Retinal detachment

 Retinal detachment

Retinal detachment is separation of sensory area of retina (rods and cons) from the retinal pigment epithelium and choroid.

Classification of Retinal Detachment

1. Rhegmatogenous Retinal Detachment

Usually associated with hole or tear in sensory retina, allowing sub retinal fluid/vitreous to seep and separate sensory retina from retinal pigment epithelium.

2. Tractional Retinal Detachment

When fibrovascular tissue, caused by injury, inflammation or nevovascularization pulls sensory retina from retinal pigment epithelium.

3. Exudative Retinal Detachment

Occurs due to inflammation, injury or vascular abnormalities that results in fluid accumulating underneath the retina without presence of hole, fear or break.

Etiology

1. Degenerative changes in retina and vitreous

2. Trauma; penetrating trauma

3. Aging

4. Myopia

5. Diabetic retinopathy

6. Vitreous hemorrhage

7. Uvietis; inflammation in middle eye 

8. Macular degeneration

9. Tumor infront or behind retina

Pathophysiology

Retina thin layer of light sensitive tissue on back wall of eye.

Retina translate focused image into neural impulses and sends them to brain via optic nerve.

Posterior vitreous detachment, injury or trauma to eye or head may cause small tear in retina.

Tear allows vitreous fluid to seep through it under retina, and peel it away like bubble.

Initial detachment may localized but without rapid treatment entire retina detach, leading to vision loss and blindness.

Diagnostic Evaluation

1. Indirect ophthalmoscopy shows gray or opaque retina

2. Slit lamp examination

3. Goldmann three mirror examination

4. Electrode tomography

Surgical Management

1. Photocoagulation

Argon laser beam passed through pupil, causing small burn and producing exudates between pigment epithelium and retina.

2. Cryosurgery

Super cooled probe touched to sclera, causing minimal damage as result of scarring, pigment epithelium adheres to retina.

3. Electro Diathermy

Electrode needle passed through sclera to allow subretinal fluid to escape.

Exudates forms from pigment epithelium and adheres to retina.

4. Vitrectomy

Made incisions at space between retina and ciliary body on each side cornea. 

One incision is used to introduce fiber optic light source and other is used to introduce instrument to aspirate vitreous, manipulate tissue or apply diathermy or laser treatment.

5. Scleral Buckling

Reattachment of retina is accomplished by aspirating subretinal fluid and forcing pigment epithelium closer to retina.

6. Pneumatic Retinopexy

Involves intraocular injection of air or gas (sulfur hexafluoride) holding retina in place during reattachment surgery.

Nursing Intervention

1. Use eye patch to restrict eye movement

2. Avoid rapid eye movement for several weeks 

3. Not to touch eye to decrease chance of infection

4. Administer antibiotic eye drops to prevent infection and corticosteroids eye drops to reduce inflammation

5. No to cough or sneeze or to perform strain inducing activities will increase IOP

6. Apply warm compress 4-6 times a day to promote healing

7. Apply clean warm, moist wash cloth to eye 

8. Use eye shield to protect eye during healing process

9. Activities require close vision such as; reading, needle work or writing limited because require rapid eye movement.