RETINAL DETACHMENT

DESCRIPTION NURSING MANAGEMENT/ INTERVENTION

● Separation of the sensory retina and the underlying
pigment epithelium with fluid accumulation in between
the two layers
● 4 types of retinal detachment:
○ Rhegmatogenous detachment
■ Hole or tear in sensory retina
■ Allows liquid vitreous to seep
through and detach the retinal
pigment epithelium
○ Traction retinal detachment
■ Tension or pulling force leading to
detachment
■ Patient develops scar tissue
○ Exudative retinal detachment
■ Production of serous fluid under the
retina from the choroid
● Uveitis and macular
degeneration may cause
production of serous fluid
○ Combination of rhegmatogenous traction and
exudative detachment
■ Both traction and tear/hole in retinal
tissue
FOCUS ASSESSMENT (SIGNS AND SYMPTOMS)
● Floaters
● Photopsia- flashes of light
● Blurred vision
● Gradually reduced peripheral vision
● Curtain- like shadow over visual field
DIAGNOSTIC AND LABORATORY TEST
● Ultrasound
○ To assess if cornea,lens or vitreous is hazy or
opaque
● Visual acuity measurement
● Ophthalmoscopy
● Slit lamp microscopy
RISK FACTORS
● Aging
● Previous retinal detachment
● Family history
● Previous eye surgery or eye injury
● Severe myopia
● Other eye disorders such as retinopathy
NURSING DIAGNOSES BY PRIORITY
1. Disturbed sensory perception related to visual
impairment
2. Anxiety related to lack of knowledge about surgical
and post operative experience
3. Risk for injury related to impaired vision
● Teach the patient about the role of the retina and why
floaters, flashes and decreased vision occurs
● Position the patient face down if gas has been injected
to maintain the pressure on retina
● Watch out for post op complications such as increased
IOP, endophthalmitis, retinal detachment and
development of cataract
● Discourage the patient from travelling at high altitudes
to prevent increased IOP
● Instruct the patient to take measure to prevent post op
complication such as:
○ Avoid bumping head
○ Encourage the patient to not cough or sneeze
or other strain inducing activities
● Administer medication for pain, nausea and vomiting
as prescribed
● Teach proper technique in giving eye medication
● Teach the patient to recognize and report symptoms of
recurring detachment such as floating sports, flashing
lights and progressive shadows
MEDICAL/ SURGICAL INTERVENTION
● Laser photocoagulation
○ Seal retinal breaks by creating an
inflammation reaction
○ Causes chorio retinal adhesions or scar
● Cryopexy
○ Freezing (cryotherapy) retinal break
● Scleral buckling
○ Extraocular surgical procedure
○ Moves the pigment epithelium, choroid and
sclera toward the detached retina by placing a
band around the globe
● Pneumatic retinopexy
○ Intraocular procedure
○ Intravitreal injection of gas to form temporary
bubbles that close retinal breaks
● Vitrectomy
○ Surgical removal of vitreous to relive traction
on the retina
DRUG ANALYSIS
● Cycloplegic agents
○ Cause dilation of the pupil and red of the
muscles of accommodation
■ Cyclopentolate hydrochloride
● Antibiotics
○ Prevent eye infection
■ Gentamicin
● Antiemetics
○ To manage nausea and vomiting
● Analgesics
○ To manage pain