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Diagnosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

An ophthalmic assessment is necessary when a patient presents with symptoms and risk factors suggesting retinal breaks or detachment (1).

The diagnosis of a retinal detachment may require:

Direct ophthalmoscopic examination:
- loss of red reflex (caused by retinal detachment or vitreous haemorrhage)
- retinal detachments near the macula can be seen
- detached retina may appear as pale, opaque, and wrinkled with absent normal choroidal pattern
Visual acuity testing:
- should be done before the pupil is dilated
- reduced acuity is caused by:
  - macular detachment
  - vitreous haemorrhage
Relative afferent pupillary defect is seen in extensive retinal detachment

Due to its narrow field of view a normal examination with direct ophthalmoscopy cannot be used to exclude retinal detachment. Slit lamp or indirect ophthalmoscopy with a consdensing lens should be used to detect retinal breaks in the peripheral retina (1). This will usually require an ophthalmological referral.

Reference:
1. Kang HK, Luff AJ. Management of retinal detachment: a guide for non-ophthalmologists. BMJ. 2008;336(7655):1235-40

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