VR Disorders; Clinical

presentation, classification and

RDAyesha S Abdullah

21.12.2012

Learning outcomesBy the end of the lecture the students

would be able to: Identify the symptoms of VR disorders

and correlate them with underlying pathophysiological mechanisms.

Classify VR disorders into broad categories.

Describe the clinical presentation and epidemiology of RD

Correlate the mechanism of retinal detachment with the development (RD) of the eye

Classify RD Identify major causes of RD Outline the principles of management

Common symptoms of VR diseases

Blurred vision/decreased vision Distorted vision ( metamorphopsia) Difficulty in near work difficulty in recognizing faces Something blocking central vision ( positive

scotoma) Minified image/micoropsia-spreading apart of

foveal cones Magnification of images/ macropsia-crowding

of cones at fovea

Problems with colour vision Difficulty in dark adaptation Field loss Seeing sparkilign bright lights/

photopsia Seeing webs/ black dots -floaters Difficulty in night vision-nyctalopia Difficulty in day vision-hemeralopia

Common signs

Decreased visual acuity RAPD Opacities in the vitreous Liquified vitreous gel Cells in the vitreous Signs in the retina specific to the specific disease

entity Self-reported Amsler grid Nystagmus

Classification of VR disorders

Diseases of the vitreous Retinal Detachment Vascular retinopahties Vitreoretinal degenerations Inflammatory & infective disorders Tumours of the retina

DEVELOPMENT OF THE EYE

What is RD?

Separation of the sensory retina from the retinal pigment epithelium by the subretinal fluid

Rhegmatogenous RDNon- rhegmatogenous

–Exudative RD–Tractional

TYPES

RRD-some anatomical considerations

Vitreo-retinal adhesions disc, ora, blood vessels & at fovea

Potential subretinal space

RRDRD secondary to a break in the retina

Causes & risk factors

In 15% of cases with Posterior vitreous detachment (PVD) a tear develops in the retina

60% of tears develop in peripheral retina with retinal degenerations like Lattice degeneration

40% of the RD occur in myopic eyes; the higher the error the greater the risk

Post- Cataract surgery (pseudophakia) ; especially in eyes with retinal degeneration and myopia can develop retinal tears and RRD

Clinical presentation –symptoms

Flashes of light Floaters Visual loss Visual field loss Usually an acute event History of predisposing factors, myopia,

cataract surgery, trauma etc

Field loss

Clinical examination –signs

Visual acuity Anterior segment examinationPupils, (RAPD)Posterior segment examinationVitreous- tobacco dustRetinal signsIOP ( may be low)

Clinical examination –signs

Direct ophthalmoscopy

Indirect Ophthalmoscopy

Normal fundus

Rtinal detachment with tear

RD

RD with giant tear

Tractional retina detachment

Principles of management

External temponade/ scleral buckling– Seal the break– Create a buckle– Drain the SRF-if required

Internal temponade/

Management

Prophylaxis of RRD

Photocoagulation of the risky lesions with laser

So patients with risk facotrs should be referred for treatment/ consideration of the treatment

Let us Summarize