Last updated: 02/17/2009

Diagnosis

The diagnosis of retinal detachment requires direct examination of the eye as well as taking the patient's medical history. The diagnosis may be made in some cases by an optometrist, who is a health professional qualified to...

examine the eye for diseases and disorders as well as taking measurements for corrective lenses. If the symptoms of RD appear suddenly, however, the patient is more likely to be diagnosed by an ophthalmologist, who is a physician specializing in treating disorders of the eye.

PATIENT HISTORY. Retinal detachment is not usually painful, and the patient's eye will look normal from the outside. In almost all cases, a patient with RD consults a doctor because he or she is having one or more of the following visual disturbances:

• blurring of vision that is not helped by blinking the eye
• a gray or black curtain or shade coming across the field of vision from one direction
• floaters, which appear as moving black spots in front of the eye (The sudden appearance of a large group, or "shower," of floaters is a serious symptom of RD.)
• flashes of light
• objects appearing wavy or distorted in shape
• blind spot in the visual field

The visual symptoms of retinal detachment may develop either gradually or suddenly. In a very small number of cases, a sudden retinal detachment may cause complete loss of vision in the affected eye.

Patients who have gone to a primary care physician or emergency room for these visual symptoms are referred to an ophthalmologist. Many ophthalmologists will give patients a piece of paper with a circle on it and ask them to draw what they are seeing on the circle in the area corresponding to the part of their visual field that is affected. In some cases, the location of the spots, light flashes, or shadows that a patient sees is a clue to the part of the retina that is detached.

The ophthalmologist will take a patient history, asking about a family history of eye disorders; previous diseases or disorders of the eye; other diseases or disorders that the patient may have, particularly diabetes or sickle cell disease; and a history of head trauma, direct blows to the eye, or surgical removal of a foreign body from the eye. If the patient suffered a head or eye injury within the past six months, the ophthalmologist will ask whether the visual disturbances started at the time of the injury or several months later.

EYE EXAMINATION. After taking the history, the ophthalmologist will examine the eye itself. This examination has several parts, including:

• A test of visual clarity or sharpness. This test is the same one used by an optometrist when fitting a patient for glasses or contact lenses.
• An external check for bleeding or any other signs of trauma to the eye.
• A test that measures the response of the pupil of the eye to changes in light intensity. One sign of RD is a difference in the pupillary reaction between the affected eye and the normal one. The pupil will not contract as far as it normally does when the doctor shines a light into the affected eye.
• A test that measures the amount of fluid pressure inside each eyeball. In RD, the affected eye typically has a lower pressure measurement than the other eye.
• Examination of the eye with a slit lamp, which is an instrument with a high-intensity light source that can be focused as a thin sliver of light. The examiner uses the slit lamp together with a binocular ophthalmoscope (an instrument that looks like a microscope with two eyepieces) in order to check first the front and then the back of the eye for any abnormalities. To check the front part, the doctor will touch the side of the eye with a strip of paper containing an orange dye. The dye stains the film of tear fluid on the outer surface of the eye, making it easier to see the structures in the front of the eye. Patients with RD usually have normal results for this part of the slit-lamp examination. In the second part, the doctor puts some drops in the patient's eye to make the pupil dilate. This procedure allows him or her to see the structures in the back of the eye. If the patient has RD, the doctor may see the retina lifted upward or forward, possibly moving back and forth. The retina will have a grayish color with darker blood vessels visible. It may have a pitted surface resembling an orange peel, and there may also be a line visible at the edge of the detachment.

LABORATORY AND IMAGING STUDIES. Today, there are no laboratory tests for retinal detachment. Ultrasound, however, can be used to diagnose retinal detachment if the doctor cannot see the retina with a slit lamp because of cataracts or blood seeping into the vitreous body. If the RD is exudative, ultrasound can be used to detect a tumor or hemorrhage underneath the retina.

Preparation

Treatment of RD follows as soon as possible after the diagnosis; however, an immediate procedure is not usually necessary since the time frame for treatment of a detached retina is several hours rather than only a few minutes.

If the patient has suffered a traumatic injury to the eye, the eye may be covered with a protective shield prior to treatment.

Preparation for photocoagulation therapy consists of eye drops that dilate the pupil of the eye and numb the eye itself. The laser treatment is painless, although some patients require additional anesthetic for sensitivity to the laser light.