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.

 

Guidelines for Management of Posterior Vitreous Detachment, Retinal Tears, Holes in Eye, Casualty Management

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

References

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.

Last reviewed: 11 August 2020

Next review: 31 July 2023

Author(s): David Yorston

Version: 4

Author Email(s): [email protected]

Approved By: Ophthalmology Clinical Governance Subcommittee

Document Id: 233