Retinal detachment: symptoms

Symptoms of retinal detachment are made up of subjective and objective symptoms.

Patients complain of a sudden fall in the field of vision (designated by the patient as a "veil", "shroud" before the eyes). Disturbances progressively increase and lead to an even deeper decline in visual acuity. These symptoms of retinal detachment can be preceded by a feeling of "flashes and lightning", curvature of objects, floating opacities. These symptoms, characteristic of retinal detachment, depend on the localization and prevalence of retinal detachment and the involvement of the macular area in the process. Falling into the field of vision usually occurs on the side opposite to the location of the retina detachment.

In ophthalmoscopic examination, detachment of the retina is characterized by the disappearance of a normal red reflex on one or another part of the fundus, which becomes grayish in the retinal detachment area, and the retinal vessels are darker and more convoluted compared to the norm. Depending on the prevalence, height and prescription of retinal detachment, it more or less protrudes into the vitreous, retaining in the early periods almost complete transparency. At a small height of the retina detachment (the so-called flat retinal detachment), it is possible to judge the presence of the process only by changing the course of the vessels and less clearness of the figure of the choroid, and also in reducing the bioelectrical activity of the retina. With a high and vesicular detachment of the retina, the diagnosis is unquestionable, since a swaying whitish-gray bubble is seen. With the prolonged existence of the detached retina, coarse folds and stellate scars appear in it. The detached retina becomes inactive, rigid. In the final analysis, it acquires a funnel-like shape and remains connected with the underlying membranes only around the optic disc

[1], [2], [3], [4], [5], [6]

Symptoms of primary retinal detachment

Classical symptoms-precursors, noted in 60% of patients with spontaneous rheumatogenic retinal detachment, are photopsy and floating opacification of the vitreous. After a while, patients notice relative visual field defects that can progress and cover central vision.

Photopsy with acute posterior detrimental detachments can be caused by traction of the retina in the area of vitreoretinal fusion. The termination of a photopsy is associated with the detachment of adhesions, including complete separation, together with the retinal area of the fusion region. In the eyes with posterior vitreal shots, the photopsy can be caused by eye movements and more obvious in low light. They are mostly noted from the temporal side and unlike floating turbidity are not inclined to lateralization.

Floating opacities of the vitreous body are mobile and are perceived when a shadow falls on the retina. Vitreal opacities in the eyes with acute posterior vitreal detachments can be of three types:

1. single rounded opacities, representing an exfoliated ring located along the edge of the optic nerve disk (Weiss ring);
2. cobweblike opacities as a result of the accumulation of collagen fibers inside the destroyed cortical part of the vitreous body;
3. minute accumulations of red or dark spots usually indicate a secondary vitreal hemorrhage after rupture of peripheral retinal vessels.

Changes in the field of vision that occurred again after detachment of the retina are described as the appearance of a "dark curtain". In some patients, this symptom may be absent when lifting after a night's sleep due to spontaneous absorption of subretinal fluid, but appear later in the day. Initial changes in this or that quadrant of the field of vision are of diagnostic importance for determining the localization of the primary rupture of the retina (which will be located in the opposite quadrant). Violations of central vision may be due to the leakage of subretinal fluid into the fovea and less often - the closure of the visual axis by the extensive bullous retinal detachment at the top.

General features

• Pupil Marcus Gunn (relative afferent pupillary defect) is noted in the eyes with extensive retinal detachments regardless of their species.
• Intraocular pressure is usually below the norm by about 5 mm Hg. Art.
• Often accompanied by moderate uveitis.
• The so-called "tobacco dust" is determined in the anterior part of the vitreous humor.
• Retinal tears look like irregular patches on the retina.
• Retinal manifestations depend on the prescription of retinal detachment, as well as on the presence or absence of proliferative vitreoretinopathy, as described below.

Fresh detachment of the retina

• The detached retina has a convex shape "somewhat turbid and uneven due to intra-retinal edema. When you move your eyes, it freely undulates.
• The disappearance of the underlying structure of the choroid is noted, the retinal vessels appear darker than in the flat part of the retina, while the venules and arterioles differ little in color.
• The subretinal fluid spreads higher up to the "dentate" line, except in rare cases with macular gaps, in which the subretinal fluid initially accumulates in the region of the posterior pole.

