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Posterior Vitreous Detachment
Aka: Posterior Vitreous Detachment, Vitreous Detachment
- See Also
- Retinal Detachment
- Pathophysiology
- Vitreous humor is hydrated gel in matrix
- Matrix collapses with aging and vitreous shrinks
- Results in traction between vitreous and posterior Retina
- Risk Factors
- Severe near-sightedness
- Thinner Retina
- Greater Retina length anterior to posterior increases tractional force
- Anticoagulants decrease the risk of Retinal tear (listed in order of protective effect)
- Warfarin (most protective)
- Clopidogrel
- Aspirin
- NSAIDs (least protective)
- Epidemiology
- Age
- May occur in younger patients with severe near sightedness (predisposes to Retinal traction)
- Typically occurs in age >55 years old
- Prevalence over age 60 years: 25%
- Prevalence over age 70 years: 66%
- Symptoms
- Visual flashes (photopsia)
- Occurs as vitreous pulls on the Retinal margins
- Visual Floaters
- May be only finding of an uncomplicated Vitreous Detachment
- Differential Diagnosis
- Retinal Tear
- Retinal Detachment
- Precautions: Red Flags with higher risk of Retinal Detachment or tear
- Decreased Vision or Visual Field loss
- Relative Afferent Pupillary Defect (RAPD)
- Retina obscured on Funduscopic Exam
- Sudden increase in number of Floaters (esp. >10 and if preceded by shower of black dots)
- Management
- Urgent evaluation
- Obtain a formal ophthalmology evaluation with dilated indirect exam within 24 hours
- Evaluate for Retinal tear or Retinal Detachment
- Subsequent evaluation
- Repeat exam in 4-6 weeks may be recommended (even if no tear or detachment on initial evaluation)
- Indicated to evaluate for progression (may not be needed if number of Floaters does not increase)
- Complications
- Retinal tear (10-15% risk)
- Associated with Photopsias (Light Flashes)
- Retinal Detachment (9% risk)
- Progresses from tear
- References
- Sales, Patel and Patel (2019) Crit Dec Emerg Med 33(12): 3-13
- Hartmann (2016) Crit Dec Emerg Med 30(6): 3-11