YENI ANGGRAINI

I11107014
ANGGI PATRANITA
I11107022

NORMAL EYE WITH

SUDDEN DECREASED
VISION
RETINAL DETACHMENT
occurs when subretinal fluid accumulates in
the potential space between the
neurosensory retina and the underlying
retinal pigment epithelium (RPE)
 Retinal detachment occurs
when subretinal fluid
accumulates in the potential
space between the
neurosensory retina and the
underlying retinal pigment
epithelium (RPE).

 Depending on the mechanism of

subretinal fluid accumulation,
retinal detachments traditionally
have been classified into
rhegmatogenous, tractional, and
exudative.
EPIDEMIOLOGY
 A retinal detachment can occur at any
age
 more common in people over age 40
 It affects men more than women, and
Whites more than African Americans.
Rhegmatogenous

 A tear or break in the retina

allows fluid to get under the
retina and separate it from
the retinal pigment
epithelium (RPE), the
pigmented cell layer that
nourishes the retina. These
types of retinal detachments
are the most common.
 Most RRDs occur in persons
aged 40-70 years. It is at this
time that the syneretic
vitreous undergoes
separation from the retina.
Pathophysiology
 Vitreoretinal traction is responsible for the
occurrence of most RRD. As the vitreous
becomes more syneretic (liquefied) with age, a
posterior vitreous detachment (PVD) occurs. In
most eyes, the vitreous gel separates from the
retina without any sequelae. However, in
certain eyes, strong vitreoretinal adhesions are
present and the occurrence of a PVD can lead to
a retinal tear formation; then, fluid from the
liquefied vitreous can seep under the tear,
leading to a retinal detachment.
Risk factors include:
 Increasing age
 Short-sightedness
 Some abnormalities of the peripheral part
of the retina
 A history of retinal detachment
 A family history of retinal detachment,
inherited retinal weakness
 Previous cataract surgery
 Trauma
Tractional
 In this type of
detachment, scar
tissue on the retina’s
surface contracts and
causes the retina to
separate from the
RPE. This type of
detachment is less
common.
Exudative
 Frequently caused by retinal diseases,
including inflammatory disorders and
injury/trauma to the eye. In this type,
fluid leaks into the area underneath the
retina, but there are no tears or breaks
in the retina.
SIGNS AND SYMPTOMS
 Light Flashes
 Wavy or watery vision
 Veil or curtain obstructing vision
 Shower of floaters that resemble spots,
bugs, or spider webs
 Sudden decrease of vision
 Floaters are
opacities in the
vitreous that cast
a dark shadow
according to their
form and shape in
the patient's visual
field as they float
in the vitreous
cavity.
 Loss of Side Vision Caused by Retinal
Detachment
• When the macula becomes detached (ie, extension of subretinal
fluid into the macula), the patient experiences a drop in visual
acuity.
Physical assesment
 Slit Lamp
Cell and flare may be seen in the anterior
chamber of eyes with a rhegmatogenous retinal
detachment (RRD)
 Examining the retina with ophthalmoscopy
to determine whether the macula .
 Ultrasound imaging of the eye is also very
useful to see additional detail of the
condition of the retina from several angles.
Retinal detachment.
 A 60" view of the
fundus reveals folds of
retina extending into
the macula
inferotemporal to the
disc. In this
photograph, the focus
is on the elevated
retina, which renders
the disc slightly out of
focus.
 Clinical picture of a rhegmatogenous retinal detachment.
Notice that the macula is involved and that the retina is
corrugated and has a slightly opaque color.
Retinal Detachment Surgery
1. Laser therapy
For Small holes and tears, by using
a laser beam, which burns the tears
in the retina, which leads to
fibrosis and the fibrous tissue to
meet the parties to these holes,
cracks or ruptures and thus prevent
leakage of fluid
2 - Treatment freeze (cryopexy)
freezes the area around the hole
and helps reattach the retina
using (Nitrous oxide),
3. Pneumatic Retinopexy is a technique
in which a temporary gas bubble is
inserted into the vitreous cavity and
used to close the retinal tear and push
the detached retina back into position.

