What is Exudative Retinal Detachment?
Exudative retinal detachment is a condition where fluid accumulates under the retina without any tears or pulling forces in the retina. This is caused by a disruption in the ‘blood-retinal barrier,’ a natural defense mechanism that protects the eye. This can happen either actively or passively, allowing for extra fluid to build up in the subretinal space, an area below the layer of cells called the retinal pigment epithelium and the sensory part of the retina. When this buildup of fluid causes the retina to detach, it results in reduced blood flow to the retina and damages the light-sensitive cells (photoreceptors).
The subretinal space, where the fluid builds up during retinal detachment, is a part of the eye that develops from an embryonic structure known as the optic vesicle. The causes for the fluid buildup are categorized into three main types: rhegmatogenous, tractional, or exudative. Sometimes, a combination of these types may be seen. The first type, rhegmatogenous retinal detachment, happens when tears or holes in the retina cause fluid to seep into the subretinal space. Tractional retinal detachment occurs due to pulling forces on the retina, often resulting from the growth of scar tissue over the retina, usually caused by lack of oxygen or other factors.
Keep in mind that there’s no natural binding between the retinal pigment epithelium and the sensory part of the retina. Specific molecules present on the cells facilitate attachment between these components of the eye. Various causes, such as inflammation, infection, surgical procedures, tumors, issues with blood vessels, or the effects of certain drugs, can disrupt the blood-retinal barrier causing symptoms.
If diagnosed and treated promptly, patients with exudative retinal detachment have a good chance of maintaining reasonable vision. Often, this condition is managed medically. Surgical intervention, such as tightening the outer layer of the eye (scleral buckling) or removing the vitreous (vitrectomy), is usually considered only if all medical treatments prove unsuccessful.
What Causes Exudative Retinal Detachment?
Exudative retinal detachment, a type of eye condition, can happen when too much fluid builds up under the retina or when the body can’t remove fluid from that area as it usually should. Several factors might lead to this situation, including inflammation, unknown cause (idiopathic), infection, surgery, the growth of a tumor or cancer (neoplasia), problems with blood vessels (vascular issues), or reactions to certain medications (drug effects).
Different things might cause the inflammation that can lead to this kind of retinal detachment. For instance, it can be due to certain illnesses and conditions such as Vogt-Koyanagi-Harada syndrome or Behçet’s disease, among others. Certain genes have also been associated with some of these conditions, like Vogt-Koyanagi-Harada syndrome, in different ethnic populations.
Also, there are cases where the cause is not known, such as central serous chorioretinopathy or idiopathic uveal effusion. It might even be due to infections, like tuberculosis or dengue, and others.
Sometimes, this problem happens after surgery. For example, it can follow procedures like panretinal photocoagulation or scleral buckle. It can also be linked to eye problems due to cancer, like a metastatic disease or retinoblastoma, and many others.
Patients who are suspected of having bilateral diffuse uveal melanocytic proliferation, a condition where there’s an abnormal growth of cells in the eye, should get checked for ovarian, lung, and urogenital cancer. Regular eye check-ups are necessary too, to catch and manage any potential complications in the eye early.
There are also cases of retinal detachment caused by conditions or problems related to the blood vessels or blood, such as preeclampsia, malignant hypertension, or systemic lupus erythematosus. For example, patients with severe diabetic retinopathy, kidney diseases or conditions like age-related macular degeneration can experience this too.
Norrie disease, a rare genetic disorder, can also result in exudative retinal detachment. Affected children usually have several symptoms of the eyes as well as other areas like developmental delays, hearing loss, and issues with sleep-wake cycles.
Lastly, the use of certain medications like interferon-α, ribavirin, and others can be linked to this problem, especially if they worsen a condition known as central serous chorioretinopathy.
Risk Factors and Frequency for Exudative Retinal Detachment
The occurrence of exudative retinal detachment, which is a type of eye disease, differs depending on several factors such as age, race, and sex. Similarly, the risks associated with different types of diseases that can lead to this condition also vary.
- Exudative retinal detachment often shows up in younger patients when it’s caused by Coats disease.
