|Type of Lesion||Management||Follow Up|
|Symptomatic PVD with no retinal breaks
No tobacco dust
|Meticulous fundus examination; Reassure; PVD leaflet, RD warnings||Discharge if no risk factors (previous retinal breaks in same or fellow eye, RD, F/H of RD, high myopia, lattice degeneration, RPE or blood in vitreous)|
|Symptomatic PVD with haemorrhage and no breaks||Reassure; PVD leaflet, RD warnings||Follow up in casualty clinic within 2 weeks. If no new pathology - Discharge|
|Acute symptomatic/ asymptomatic horseshoe or operculated tear||Treat on the same day as presentation (Laser Retinopexy)||Follow up in clinic in 2 weeks|
|Asymptomatic atrophic round holes/lattice degeneration||Do not treat||If no other pathology, discharge with RD warnings
and appropriate information leaflet
Posterior Vitreous Detachment, Retinal Tears, Holes in Eye, Casualty Management (233)
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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.
Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.
If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.
1. Wilkinson CP. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD003170. DOI: 10.1002/14651858.CD003170.
2. Posterior Vitreous Detachment, Retinal Breaks and Lattice Degeneration (Initial and Follow-Up Evaluation) http://www.icoph.org/dynamic/attachments/resources/icopvdetachinfu_2.pdf
3. Management of posterior vitreous detachment, retinal breaks and lattice degeneration. San Francisco: American Academy of Ophthalmology, 1998.
4. Management of posterior vitreous detachment, retinal breaks, and lattice degeneration. San Francisco: American Academy of Ophthalmology, 2003.
5. Byer NE. Long-term natural history of lattice degeneration of the retina. Ophthalmology 1989; 96: 1396–401
6. Byer NE. What happens to untreated asymptomatic retinal breaks, and are they affected by posterior vitreous detachment? Ophthalmology 1998; 105: 1045–9.