Descolamento da retina: clínica e diagnóstico

Abstract

Introduction: Retinal detachment is the separation of the retina from the retinal pigment epithelium and choroid. Without treatment, many peripheral detachments progress to involve the central retina and lead to visual loss. Such separation can occur passively, as when a retinal hole or tear allows fluid to accumulate between the layers, or actively, as vitreous traction or by an exudative process.Objective: to discuss the clinical and diagnostic characteristics of retinal detachment. Methodology: Literature review from Scielo, PubMed and BVS databases, from January to April 2024, with descriptors “Retinal Detachment”, “Clinic” and “Diagnosis”. Articles from 2019-2024 (total 43) were included, excluding other criteria and choosing 05 full articles. Results and Discussion: Patients with retinal detachment present with painless loss of vision in the affected eye, with sudden (minutes to hours) increase in “floaters” (shapes that appear to float under the eye) and/or flashes of light (photopsias). If detachment occurs, the patient notices a dark curtain over part of his or her visual field. When only the peripheral retina is involved, central visual acuity remains good. Symptoms progress over hours to a few days. Once the macula is involved, central vision is lost. If left untreated, a retinal detachment can progress to the entire retina, resulting in complete visual loss. Diagnosis is made based on history (sudden onset of floaters, flashes of light, and/or visual loss) and confirmed by ophthalmologic examination. When visual loss is painless (partial or complete), referral should be made within 24 hours. If retinal tear or detachment occurs, both require urgent treatment. Visual acuity, intraocular pressures, anterior segment examinations, dilated fundoscopy with condensing lenses, and ultrasound should be assessed if there is concomitant vitreous hemorrhage. There is a high rate of bilateral retinal tears or detachments (8-40%). If present, a general ophthalmologist will usually refer the patient to a retina specialist for treatment. Conclusion: Patients at high risk (visual field loss, decreased subjective or objective vision, vitreous hemorrhage on fundoscopy) should be instructed to reduce eye movement and urgently referred to an ophthalmologist within 24 hours for retinal evaluation.