Retinal Detachment

Retinal Detachementseperation of retmal pigment enthelium from theneurosensory layer4typesof retmas detachment1. thegm atogenous2. traction3. combo of rheymatogenous /traction4. exudativemost CO Immon: they m atogenous retinal detachementhole or tear develops in the sensory reting, allomnysome of the liquid vitreous to sleep through thesensory retina and detach it brom the retinanplament epithelium(at NSK: those T high myora or who have arhakia.) Detached retinaRetinal tearLensFluidVitreoushumorFigure 58-10Retinaldetachment.Tension, or a pulling force, is responsiblefor traction retinal detachment. Anophthalmologist must ascertain all of theareas of retinal break and identify andrelease the scars or bands of fibrousmaterial providing traction on the retina. Ingeneral, patients with this condition havedeveloped fibrous scar tissue fromconditions such as diabetic retinopathy,vitreous hemorrhage, or the retinopathy ofprematurity. The hemorrhages and fibrousproliferation associated with theseconditions exert a pulling force on thedelicate retina.Patients can have both rhegmatogenousand traction retinal detachment. Exudativeretinal detachments are the result of theproduction of 2 corous fluid under the UI a serous num meretina from the choroid. Conditions such asuveitis and macular degeneration maycause the production of this serous fluid. Clinical manifestations:sensation of a shade or curtain coming accreesthe vision of one eye, cobwebs, bright flashing lights,sudden on set of a great # of floaters.*painless (but its considered an emergency.)DX:must home a dilated bundus exam using anIndirect opthal mosure and 1 slit-lamp blomiumscopyoptical wherenee tomographyultrasoundSX: most commonly used are: Scleral buckle andvirrectomy.rhegmatogenous retinal detachment: attempt to sxreattach the sensory retina to the retinal pigment epithelivintraction retinal detachement: source of traction must beremoved and the sensony retina reattached.scleral bulkle SX SX compresses the Screm toIndent the scleral wall from the outside of the eyeand bring the 2 retinal layers In contact t/each other. Scleral buckleencircles globeBuckle holds scleraagainst the retinaRepairedtearFigure 58-11Scleral+buckle. Virectimy - Intraocular procedine that allow theintroduction of a light source through on incision; a secondincision serves as the Portal for the intrectomy InstrumentSx dissects preretinal membranes under directvisualization while the retina IS stabilized by anIntraoperative vitreous substitute-agas bubble silicone oil, or perfluoncarbon and liquidsmay be injected into the vitreous eavity to herepush the sensory retina up against the retinalpigment epitheliumVNursing managementpost- - or pisitioning of the patient IS critical when agas bubble IS used because the infected b ubble mus tremain in position overlying the area of detachementneeds to be prone in position that woma allow thegas bubble to act as a tamponade for the retinal break.