July 27, 2012 by EmerJencyWEBB
If you didn’t catch part 1, just click HERE to read about the patient’s presentation.
So, we left off with me calling my eye buddy down to the ED to see this patient that I presumed likely had retinal detachment of the right eye.
After pupils were dilated, indirect fundoscopy was performed to visualize the entirety of the retina and posterior eye structures. The ophthalmologist saw something like this:
Another view here:
What we are seeing is called a Weiss Ring, which is one of the signs of a Posterior Vitreous Detachment (PVD).
What is a posterior vitreous detachment?
Basically, as we age, the vitreous humor (the gel-like substance between the lens and retina) degenerates and liquefies. Over time, pockets of liquefaction crop up and eventually cause separation from the retina (see image below). This typically starts in the posterior eye in the peripapillary region and spreads anteriorly towards the areas most tightly affixed to the retina at a structure called the vitreal body. The Weiss ring probably represents separation at the optic nerve head, causing a ring structure. Older age groups (40’s-60’s) are more commonly affected due to the natural aging of vitreous. Interestingly, myopic (nearsighted) individuals are at increased risk for earlier onset detachment.
How does this present?
When symptomatic, patients typically see an abrupt increase in floaters and also may visualize an arc of temporal light, or flashing light. There are a few patients that might experience complications from PVD, such as vitreal hemorrhage and retinal detachment (due to traction placed on retina from separating vitreous), and these patients will have complaints of decreased visual acuity.
What is the treatment?
Uncomplicated cases are usually managed conservatively with follow up in 2-8 weeks scheduled for repeat examination, as some studies have shown delayed complications may appear. The symptoms will usually begin to improve in several weeks time. For complicated cases with hemorrhage/retinal detachment, patients usually require urgent ophthalmology intervention, such as laser photocoagulation.
Disclaimer: The Case Report series employs no real life patient data or identifiers. All case descriptions are loosely based on an amalgam of cases encountered in clinical practice, but not on any one case in particular. The primary goal is to set the stage for a clinical question to be answered in sequence.