“A 68-year-old female sees you because she developed increased floaters followed by flashes of lights after a sneezing attack. She then noted a dark spot in the periphery of her right eye. Three weeks ago she underwent cataract removal with intraocular lens implantation in this eye. Her examination is notable for decreased visual acuity and a loss of peripheral field in the right eye.
Which one of the following is the most likely diagnosis? Answer: Retinal Detachment.
Retinal detachments can be caused by a break in the retina, exudate or leakage from beneath the retina, or traction on the retina. Retinal detachments are often preceded by a posterior vitreous detachment, which can lead to a break in the retina, and patients may experience an increase in floaters but not light flashes or loss of vision. With a retinal detachment, patients typically experience floaters followed within 1 week by flashes of light as the retina tears. If the retinal tear becomes large enough vision is impaired. Any patient with the typical history and loss of visual acuity or peripheral field should be urgently referred to an ophthalmologist, as urgent surgery may be required.
Risk factors for retinal detachment include age 50–75, ocular trauma, previous cataract surgery, family history, and a past history of retinal detachment. A patient with a previous retinal detachment has a 25% risk of developing a retinal detachment in the other eye. Myopia is the other significant risk factor, associated with a tenfold increased risk in patients with >3 diopters of refractive error. Central retinal artery occlusion is manifested by painless complete loss of vision in the affected eye. Acute angle-closure glaucoma is associated with eye pain, photophobia, headache, nausea and vomiting, and cloudy loss of vision, and the onset is not typically associated with coughing or sneezing.” ABFM
Ref: Gelston CD: Common eye emergencies. Am Fam Physician 2013;88(8):515-519.