Pseudorayers are more often detected when the detachment is located in the posterior pole.

Pseudorupplies should not be mistaken for true ruptures of the macula, which can be complicated by retinal detachment in the eyes with a high degree of myopia or after blunt trauma to the eye.

Old retinal detachment

The main features of the old rhegmatogenous retina detachment, which are characteristic of other species.

• Secondary thinning of the retina in response to atrophy, which should not be mistaken for retinosis.
• Secondary intra-retinal cysts may appear if retinal detachment persists for more than 1 year.
• The subretinal demarcation line (with a high level) is noted in the proliferation of PES cells on the border of the flat and exfoliated parts of the retina and develops within 3 months.

Proliferative vitreoretinopathy

Proliferative vitreoretinopathy develops during proliferation and contraction of membranes on the inner surface of the retina (epiretinal membranes), on the posterior surface of the detached hyaloid membrane, and sometimes on the outer surface of the retina (subretinal membranes). Significant postoperative reduction of these membranes is the most common cause of failure in the operations of retinal detachment. The main clinical signs of proliferative vitreoretinopathy include retinal folds and rigidity, while the degree of retinal shaking during eye movement or sclerocompression depends on the severity of the process. Classification of proliferative vitreoretinopathy reduces to the following.

1. Degree A (minimal) is characterized by diffuse opacification of the vitreous (in the form of "tobacco dust"), sometimes the presence of pigment cells in the lower parts of the retina.
2. Degree B (moderate) is characterized by rupture of the retina with wrapped uneven edges, wrinkling of the inner surface of the retina and the tortuosity of the vessels, compacting and diminishing vitreous body mobility. The main role in this case belongs to the epiretinal membranes, which can be seen only with indirect contactless ophthalmoscopy on the slit lamp and which are not detected with ordinary indirect ophthalmoscopy.
3. The degree of C (expressed) is characterized by thickened rigid retinal folds with compaction and destruction of the vitreous. It can be front or back, With an uneven dividing line corresponding to the equator of the eyeball.
   • the severity of proliferation is determined by the volume of retinal pathology, expressed by the number of hourly meridians (1-12), even with non-adjacent proliferation;
   • the type of membrane reduction is in turn divided into: type I (local), type 2 (diffuse), type 3 (subretinal), type 4 (circular) and type 5 (with anterior displacement).

Symptoms of traction detachment of the retina

Photopsy and floating opacities are usually absent, as vitreoretinal tract develops secretly and is not accompanied by acute posterior vitreal detachment. Progression of changes in the field of vision is slow and can be established for several months and even years.

Symptoms

• The detached retina has a concave shape, without ruptures.
• The level of subretinal fluid is lower in comparison with rhegmatogenous retinal detachment and rarely extends to the "dentate" line.
• The retina is most elevated in the area of vitreoretinal tracts.

Mobility of the retina is significantly reduced, there is no movement of the fluid.

If traction detachment of the retina leads to the formation of ruptures, it acquires the properties of rheumatogenic retinal detachment and very quickly progresses (combined traction-regmatogenic retinal detachment).

Symptoms of exudative retina detachment

Photopsy is absent, as there is no vitreoretinal traction, although in the case of concomitant vitreitis there may be floating opacities. Changes in the field of vision develop suddenly and rapidly progress. In some cases of Harada disease, both eyes are affected.

Symptoms

• The detached retina has a convex shape without ruptures.
• The surface is more often smooth than uneven.
• Sometimes the level of the subretinal fluid is so high that retinal detachment can be detected on a slit lamp without a lens; The retina can even touch the back of the lens.
• The detached retina is very mobile, the phenomenon of "fluid movement" is manifested, in which the subretinal fluid under the action of gravity exfoliates the retina, under which it accumulates. For example, in the vertical position of the patient, the subretinal fluid accumulates in the lower parts of the retina, but in the prone position the lower retina is flattened and the subretinal fluid is displaced posteriorly, exfoliating the macula and the upper retina.
• Scattered areas of subretinal pigmented lumps like "leopard spots" are detected after allowing retinal detachment. When examining the fundus, you can identify the cause of retinal detachment, for example a tumor of the choroid.