Posterior Vitreous Detachment

Aka: Posterior Vitreous Detachment, Vitreous Detachment

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II. Pathophysiology

  1. Vitreous humor is hydrated gel in matrix, that is stabilized by Collagen fibrils
  2. With aging, Collagen fibrils harden and lose elasticity
  3. Matrix collapses and vitreous shrinks
  4. Results in traction between vitreous and posterior Retina, and posterior vitreous separates from the Retina

III. Risk Factors

  1. Severe near-sightedness
    1. Thinner Retina
    2. Greater Retina length anterior to posterior increases tractional force
  2. Anticoagulants decrease the risk of Retinal tear (listed in order of protective effect)
    1. Warfarin (most protective)
    2. Clopidogrel
    3. Aspirin
    4. NSAIDs (least protective)

IV. Epidemiology

  1. Age
    1. May occur in younger patients with severe near sightedness (predisposes to Retinal traction)
    2. Typically occurs in age >55 years old
      1. Prevalence over age 60 years: 25%
      2. Prevalence over age 70 years: 66%

V. Symptoms

  1. Visual flashes (photopsia)
    1. Occurs as vitreous pulls on the Retinal margins
  2. Visual Floaters
    1. May be only finding of an uncomplicated Vitreous Detachment

VI. Differential Diagnosis

  1. Retinal Tear
  2. Retinal Detachment

VII. Precautions: Red Flags with higher risk of Retinal Detachment or tear

  1. Decreased Vision or Visual Field loss
  2. Relative Afferent Pupillary Defect (RAPD)
  3. Retina obscured on Funduscopic Exam
  4. Sudden increase in number of Floaters (esp. >10 and if preceded by shower of black dots)

VIII. Management

  1. Urgent evaluation
    1. Obtain a formal ophthalmology evaluation with dilated indirect exam within 24 hours
    2. Evaluate for Retinal tear or Retinal Detachment
  2. Subsequent evaluation
    1. Repeat exam in 4-6 weeks may be recommended (even if no tear or detachment on initial evaluation)
    2. Indicated to evaluate for progression (may not be needed if number of Floaters does not increase)

IX. Complications

  1. Retinal tear (10-15% risk)
    1. Associated with Photopsias (Light Flashes)
  2. Retinal Detachment (9% risk)
    1. Progresses from tear

X. References

  1. Sales, Patel and Patel (2019) Crit Dec Emerg Med 33(12): 3-13
  2. Hartmann (2016) Crit Dec Emerg Med 30(6): 3-11
  3. Yu and Jasani (2024) Crit Dec Emerg Med 38(1): 27-34

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