Retinal Detachment: Pathogenesis
Authors: Natalie Arnold, Davis Maclean Reviewers: David Sia*, Yan Yu* * MD at time of publication
Ocular Trauma
Proliverative retinal diseases – retinal conditions involving neovascularization, e.g. diabetic retinopathy
Vitreoretinal disease – disease of the back of the eye (retina and the vitreous fluid around it) e.g. macular degeneration
Formation of fibrous tissue bands in vitreous cavity
Bands contract and exert a tractional (pulling) force on the retina
Retina is pulled off the choroid layer at the back of the eye by tractional forces, without a retinal tear
Tractional Retinal Detachment (TRD):
Retina is pulled off the choroid layer at the back of the eye in the absence of retinal tears
Posterior Vitreous Detachment
For complete pathogenesis and clinical findings see: Calgary Guide – Posterior Vitreous Detachment: Pathogenesis and Clinical Findings
Note: Not every retinal tear leads to retinal detachment
Parts of the gel- like vitreous humour detach from the retina
↑ Age
Vitreous gel liquification
Vascular Damage Optic disc Anomalies Degenerative Conditions
During rotational eye movement, the vitreous humour moves within the vitreous cavity
Strong tractional forces transmitted to retina through remaining attachments
Retinal Tear: Physical defect in the retina associated with vitreous traction
Defect held open by vitreoretinal traction
Defect in retina allows vitreous fluid to gain access into sub retinal space
Tumour/ Malignancy
Idiopathic
Rhegmatogenous Retinal Detachment (RRD): Accumulation of sub retinal fluid due to a tear in the retina allowing liquid vitreous gel to get underneath the retina
Separation of the retina from choroid layer at the back of the eye
Inflammatory/Infectious Conditions
↑ Permeability of choroid or retinal blood vessels
Fluid leaks out of retinal/choroid blood vessels
Accumulation of fluid beneath retina and without retinal tear or vitreous traction
Exudative Retinal Detachment (ERD):
Fluid accumulation in subretinal space in the absence or tears or traction from the vitreous
Retinal Detachment:
Sight threatening condition, considered ocular emergency
See Calgary Guide slide: Retinal Detachment: Clinical findings

Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published July 11, 2020 on www.thecalgaryguide.com