Vitreo-Retina

We do not run a vitro retinal service at Queens Hospital. Please refer to the patients local unit. Local units to Queen's include: Whipps Cross Hospital and Moorfields Eye Hospital

For Urgent advice in hours call: 01708 435 000 Ext. 6662

Vitreo-retinal related conditions and advise

  1. Vitreous Haemorrhage
  2. Retinal detachment

1. Vitreous haemorrhage

Main causes include:

  • Proliferative diabetic retinopathy.
  • Trauma
  • Hemorrhagic posterior vitreous detachment,
  • Retinal detachment,
  • Exudative age related macular degeneration,
  • Retinal vein occlusion
  • Intraocular tumor.12

If suspected the patient should be referred to an ophthalmologist for further work up within the next few days. If in hours please call the Urgent advice line: 01708435000 Ext. 6662 if in hours.

Do not send the patient to the Emergency Eye clinic without prior discussion. If out of hours or no answer, fill in the the  Urgent eye emergency referral form and email it to bhrut.urgenteyecare@nhs.net. Include the parent’s contact details and we will arrange a review.

The condition is usually monitored as the blood is reabsorbed internally. Surgical removal of blood (vitrectomy) is performed if there is an accompanying retinal detachment or three months down the line if the blood has not reabsorbed.14

Retinal detachment

This occurs when the sensory retina comes apart from the retinal pigmented epithelia (RPE) base layer and underlying choroidal blood supply. There are 3 types of retinal detachment. The most common is rhegmatogenous then tractional and then exudative.15 See Figure 16.

Figure 16

Retinal detachment diagram

Rhegmatogenous retinal detachment.

A tear occurs in the retina. This could be due to trauma, surgery or extended from a pre-existing tear which are more common in large, myopic eyes. Fluid from the vitreous collects behind the tear in the subretinal space which eventually causes the retina to peel off and away. This can spread and involve more of the retina.

Tractional retinal detachment.

The retina is pulled from its base. This could be from the vitreous or from diseases like diabetic retinopathy where the new friable vessels have grown into the vitreous and tug on the retina as they grow.15

Exudative or hemorrhagic retinal detachment

Blood or subretinal fluid builds up underneath the retina, pushing it upwards. This may occur if the RPE layer, which usually acts as a tight barrier is dysfunctional. It may occur due to other breakdowns in the blood retinal barrier such as inflammatory conditions or ocular tumors.16

The patient may present with painless flashing lights, floaters or a total curtain going over their vision.

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