The retina plays a vital role in vision by capturing light and converting it into neural signals that the brain interprets. Any pathology affecting the retina, particularly the macular region responsible for central vision, can significantly impair visual function. Among the most clinically significant retinal disorders are Retinal Detachment (RD), Central Serous Retinopathy (CSR), Cystoid Macular Edema (CME), Retinoblastoma, CRAO, CRVO, BRAO, BRVO, and EALE'S Disease.
These conditions are common topics in ophthalmology, particularly for medical students, as they represent important causes of vision loss requiring timely diagnosis and management. Retinal detachment is an ophthalmic emergency where the retina separates from the underlying retinal pigment epithelium, leading to potential permanent blindness if not promptly treated. Central serous retinopathy, on the other hand, involves serous detachment of the neurosensory retina at the macula and is often associated with stress and steroid use. Cystoid macular edema refers to fluid accumulation in cystic spaces of the macula, commonly seen after ocular surgery, in diabetes, or following retinal vascular events.
Understanding the etiology, clinical presentation, diagnostic approach, and appropriate management of these conditions is essential for future clinicians to ensure optimal visual outcomes for patients.
Retinal Detachment (RD)
Retinal detachment is the separation of the neurosensory retina from the underlying retinal pigment epithelium (RPE), leading to vision loss if untreated.
Types
- Rhegmatogenous RD – Caused by a retinal tear or hole.
- Tractional RD – Due to pulling forces from proliferative diseases (e.g., diabetic retinopathy).
- Exudative (Serous) RD – Due to fluid accumulation without a tear (e.g., central serous chorioretinopathy, inflammation, tumors).
Causes
- High myopia (In high myopia which is above -6.00 D, the retina becomes thin and there is an increased risk of peripheral retinal degeneration (such as lattice degeneration), which may lead to retinal tears or detachment.)
- Trauma
- Posterior vitreous detachment (PVD)
- Diabetic retinopathy
- Intraocular tumors
- Inflammatory diseases (e.g., uveitis)
Signs and Symptoms
- Sudden painless vision loss
- Floaters and flashes of light (photopsia)
- Curtain-like shadow over vision
- Reduced visual acuity
Diagnosis & Investigations
- Dilated Fundoscopy: Detects retinal tears, detachment.
- Ultrasound B-scan: If media is opaque.
- OCT: Confirms sub-retinal fluid.
- Fluorescein Angiography (FA): Sometimes used in complex cases.
Treatment & Management
Medical
No medical treatment for rhegmatogenous RD. In exudative RD, treat the underlying cause (e.g., anti-inflammatory therapy).
Surgical
- Laser Photocoagulation / Cryotherapy: For small breaks.
- Scleral Buckling: Indentation of sclera to close retinal break.
- Pneumatic Retinopexy: Intravitreal gas injection (C3F8 or SF6) with laser.
- Pars Plana Vitrectomy (PPV): Removal of vitreous, retinal reattachment with gas/oil tamponade.
Central Serous Retinopathy (CSR)
A self-limiting condition characterized by serous detachment of the neurosensory retina at the macula due to choroidal hyperpermeability.
Causes & Risk Factors
- Stress (cortisol-related)
- Steroid use
- Hypertension
- Pregnancy
- Sleep disturbances
- Type A personality
Signs and Symptoms
- Painless, sudden central vision loss
- Micropsia (objects appear smaller)
- Metamorphopsia (distorted vision)
- Hyperopic shift (due to retinal elevation)
Diagnosis & Investigations
- OCT: Confirms sub-retinal fluid accumulation.
- Fluorescein Angiography (FA): Shows "ink-blot" or "smokestack" leakage pattern.
- ICGA: Assesses choroidal vasculature.
Treatment & Management
Observation
Most cases resolve in 3–6 months.
Medical
- Acetazolamide (Diamox) 250 mg BD – Decreases fluid accumulation.
- Spironolactone or Eplerenone – Reduces choroidal permeability.
- Discontinue corticosteroids if possible.
Laser & Other Therapies
- Focal Laser Photocoagulation: For persistent cases.
- Photodynamic Therapy (PDT) with Verteporfin: For chronic CSR.
- Anti-VEGF: Considered for non-resolving cases.
Cystoid Macular Edema (CME)
Accumulation of fluid in the macular region within cystic spaces in the retina, leading to visual impairment.
Causes
- Post-surgical (Irvine-Gass Syndrome)
- Retinal vein occlusions
- Diabetic macular edema
- Uveitis
- Intraocular inflammation
Signs and Symptoms
- Blurred vision
- Metamorphopsia
- Loss of central vision
- Amsler grid distortion
Diagnosis & Investigations
- OCT: Confirms cystic spaces in the macula.
- Fluorescein Angiography (FA): Shows petaloid pattern leakage.
- ICGA: In inflammatory cases.
Treatment & Management
Medical
- NSAID eye drops: Nepafenac, Bromfenac.
- Steroids: Prednisolone acetate, Dexamethasone implant (Ozurdex).
- Anti-VEGF: Ranibizumab, Aflibercept, Bevacizumab.
- Acetazolamide (250 mg BD): Reduces fluid accumulation.
Laser & Surgical
- Focal/Grid Laser Photocoagulation: In diabetic CME.
- Vitrectomy with ILM Peeling: For chronic cases.
Summary Table
| Condition | Causes | Symptoms | Diagnosis | Treatment |
|---|---|---|---|---|
| Retinal Detachment (RD) | Myopia, Trauma, PVD, Diabetic Retinopathy | Floaters, Flashes, Curtain-like vision loss | Fundoscopy, B-scan, OCT | Scleral buckle, Pneumatic retinopexy, Vitrectomy |
| Central Serous Retinopathy (CSR) | Stress, Steroids, Hypertension | Central vision loss, Micropsia, Metamorphopsia | OCT, FA, ICGA | Observation, Spironolactone, PDT |
| Cystoid Macular Edema (CME) | Surgery, Diabetes, Uveitis, Vein occlusion | Blurred vision, Metamorphopsia | OCT, FA | NSAIDs, Steroids, Anti-VEGF, Vitrectomy |