- However, if it’s due to conditions like cancer or age-related macular degeneration, it is more likely to occur in older individuals.
- In some cases, such as when it’s a result of preeclampsia, eclampsia, HELLP syndrome, VKH syndrome, or central serous chorioretinopathy, it commonly affects middle-aged people.
- Racial predisposition also exists, with White patients having higher rates of choroidal malignancies and exudative age-related macular degeneration, while Black patients often have a higher incidence of inflammatory eye diseases.
- VKH syndrome is generally more common in people of Asian descent.
- When it comes to sex, central serous chorioretinopathy, Coats disease, and uveal effusion syndrome are usually diagnosed in males more than females.
- Stressful lifestyle situations, a type A personality, and pregnancy are also known to increase the risk of developing central serous chorioretinopathy.
However, the multifactored nature of exudative retinal detachment makes it difficult to firmly establish the frequency of this disease.
Signs and Symptoms of Exudative Retinal Detachment
A person with retinal detachment can have a wide range of symptoms. These might include blurry vision, spots in their field of vision known as floaters, eye discomfort, vision loss, redness, white pupil, and distorted vision. The doctor will want to know if there has been a long duration of these symptoms, as well as any history of eye surgeries, systemic illnesses or use of any medication. Sudden weight loss and lack of appetite can also be important to check, as these could indicate potential cancer.
A detailed physical examination is needed to figure out what might be causing the retinal detachment. It is important to check the patient’s blood pressure, along with their best possible vision, eye pressure, and any signs of lazy eye. If the patient shows droopy eyelid, bulging eye, or pain when moving their eyes, it may indicate inflammation of the sclera (white part of the eye) and the muscles around the eye.
The front part of the eye examination could be mostly normal. However, in cases where there is inflammation, doctors might see some signs like around the cornea (clear front layer of the eye), cells in the fluid within the eye, cataract, deposits on the cornea, hypopyon (pus in the anterior chamber of the eye), cells behind the lens, or cells in the front part of the vitreous humor (clear gel that fills the back part of the eye). Increased eye pressure could also be seen in conditions like scleritis or in patients after certain laser procedures.
If the patient has a syndrome known as VKH, tiny blood vessels may grow on the iris (colored part of the eye) and the corner where the iris meets the cornea. It’s also helpful to check the pupils of the eyes for anomalies, as this can give insights about the severity of the retinal detachment. Other indications of this type of retinal detachment, such as pigments behind the lens or low eye pressure, should be noted too.
Fluid shifting across the retina is common in a certain type of retinal detachment known as exudative retinal detachment. As the patient changes their position, fluid collects in the lowest area of the retina. Exudative retinal detachment can also be characterized by a smooth retinal surface without folds, and the presence of cells in the vitreous humor. Other signs could include redness of the optic disc (part of the eye where the optic nerve leaves towards the brain), the formation of new blood vessels in the area beneath the retina in chronic cases. Sometimes, cancer spread to the choroid (layer of blood vessels and connective tissue between the sclera and the retina) can also present as an exudative retinal detachment.
A close examination of the retina is very important for the diagnosis. The doctor will check for any tractional bands or retinal breaks which are indications for different types of retinal detachments. If these are present, surgical management might be necessary.
Testing for Exudative Retinal Detachment
If you are experiencing symptoms that suggest a condition called exudative retinal detachment, your doctor will need to examine your eyes thoroughly. Based on this examination, your doctor may recommend additional tests to find the underlying cause of your problem.
These tests differ for each patient, and your doctor will advise the best ones for you, based on your medical history, symptoms, and examination results. Some possible tests you might have include:
– A complete blood count to assess your overall health
– Tests for tuberculosis, sexually transmitted infections
– Tests to check the functioning of your kidney, liver, cortisol (stress hormone) level and blood sugar levels
– Tests to look for auto-immune conditions, which are diseases where the body’s immune system attacks its own cells
– Tests for certain infections during pregnancy (TORCH markers)
– Tests to assess your body’s blood clotting capability
Additionally, your doctor may ask you to use an Amsler grid. This is a simple tool to detect changes in your central vision over time and can help to check how well your retina is functioning.
