Clinical manifestations

Classic symptoms of all types RD are decreased vision and progressive monocular visual field loss. The latter is described by patients as “dark curtain ”, “cloud” or “web” over the field of vision and is due to mechanical disturbance of the retina by vitreoretinal traction. Patients frequently report history of light flashes or floaters that typically increase over a short period of time. Visual acuity may not be reduced if the detachment is peripherally located. Macular involvement leads to central vision loss. Vitreous hemorrhage may be present.

By definition, RRD, the most common type RD, is caused by one or more retinal breaks (full-thickness defects in the retina) (Fig. 2). Thus, on clinical examination, retinal break(s) must be present, although in some cases they may not be detected (e.g. in pseudoaphakic eyes). Pigmented cells described as “tobacco dust” are seen in the vitreous and occasionally in the anterior chamber. The underlying detached retina is opaque with a corrugated appearance and often undulates with eye movement. The subretinal fluid is usually clear. A major detachment shows an abnormal or diminished red reflex; however, this may not be present if the tear is in the periphery of the retina. Pupil examination is normal.

Retinal breaks and shifting fluid are characteristic for RRD, but not ERD and TRD. Secondary retinal breaks in TRD are possible. In some cases (trauma), pigment in the vitreous may be present also in TRD. Blocked transillumination and choroidal mass may be present in ERD. Intraocular pressure is usually normal in TRD, low in RRD and variable in ERD. RRD is an important cause of visual loss. If left untreated, symptomatic RRD invariably results in loss of vision.