NCLEX Review Guide: Retinal Detachment

Understanding Retinal Detachment

• Retinal detachment occurs when the neurosensory retina separates from the retinal pigment epithelium (RPE), disrupting visual function. This separation prevents the photoreceptors from receiving adequate nutrition and oxygen from the choroidal blood supply.
• Three main types exist: rhegmatogenous (most common, caused by retinal tears), tractional (scar tissue pulls retina away), and exudative (fluid accumulation without tears).

Signs & Symptoms

• Classic triad includes sudden onset of flashing lights (photopsia), floaters, and curtain-like visual field defect. Patients often describe seeing "a curtain being drawn across their vision" starting peripherally.
• Painless vision loss is characteristic - pain suggests other ocular emergencies like acute glaucoma or infection.
• Visual field defects correspond to the area of detachment: superior detachment causes inferior visual field loss and vice versa.

High-Risk Populations

• Major risk factors include high myopia (nearsightedness), previous cataract surgery, eye trauma, and family history. Myopic patients have longer eyeballs with thinner retinas prone to tears.
• Age-related changes cause posterior vitreous detachment (PVD), where vitreous gel shrinks and pulls away from retina, potentially causing tears.

Priority Nursing Actions

1. Position patient with detached area dependent - if superior detachment, keep head elevated; if inferior detachment, position flat or head down
2. Restrict eye movement by applying bilateral eye patches to prevent further detachment progression
3. Maintain strict bed rest until ophthalmologist evaluation to prevent extension of detachment
4. Administer prescribed cycloplegic drops (atropine) to paralyze ciliary muscle and reduce eye movement

Surgical Interventions

• Pneumatic retinopexy involves injecting gas bubble into vitreous cavity to push retina against RPE, combined with laser photocoagulation. Patient must maintain specific head positioning for 1-2 weeks.
• Scleral buckling places silicone band around eye to indent sclera and reduce vitreous traction on retina. More invasive but effective for complex detachments.
• Vitrectomy removes vitreous gel and replaces with gas or silicone oil tamponade. Used for tractional detachments or when other methods fail.

Post-Operative Care

• Teach patients to maintain prescribed head positioning for gas bubble procedures - face-down positioning for up to 2 weeks to ensure bubble contact with retina.
• Instruct on activity restrictions: no heavy lifting, straining, or air travel until gas bubble absorbs. Gas expands at altitude, increasing intraocular pressure dangerously.
• Emphasize importance of bilateral eye protection and immediate reporting of new symptoms like increased flashing lights or expanding visual field defects.