After these preliminary tests, your doctor might order additional imaging studies. These tests provide detailed pictures of the structure of your eyes, which help the doctor identify specific issues and plan treatment accordingly.
Optical coherence tomography (OCT) scans provide particularly detailed images of the macula – the part of the retina responsible for clear, detailed vision. This test can measure the thickness of the back of your eye and detect any changes in the structure of your retina and choroid, the layer of blood vessels behind the retina.
Fundus fluorescein angiography (FFA) is another imaging technique which uses a dye to capture images of the blood vessels in your eyes. The pattern of this dye can tell your doctor a lot about what’s happening in your eyes.
Indocyanine green angiography is similar to FFA but uses a different dye. It can provide images of the deeper layers of the eye that are difficult to see with other methods.
Ultrasound might also be recommended by your doctor if other methods are not sufficient. This test is useful to measure the thickness of your eyes and to assess the location and size of any abnormal masses found in your eyes.
So, in summary, if your doctor suspects an exudative retinal detachment, they will order a series of tests to help them better understand your condition. Each test gives important information about the structures of the eye and can help guide treatment plans.
Treatment Options for Exudative Retinal Detachment
An exudative retinal detachment is a condition where fluid builds up behind the retina in your eye. This kind of problem can be caused by a number of different factors. Each person’s treatment will depend on the type, severity, and stage of their condition. The initial approach typically involves medical treatments. Only in very rare cases, when other treatments have failed, is surgery necessary.
For people experiencing inflammation related conditions like VKH syndrome and posterior scleritis, practitioners often use corticosteroids. They inject these medications into the patient’s veins for three to five continuous days, before the patient starts taking oral corticosteroids. These drugs work to reduce inflammation in the eye.
In managing VKH syndrome, doctors also use immunosuppressive drugs, like methotrexate, azathioprine, and cyclosporine, to suppress the immune response that is part of the syndrome.
There are different guidelines on which treatment options to use for exudative retinal detachment based on the exact causes and conditions. For example, Central Serous Chorioretinopathy, another eye condition, can be managed through various methods, like laser treatment, medication and photodynamic therapy, while serious cases may demand surgical intervention.
When this retinal detachment happens due to a wound or low pressure after eye surgery, it usually improves with timely wound stitches and administration of anti-inflammatory treatments.
For example, when somebody has high blood pressure in their eye, timely medical intervention and careful continuous monitoring of blood pressure levels can prevent further retinal damage and help preserve their remaining vision.
When the detachment happens due to underlying health conditions, such as hematologic and vascular diseases, this can usually improve once the underlying disease is controlled and treated. In other cases, the retinal detachment might occur as a result of certain medications. In these cases, it typically improves once the medication is stopped and corticosteroid treatment is started.
Lastly, issues like infectious causes that lead to exudative retinal detachment need immediate treatment with appropriate antibiotics. Different infections might require different combinations of medicine and steroids to treat them effectively.
What else can Exudative Retinal Detachment be?
An exudative retinal detachment is a condition where the retina detaches as a result of fluid accumulation. It can be caused by a variety of factors such as inflammation, infections, tumors, and other conditions. In making a diagnosis, it’s important for doctors to distinguish it from other types of retinal detachments like rhegmatogenous and tractional retinal detachments.
Exudative, rhegmatogenous, and tractional retinal detachments each have unique causes. Check out the comparison below to understand how they differ:
- Rhegmatogenous Retinal Detachment: Occurs due to a break in the retina. Commonly found in 90% to 95% of cases and often associated with trauma, myopia, or aphakia. The retina is usually undulating with lines of demarcation and pigment in the vitreous. This type of detachment often results from conditions like a retinal break.
- Tractional Retinal Detachment: Triggered by factors such as diabetes mellitus, prematurity, penetrating trauma, venous occlusions, and sickle cell disease. Vitreous changes such as vitreoretinal traction are often noted. There’s almost no retinal break and usually involves conditions like proliferative diabetic retinopathy and sickle cell retinopathy.