After the retina is back in position, laser

or freezing therapy is used to seal the
retina to the eye wall.
The patient’s head position must be
strictly maintained for about seven
days to keep the bubble in contact
with the area of detachment.
The gas bubble is slowly absorbed, and
the space it occupied in the vitreous
cavity is filled by fluid normally
produced by the eye.
4. Scleral Buckling is a technique in
which a piece of soft silicone
material is sewn against the outside
wall of the eye.
This creates an indentation that closes
the retinal defect that caused the
retinal detachment.
The surgeon may also drain the fluid
which has accumulated behind the
retina.
Laser or freezing therapy is used to
seal the retina back in place once it
is reattached.
The scleral buckle stays in place
permanently and does not harm the
eye.
 In a scleral buckling procedure, one of the eye's rectus muscles are
severed to gain access to the sclera (A). The sclera is cut open (B),
and an electrode is applied to the area of retinal detachment (C). A
silicone buckle is threaded into place beneath the rectus muscles (D),
and the severed muscle is repaired
5. Vitrectomy Surgery is a technique
in which microscopic cutting
instruments are used to remove the
vitreous gel and any scar tissue
which may be present inside the
eye.
The fluid which created the retinal
detachment is then drained through
the existing retinal tear, which
reattaches the retina.
A temporary gas bubble holds the
retina in position as laser or
freezing treatment seals the retina
to the eye wall.
Removing the vitreous does not affect
the function of the eye. The gas
bubble is slowly absorbed and the
vitreous cavity is filled by fluid
normally produced by the eye.
Prognosis
 over 90 percent of those with a retinal detachment
can be successfully treated
 the visual outcome is not always predictable. The
final visual result may not be known for up to
several months following surgery.
 Even under the best of circumstances, and even
after multiple attempts at repair, treatment
sometimes fails and vision may eventually be lost.
 Visual results are best if the retinal detachment is
repaired before the macula detaches
 in about 10 to 20% of cases, repeat surgery is
needed.
COMPLICATION
 Complications retinal detachment
surgery:
- Infections of the eye.
- Bleeding in the eye.
Prophylaxis Indirect Ophthalmoscope (IDO)
Laser Cerclage
 treating visible areas of retinal pathology (focal
prophylaxis laser photocoagulation) in high risk eyes. 
 Laser Cerclage nearly eliminates future tear
occurrence in the areas of treatment. Treatment to
the peripheral area of the retina is advantageous for
the patient subjectively because visual function in the
peripheral retina is low, rarely noticed.
 Focal laser prophylaxis does prevent retinal
detachment from the specific area treated but has
been disappointing in preventing retinal detachment.
 Because new tears can develop in the untreated
peripheral areas of focally treated high risk eyes and
often lead to retinal detachment.
OPTIC NEURITIS
 Optic Neuritis
 Is an inflamation of optic
nerve that is usually
idiopathic
 Reduce visual acuity and
relative afferent pupillary
defect are regular feature
 The optic disc appear
hyperemic and swollen
 This most commonly occurs in
association with a plaque of
demyelination in the optic nerve in
patients with multiple sclerosis.
 The prognosis for the return of vision of
single attack is good
 Certai patiens may benefit from high
dose intravenous corticosteroid
Causes
Optic neuritis is associated with various diseases and
conditions, such as:
 mumps;
 measles;
 influenza;
 multiple sclerosis;
 Leber’s optic neuropathy (a rare eye condition that
runs in families);
 vascular occlusions of the optic nerve.
 In most cases, however, optic neuritis occurs with
noknown cause.
Signs and Symptoms
 Pain with eye movement (more than 90% of patients)
 Tender, sore eye
 Mild to severe decrease in central vision
 Dull, dim vision
 Reduced color perception
 Decreased peripheral vision
 Central blind spot
 Fever
 Headache
 Nausea
 Decreased vision following exercise, hot bath or shower
(activities that e levate body temperature)
Retrobulbar Optic Neuritis
 A young adult who is experiencing a monocular
loss of vision that has developed over hours to
days and that is often accompanied by pain on
movement of the eye who shows NO
abnormalities in eye examination probably has
retrobulbar optic neuritis
 Vision is poor and afferent pupillary defect is
present.
 In severe cases, the sight of the affected eye
can be lost completely
 On examination, a relative afferent pupil
defect on the affected side might be the only
objective evidence of disease.
 The fundus is often normal initially
(retrobulbar neuritis), although there can be
slight swelling of the optic disc (optic
neuritis).
 In retrobulbar optic neuritis, the inflammation and
demyelination occur behind the globe of the eye. The optic
disc appears normal with no signs of swelling or pallor.
 The attack is unilateral in 90% of cases,
although there is a risk that the other
eye can be affected at a later date and
recurrent attacks in one or both eyes
can cause permanent damage to the
vision.
 Fortunately, it is extremely rare for a
patient to be made blind by multiple
sclerosis.
Papilitis
 is an inflammation of the optic disc or
papilla
 Vision is usually (but not always)
significantly decreased and examination
of the pupils will reveal a relative
afferent pupillary defect.
Papillitis
The margin of the optic disk is
slightly obscured by edema and
hyperemia of the head of the optic
nerve. The optic cup is obscured.
assesment
 The diagnosis at the time of the acute attack relies on
the history and noting the pupil reaction.
 It is often advisable to make the diagnosis in
retrospect.
 The patient might give a history of visual loss in one
eye, which has recovered, and at a later date,
presents with other nonocular signs and symptoms of
demyelinating disease.
 If it can be confirmed that the patient has had a
previous attack of optic neuritis, this can help in the
confirmation of the diagnosis of disseminated
sclerosis.
 Under these circumstances, the pallor of the
disc can be helpful, but careful assessment
of the colour vision, visual acuity and
measurement of the visually evoked
potential can provide conclusive evidence.
 At the time of the acute attack, testing the
visual field might reveal a central scotoma.
 The size of this defect diminishes as healing
occurs, often leaving a small residual defect
between blind spot and central area.
Treatment
 Intravenous steroid medication (but not
oral steroids) reduces the risk of
developing MS later on.
 May be important to recognize those
patients at higher risk to start earlier
treatment. This is best determined by
MRI.
 There is no treatment that will absolutely
prevent ON
Prognosis
 In most cases, vision will either improve
significantly or return to normal over a period of
days to weeks.
 For some, a complete recovery may take
months.
 Some patients, however, may not recover their
normal vision, particularly if they have a pre-
existing condition such as multiple sclerosis.
 The visual prognosis is generally good. Most
patients make a complete or nearly complete
recovery after 6–12 weeks.
Resolution of right optic disc swelling Resolution of left optic disc swelling
in the same patient 2 weeks later in the same patient 2 weeks later
 THANK’S
FOR YOUR ATTENTION
Vitreous Haemorrhage
Haemorrhage into the vitreous
cavity can result in sudden pain-
less loss of vision.The extent of
visual loss will depend on the de-
gree of haemorrhage.
•A large haemorrhage will cause
total visual loss
•A small haemorrhage will present
as floaters and normal or only
 slightly reduced visual acuity
Aetiology:

