Retinal Detachment for Certified Emergency Nursing (CEN)

Retinal Detachment

Definition/Etiology:

• Retinal detachment occurs when the retina separates from the back of the eye.

• Can occur spontaneously or due to blunt trauma.

Risk groups:

• Ehler-Danlos syndrome, a connective tissue disorder, kyphoscoliosis type
• Prematurely born patients with retinopathy
• Severely myopic patients
• Child abuse
• Soccer players, other sports with repetitive head trauma

Pathophysiology:

• Patients who are very myopic are more likely to have retinal detachments because their eyes are more oblong than normal, and this stretches and thins the retina, making it more likely to tear.
• Can occur spontaneously or due to blunt trauma.

Clinical Presentation:

• “Looks like a curtain coming down”
• New large floaters in visual field
• New flashes of light
• New visual loss
• New black dots in visual field
• Painless if spontaneous
• No red eye unless accompanying trauma
• No impairment of eye movement

Collaborative Management:

• Visual acuity testing.
• Retinal detachment is a surgical emergency. Those involving the macula and central vision are a priority over more lateral detachments.
• Bedrest.  Caution when getting up to restroom due to loss of depth perception.

Ophthalmology consult for surgery.  Procedures include:

• Vitrectomy–remove vitreous humor and cut fibrous tissue that is applying traction to the retina, then retina may settle back onto the wall of the eye.  A gas bubble is frequently injected into the eye to press the retina against the choroid, and this requires lying in a certain position as directed for several days post-op
• Scleral buckle–a tight silicone band around the eye until retina touches the choroid again

Evaluation | Patient Monitoring | Education:

• Monitor vitals
• Provide reassurance
• Protect from falls
• Educate to follow post-op instructions carefully for best possible outcome

Linchpins: (Key Points)

• Retinal detachment can be a surgical emergency
• Protect from falls
• Provide reassurance
• Utilize child protection team if abuse is suspected