Classification:

1. Rhegmatogenous
Cause: retinal break

2. Tractional (retina pulled away by contracting vitreoretinal membranes)
Causes: proliferative diabetic retinopathy, retinopathy of prematurity, toxocariasis, trauma, previous giant retinal tear

3. Exudative (fluid derived from the choriocapillaries gains access to subretinal space)
Causes: neoplastic choroidal lesions, inflammatory disease, optic pit, choroidal coloboma, vascular disorders, nanophthalmos

Symptoms:

A. Photopsia (flashes of light)
B. Floaters (solitary ring-shaped opacity, cobwebs, a sudden shower)
C. A curtain of shadow moving over the field of vision
D. Sudden loss of vision (peripheral, central or both)
E. Visual changes may vary with changes in head position in exudative retinal detachment
F. May be asymptomatic

Clinical signs

1. Rhegmatogenous (retinal break)

A. See clinical signs of retinal break
B. Elevation of the retina from retinal pigment epithelium (RPE) due to full-thickness retinal break
C. Lower IOP in the affected eye than the contralateral eye
D. Detached retina opaque in appearance
E. Relative afferent pupillary defect (RAPD)
F. Pigmented demarcation line, intraretinal cyst and fixed folds in long standing retinal detachment

2. Tractional

A. Vitreous membranes exerting traction on the retina
B. The detached retina appears concave
C. Retinal striae extending from the areas of traction
D. Tractional retinal tear may develop

3. Exudative

A. Elevation of the retina with shifting subretinal fluid
B. The detached retina is smooth

Management

A. Inderect ophthalmoscopy with sclera indentation
B. Slit lamp examination with four-mirror contact lens
C. B-scan ultrasonography
D. Patients with rhegmatogenous and tractional RD should be placed on bed rest until surgical repair (options include: laser photocoagulation, cryotherapy, pneumatic retinopexy, vitrectomy, sclera buckle)
E. Exudative RD – treatment of underlying condition
F. Follow up for all RD: 1 day, 1 week, 2 weeks, 1 month, 2 to 3 months, then every 6-12 months