 Proliferative retinopathy—spontaneous
rupture of abnormal fragile new vessels that
grow on the retinal surface cause bleeding
into the vitreous cavity. Most common is
proliferative diabetic retinopathy
 Retinal detachment—a small retinal blood
vessel may rupture when the retinal break
occurs,bleeding into the vitreous cavity
 Trauma
 Posterior vitreous detachment can result in
vitreous haemorrhage if,as the vitreous
separates from the retina,it pulls and
ruptures a small blood vessel
 Age-related macula degeneration (AMD)—
haemorrhage may occur into the vitreous
from the abnormally weak vessels forming
a subretinal neovascular membrane
 The patient complains of a sudden onset of floaters, or
“blobs,” in the vision.
 The visual acuity may be normal or, if the haemorrhage is
dense, it may be reduced.
 Flashing lights indicate retinal traction and are a dangerous
symptom.
 Haemorrhage may occur from spontaneous rupture of
vessels, avulsion of vessels during retinal traction, or
bleeding from abnormal new vessels.
 If the patient is shortsighted, retinal detachment is more
likely.
 If there is associated diabetesmellitus the patient may have
bled from new vessels and the vitreous haemorrhage may
herald potentially sight threatening diabetic retinopathy.
 The visual acuity depends on the extent
of the haemorrhage.
 Projection of light is accurate unless the
haemorrhage is extremely dense.
 Ophthalmoscopy shows the red reflex to
be reduced; there may be clots of blood
that move with the vitreous
 The patient should be referred to an
ophthalmologist to exclude a retinal
detachment.
 Underlying causes such as diabetes
must also be excluded.
 If a vitreous haemorrhage fails to clear
spontaneously the patient may benefit
from having the vitreous removed
(vitrectomy)
 Scleral Buckling, operasi untuk
memperbaiki lepasnya retina
dengan pemasangan pita silicon
yang dijahitkan pada sclera.
 Lensectomy, operasi untuk
mengangkat lensa dari mata.
 Laser photocoagulation,
pengobatan menggunakan sinar
laser dengan panjang gelombang
tertentu di dalam mata.
 Silicone oil, pengisian minyak
silikon untuk menggantikan vitreus
pada beberapa kasus lepasnya
retina. Minyak ini akan dikeluarkan
dari mata dengan operasi
beberapa bulan kemudian.
Central Retina Vein Occlusion
 The patient presents with painless loss
of vision, often mixed with sparkles, that
may be sudden or evolve over hours to
days. Systemic hypertension is the most
common cause; hyperviscous and
hypercoagulable states must also be
considered.
 Patients may otherwise complain only of a
vague visual disturbance or of field loss
 The arteries and veins share a common
sheath in the eye, and venous occlusion
most commonly occurs where arteries and
veins cross, and in the head of the nerve
 Thus raised arterial pressure can give rise
to venous occlusion
 Visual acuity will not be affected unless
the macula is damaged
 Ophthalmoscopy shows characteristic
flame haemorrhages in the affected
areas, with a swollen disc if there is
occlusion of the central vein
Branch Retinal Vein Occlusion (BRVO)
 BRVO is a retinal vascular
disease most often related to
hypertension, elevated
lipids/triglyceride/cholesterol,
diabetes, carotid artery
disease, cardiac disease, or
hematologic (blood) disorders.
In BRVO there is an occlusion
of a branch retinal vein by a
compressing, sclerotic retinal
artery. This often leads to
hemorrhage (bleeding), edema
(swelling), or ischemia (poor
circulation) of the retina and
macula with resultant visual
loss.
Central Retinal Vein Occlusion (CRVO)
 CRVO is also a retinal vascular
disease but involves occlusion
of the main central retinal vein.
Vascular, hematologic, and
cardiac disease may
predispose individuals to
develop CRVO which leads to
leakage of blood and fluid into
the retina. In many cases the
resultant poor circulation
(ischemia) can lead to
abnormal blood vessel
formation in the iris (rubeosis)
with painful increases in eye
pressure (neovascular
glaucoma).
 Hypertension, diabetes mellitus,
hyperviscosity syndromes, and chronic
glaucoma must be identified and treated
if present
Central Retina Artery
 the CRA supplies the
superficial nerve fibre
layer and inner two-
thirds of the retina
 The choriocapillaris sup-
plies the outer retina
Central Retina Artery Occlusion
 The patient complains of a sudden onset
of visual disturbance, often described as
a “greyout” of the vision or as a “curtain”
descending over the vision, in one or
both eyes.
 This may be temporary (amaurosis
fugax) if the obstruction dislodges or
permanent if tissue infarction occurs
Causes of retinal arterial occlusion

