A patient presents with flashing light. Sudden floaters and perception of a cuain falling in front of the eye. Which of the following is the most likely diagnosis:
A i.e. Rhegmatogenous Retinal Detachment Photopsia (subjective sensation of flashing lights) and vitreous floaters (moving vitreous opacities like solitary Weiss ring floater, cobwebs and sudden showers of minute red colored or dot spots) along with visual field defects perceived as black cuain is characteristic of spontaneous rhegmatogenous retinal detachment. Signs of RRD include Marcus Gunn pupil (RAPD), low IOP (extremely low in associated choroidal detachment), mild iritis (rarely with posterior synechie), tobacco dust (pigment cells) in anterior vitreous, retinal breaks (usually red discontinuities in retinal surface), slightly opaque, convex configuration, fresh retinal detachment with corrugated appearance (b/o retinal edema), subretinal fluid (SRF) extending upto ora serrata (except when caused by macular hole when SRF is confined to posterior pole), pseudohole at posterior pole (b/o thinnes of retina at the fovea) and good mobility of vitreous and retina on B-scan. - Photopsia (flashing lights) and floaters (floating opacities) are usually absentQ in tractional retinal detachment, because vitreoretinal traction develops insidiously and is not associated with acute posterior vitreous detachment (PVD). The visual field defects progress slowly. RD has a concave configuration with shallower SRF, severely reduced retinal mobility (highest elevation at sites of traction) and absence of retinal breaks & shifting fluid. In exudative RD, photopsia is absent (because there is no traction), although floaters may be present (if there is associated vitritis). The visual field defect may develop suddenly & progress rapidly. RD has a convex configuration (like rhegmatogenous) but the surface is smooth (not corrugated) and retina is very mobile exhibiting phenomenon of shifting fluid. Leopard spots and bilateral simultaneous involvement is also seen. Feature Rhegmatogenous RD Tractional RD Exudative RD Photopsia (Flashing light) Classical premonitory symptom Usually absent Absent (Present) Vitreous Classical Usually absent May be present Floaters (moving opacities) premonitory symptom (Present) (if a/w vitritis) Visual field Develop suddenly Develop insidiously Develop defect & progress rapidly; perceived as black cuain & progress slowly suddenly & progress rapidly /veil in the field of vision; may not be present in the morning, only to reappear later in day Retinal Breaks Present Usually absent Absent SRF Upto ora-serrata Shallower & posterior Usually does not extend to ora (d/t normal RPE Shifting of fluid _ Absent pump) HallmarkQ RD configuration Slightly opaque, convex, corrugated Concave with highest elevation at the site of vitreous retinal traction Convex, smooth (non corrugated) Retinal mobility (B- scan) Good mobility of vitreous & retina Severely reduced Very mobile Other features Marcus Gunn pupil (RAPD), Low IOP, Tobacco dust Leopard spots, Bilateral simultaneous involvement (pigment cells), PseudoholeQ
Rhegmatogenous Retinal Detachment
Traditional Retinal Detachment
Vitreous Hemorrhage
Eale's disease