- Exudative Retinal Detachment: This detachment doesn’t involve a retinal break. Its causes may be systemic factors like hypertensive conditions, renal failure, or results from conditions like uveitis, metastatic tumor and Coats disease. The subretinal fluid in this case may often be rapidly shifting.
Patients who have a hemorrhagic retinal detachment are different from those with an exudative retinal detachment because instead of clear or turbid fluid, there is blood under the retina. Conditions that can cause a hemorrhagic retinal detachment include peripheral exudative hemorrhagic chorioretinopathy, trauma, leukemia, and age-related macular degeneration, especially in people using blood thinners.
What to expect with Exudative Retinal Detachment
The future health outcomes of a specific eye condition, called exudative retinal detachment, can vary greatly depending on the root cause. In certain cases, like those caused by a fluid buildup in the eye (uveal effusion) or a rare inflammatory disorder called VKH syndrome, proper use of high-dose steroids can lead to improvement. However, these conditions have a high chance of coming back.
Re-occurrence is also common in patients with a condition called acute central serous chorioretinopathy. Once this condition becomes chronic, permanent loss of certain cells in the eye, called cones, can lead to less successful recovery of vision.
In cases where exudative retinal detachment is seen in patients with pregnancy-related high blood pressure disorders, such as preeclampsia and eclampsia, this eye condition usually resolves on its own over time.
For other root causes like Coats disease, choroidal tumors, infection, inflammation of the middle layer of the eye (uveitis), retinal vein blockage, and an eye disorder affecting premature babies (retinopathy of prematurity), the future health outcomes depend on how severe the underlying condition is, how well it responds to treatment, if the area in the middle of the retina (macula) is involved, and any complications that might arise from the treatment.
When these conditions have been present for a long period of time, they can cause permanent damage to light-sensing cells (photoreceptors) and the layer of cells at the back of the eye (retinal pigment epithelium). This often results in poorer outcomes despite serious efforts to treat the condition.
Possible Complications When Diagnosed with Exudative Retinal Detachment
If a retinal detachment filled with fluid isn’t treated quickly, several issues could arise, which are listed below:
- Phthisis bulbi (shrinking and hardening of the eye)
- Neovascular glaucoma (a type of eye pressure condition)
- Subretinal fibrosis (scar tissue beneath the retina)
- Choroidal neovascularization (new blood vessel growth beneath the retina)
- Pigmentary changes of the fundus (changes in eye color at the back of the eye)
- Festooned pupil (wrinkly appearance of the pupil)
- Vitreous hemorrhage (bleeding into the jelly-like filling of the eye)
- Complicated cataract (clouding of the eye lens leading to decreased vision)
Preventing Exudative Retinal Detachment
Retinal detachment is a serious eye condition where the retina (the layer at the back of the eye that senses light) separates from the layers underneath it. The detached retina doesn’t get enough blood supply and the cells that capture light (photoreceptors) start to break down. If it does not get treated, it can cause blindness.
Retinal detachment can occur when a tiny hole or tear in the retina allows fluid to accumulate between the layers of the eye. This can sometimes be due to a pulling effect from the jelly-like part of the eye (the vitreous) or as a result of a disease process that causes fluid to build up. In a specific type called “exudative” retinal detachment, the fluid comes from the blood vessels in the retina or in the layer beneath it. This can happen when the sticky forces that normally keep these layers together become overwhelmed.
There could be several possible causes, including tumors in the part of the eye beneath the retina, inflammation of the eye, high blood pressure, problems with the vessels that supply blood to the eye, certain medications, other body-wide inflammatory conditions, diseases that affect the body’s connective tissue, or infectious diseases.
There are different types of retinal detachment and it is important to be able to differentiate between them in diagnosing the condition. Patients showing symptoms of the “exudative” type of retinal detachment should undergo a thorough examination to find the cause of their condition. This would include things like lab tests and imaging, depending on the patient’s specific symptoms and history. Timely treatment by the doctor can help improve both the sight and overall health of the patient.
