Bonus Pearl – For the previously missed one…
70 y/o M presents with flashing lights and floaters in R eye. He also notes decreased vision in the same eye. R eye is painless and not TTP. No swelling noted. Visual acuity is 20/200 in the R eye and 20/30 in the left eye. You perform a slit lamp examination that is normal. What is the diagnosis?
Most likely diagnosis is retinal detachment. Retinal detachment is most commonly described with flashing lights and floater. Filmy/cloudy vision is present as well, which is what leads to decreased vision. Detachment can occur by one of two mechanisms. The first and most common is rhegmatogenous. It is a tearing of the retinal neuronal layer as the vitreous humor contracts. This can occur with normal age related changes, on average around 55 years. The other mechanism is from either blood or other fluid leaking into the vitreous. This can occur from trauma (i.e. blood) or an exudative process. Exudative processes including severe hypertension, toxemia of pregnancy or central retinal venous occlusion.