 Emboli
 Thrombosis ±atherosclerosis
 Congenital thrombophilic states
 Acquired thrombophilic states
 Vasculitis
 Infection
 Trauma
 Vasospasm
 Raised intraocular pressure
Signs
Perform a dilated fundal examination to
detect:
• Cherry red spot at macula.
• Embolus occasionally visible at optic
disc.
• Attenuation of arterioles.
• Retinal pallor.
• Mild disc swelling
Central Retina Artery Occlusion
 When the retina
infarcts it becomes
oedematous and
pale and masks the
choroidal circulation
except at the
macula, which is
extremely thin—
hence the “cherry
red spot”
appearance.
Treatment
The aim is to re-establish circulation within the CRA.This is
at-
tempted by:
• Lowering the intraocular pressure (IOP) using:
—acetazolamide 500mg i.v.;
—ocular massage;
—anterior chamber paracentesis (1ml aqueous withdrawn).
• Start cholesterol lowering
statins,e.g.Simvastatin,Atorvastatin.
• Start antiplatelets,e.g.aspirin 300mg stat then 75mg daily or
clopidogrel 75mg daily,within 48hrs.
Prognosis
 The prognosis is poor because
irreparable damage to the inner layers of
the retina occurs within one hour.
 The prognosis is better where only a
branch of the artery is occluded unless a
macular branch is affected.
THANK YOU