What is included in the physical exam for retinal detachment?

Updated: Jul 08, 2021
  • Author: Hemang K Pandya, MD, FACS; Chief Editor: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE  more...
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Answer

Check visual acuity at near and distance, correcting for refractive error.

Conduct an external examination for signs of trauma, checking the visual field (usually a confrontation field examination is adequate). Visual fields can help isolate the location of the retinal detachment.

Check pupil reaction (a fixed dilated pupil may indicate previous trauma; a positive Marcus-Gunn pupil can occur with any disturbance of the afferent pupillomotor pathway, including retinal detachment).

Check intraocular pressure measurement in both eyes (relative hypotony of >4-5 mm Hg less than the fellow eye is common).

Administer slit-lamp biomicroscopy

Examine the vitreous for signs of pigment or tobacco dust (ie, Shafer sign), which is suggestive for a retinal tear in 70% of cases with no previous eye disease or surgery.

Conduct a dilated fundus examination with ophthalmoscopy (panoptic ophthalmoscope may be used). Indirect ophthalmoscopy is the definitive means of diagnosing retinal detachment. Direct funduscopy may detect vitreous hemorrhage and large detachment of the posterior pole, but it is inadequate for complete examination because of the lower magnification and illumination, lack of stereopsis, and limited view of the peripheral retina. Obvious detachment is observed as marked elevation of the retina, which appears gray with dark blood vessels that may lie in folds. The detached retina may undulate and appear out of focus.Shallow detachments are much more difficult to detect; thus, comparing the suspected area with an adjacent normal quadrant is helpful to detect any change in retinal transparency. A pigmented or nonpigmented line may demarcate the limit of a detachment.


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