Diagnosis

An ophthalmic assessment is necessary when a patient presents with symptoms and risk factors suggesting retinal breaks or detachment (1).

The diagnosis of a retinal detachment may require:

• Direct ophthalmoscopic examination:
  • loss of red reflex (caused by retinal detachment or vitreous haemorrhage)
  • retinal detachments near the macula can be seen
  • detached retina may appear as pale, opaque, and wrinkled with absent normal choroidal pattern
• Visual acuity testing:
  • should be done before the pupil is dilated
  • reduced acuity is caused by:
    • macular detachment
    • vitreous haemorrhage
• Relative afferent pupillary defect is seen in extensive retinal detachment
  
  Due to its narrow field of view a normal examination with direct ophthalmoscopy cannot be used to exclude retinal detachment. Slit lamp or indirect ophthalmoscopy with a consdensing lens should be used to detect retinal breaks in the peripheral retina (1). This will usually require an ophthalmological referral.

Reference:
1. Kang HK, Luff AJ. Management of retinal detachment: a guide for non-ophthalmologists. BMJ. 2008;336(7655):1235-40