such as listening to a radio or audio books.

6. Teach proper technique in giving eye medications.

7. Advise patient to avoid rapid eye movements for several weeks as well as straining or bending the head below the waist.

8. Advise patient that driving is restricted until cleared by ophthalmologist.

9. Teach the patient to recognize and immediately  report symptoms that indicate recurring detachment, such as floating spots, flashing lights, and progressive shadows.

10. Avoid activities that increase IOP 11. Avoid straining and bending below

the waist

Thank You!