Tests
1st tests to order
visual acuity testing
Test
Should be ordered in all patients with suspected RD.
Visual acuity may not be reduced if the detachment is peripherally located. If vision has decreased, the central retina is probably affected, which necessitates immediate treatment. Vitreous hemorrhage may also be responsible.
The fellow eye in a patient with nontraumatic rhegmatogenous retinal detachment (RRD) is at increased risk of developing RRD.[17] Both the affected eye and the fellow eye should be evaluated, so that risk factors for subsequent RD in the fellow eye may be determined.
Result
visual impairment
slit-lamp exam
Test
Ordered in all patients with suspected RD.
The fellow eye in a patient with nontraumatic rhegmatogenous retinal detachment (RRD) is at increased risk of developing RRD.[17] Both the affected eye and the fellow eye should be evaluated, so that risk factors for subsequent RD in the fellow eye may be determined.
Result
RD; retinal break; vitreoretinal pathology (traction or presence of pigment)
indirect ophthalmoscopy
Test
Ordered in all patients with suspected RD.
Vitreous hemorrhage may be present. Bleeding caused by a torn retinal vessel occurs in a low percentage of eyes with rhegmatogenous RD. Conversely in one third of eyes in uninjured and nondiabetic patients presenting with a vitreous hemorrhage, a retinal break is the culprit.[43]
High watermarks or demarcation lines are characteristic of slow-progressing, chronic RDs.
The fellow eye in a patient with nontraumatic rhegmatogenous retinal detachment (RRD) is at increased risk of developing RRD.[17] Both the affected eye and the fellow eye should be evaluated, so that risk factors for subsequent RD in the fellow eye may be determined.
Result
RD; retinal break; vitreoretinal pathology (traction or presence of pigment)
Tests to consider
wide-field color photography
Test
Consider to detect peripheral breaks if the patient does not tolerate careful ophthalmoscopy.
The fellow eye in a patient with nontraumatic rhegmatogenous retinal detachment (RRD) is at increased risk of developing RRD.[17] Both the affected eye and the fellow eye should be evaluated, so that risk factors for subsequent RD in the fellow eye may be determined.
Result
peripheral breaks
optical coherence tomography (affected eye)
Test
Can detect the four stages of PVD (i.e., perifoveal separation and vitreous adhesion to the fovea; complete separation of the vitreous and macula; extensive vitreous separation with adherence to the disc; and complete PVD).[40]
Result
helpful to evaluate and stage PVD
B-scan ultrasonography (affected eye)
Test
Ordered when any media opacity prevents visualization of the fundus.[17] Under standard ultrasonography, direct the patient to move their eye to provide a dynamic understanding of the vitreoretinal architecture.
False-positives may occur; in one study B-scan ultrasonography falsely identified the presence of RD behind the vitreous hemorrhage in 19% of eyes.[42]
Although ultrasound can aid in the differential diagnosis, it offers less value than direct visualization.
Result
RD; occasionally retinal break
CT/MRI of orbit
Test
Order when suspecting traumatic injury.
A breach in the eye wall or the presence of an intraocular foreign body raises the likelihood of a concurrent or future rhegmatogenous RD. An intraorbital foreign body can cause retinal necrosis without breaching the eye wall and can lead to subsequent rhegmatogenous RD.
An MRI should not be ordered if you suspect a metallic intraocular foreign body.
Result
variable; may show orbital fracture or intraocular/intraorbital foreign body
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