Posterior vitreous detachment

Pathophysiology

  • A PVD is largely due to the aging process of the eye.
    • With age, the vitreous loses its strength and elasticity and becomes a little more soft/watery.  As a result, the vitreous can lose its shape and come away from the retina.
    • More common in severely myopic patients

Presentation

  • Floaters are the predominant feature- as the vitreous comes away, it casts a shadow on the retina
  • Flashes may occur- this is caused by mechanical traction on the retina causing a photopsia (flash)
    • This is a warning sign that the retina is at risk and could tear/detach.  NB retinal detachment is still a rare complication of PVD despite this.
  • A halo of floaters/hairs on the temporal side of vision may be seen.  This occurs as the vitreous detaches from the optic disc area.  This is technically a blind spot, resulting in the shadow causing a halo around it.
  • There is no pain
  • It may be difficult to visualise the retina on fundoscopy

Management/Prognosis

  • Refer urgently to ophthalmology in case of retinal detachment.
  • In most cases, watchful waiting for any signs of retinal tearing is the main management.
  • Most patients’ vitreous gels will continue to degenerate, but symptoms will either become less noticeable or will resolve.
  • If any of the signs (4 F’s) of retinal detachment appear (or worsen after seeing the doctor), refer urgently for repair.
    • Floaters
    • Flashes
    • Fall in acuity
    • peripheral Field loss.

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