Vitreous Detachment

What is it?

Separation of posterior vitreous from its normal attachments to retina
Brought on by aging (usually past age 60), eye trauma (including eye surgery), eye inflammation, myopia
Often announced by new flashes and floaters
Chief concern is retinal break leading to retinal detachment

How does it appear?

Patient may report new flashes of light in affected eye
Patient may report new floater
Ophthalmoscopy may show wispy gray fragment or ring ("Weiss ring"), which is...
Condensed back surface of detached vitreous that has pulled away from retinal surface
Detaching vitreous may tear hole in retina and sometimes cause retinal detachment visible on indirect ophthalmoscopy

What else looks like it?

New flashes may be caused by vitreous tug on retina without vitreous detachment
New flashes may also be caused by lesions anywhere in visual pathway
New floaters can be caused by retinal bleeding into vitreous
New floaters can also be caused by vitreous inflammation

What to do?

Refer patient reporting new flashes and floaters urgently to ophthalmologist
Refer even more urgently if patient also reports new visual field loss, as that suggests retinal detachment
If visual acuity has been unaffected, must still refer urgently because...
Retinal detachment starts in peripheral retina and spreads toward fovea, and...
Diagnosis of retinal detachment before spread to fovea predicts better visual outcome with surgery

What will happen?

Retinal break occurs in fewer than 10% of patients with new vitreous detachment, and...
Retinal detachment rare even when there has been retinal break, but...
Symptoms do not allow distinction between those who have or have not had retinal detachment, which can only be verified by skilled ophthalmoscopy
Retinal reattachment surgery more successful in restoring vision if detachment has not spread to fovea