II. Pathophysiology

  1. Vitreous humor is hydrated gel in matrix
  2. Matrix collapses with aging and vitreous shrinks
  3. Results in traction between vitreous and posterior 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

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

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Related Studies

Ontology: Vitreous Detachment (C0042907)

Definition (MSH) Detachment of the corpus vitreum (VITREOUS BODY) from its normal attachments, especially the retina, due to shrinkage from degenerative or inflammatory conditions, trauma, myopia, or senility.
Concepts Disease or Syndrome (T047)
MSH D020255
ICD10 H43.81
SnomedCT 53772007, 393583008, 267747007, 155202007
English VITREOUS DETACHMENT, Vitreous separation, vitreous detachment, Detachment, Vitreous, Detachments, Vitreous, Vitreous Detachment, Vitreous Detachments, vitreous detachment (physical finding), eye vitreous detached, Vitreous Detachment [Disease/Finding], Detachment;vitreous, detachment vitreous, vitreous detachments, VITREOUS, DETACHMENT OF, DETACHMENT OF VITREOUS, Vitreous detachment, Vitreous detachment (disorder)
Italian Distacco vitreale, Distacco del corpo vitreo
Spanish separación del cuerpo vítreo, desprendimiento del vítreo, separación vítrea, desprendimiento de la gelatina vítrea, desprendimiento del vítreo (trastorno), separación vítrea (trastorno), VITREO, DESPRENDIMIENTO, Desprendimiento del cuerpo vítreo, Desprendimiento del Vítreo
Japanese 硝子体剥離, ショウシタイハクリ
Swedish Glaskroppsavlossning
Czech sklivec - odchlípení, Odchlípení sklivce
Finnish Lasiaisirtauma
French DECOLLEMENT DU VITRE, Décollement du corps vitré, Décollement du vitré, Décollement vitréen
Portuguese DESCOLAMENTO VITREO, Descolamento do vítreo, Descolamento do Vítreo
German GLASKOERPERABLOESUNG, Glaskoerperabloesung, Glaskörperabhebung (Auge)
Polish Oddzielenie ciała szklistego tylne, Oddzielenie ciała szklistego
Hungarian Üvegtesti hátsó határhártya leválás
Norwegian Løsning av corpus vitreum, Corpus vitreum-løsning, Glasslegemeløsning
Dutch glasvochtloslating, Corpus-vitreumloslating, Loslating, corpus-vitreum-

Ontology: Posterior Vitreous Detachment (C0423361)

Concepts Disease or Syndrome (T047)
MSH D020255
SnomedCT 247081001
English PVD - Post vitreous detachment, Detachment, Posterior Vitreous, Detachments, Posterior Vitreous, Posterior Vitreous Detachments, Vitreous Detachment, Posterior, Vitreous Detachments, Posterior, posterior vitreous detachment (diagnosis), posterior vitreous detachment, Post vitreous detachment, post vitreous detachment, PVD - Posterior vitreous detachment, Posterior vitreous detachment, Posterior vitreous detachment (disorder), Posterior Vitreous Detachment
Dutch achterste glasvochtloslating, status na glasvochtloslating, Posterieure vitreuze loslating
French Décollement postérieur du corps vitré, Décollement derrière le corps vitré, Décollement postérieur du vitré
German Abhebung des hinteren Glaskoerpers, hintere Glaskoerperabloesung, Hintere Glaskörperabhebung (Auge)
Italian Distacco posteriore del corpo vitreo, Distacco del corpo vitreo posteriore
Portuguese Descolamento pós-vítreo, Descolamento vítreo posterior, Descolamento do Vítreo Posterior
Spanish Desprendimiento posterior del humor vitreo, Desprendimiento vítreo posterior, Desprendimiento del Vítreo Posterior, desprendimiento vítreo posterior (trastorno), desprendimiento vítreo posterior
Japanese 後部硝子体剥離, コウブガラスタイハクリ, コウブショウシタイハクリ
Czech odchlípení zadního sklivce, Odchlípení zadní plochy sklivce, Oddělení zadní plochy sklivce
Hungarian Üvegtest leválás utáni, Hátsó üvegtesti leválás
Norwegian Bakre glasslegeme-løsning, Posterior vitreum-løsning, Løsning av bakre corpus vitreum, Bakre corpus vitreum-løsning, Løsning av bakre glasslegeme