Exudative Retinal Detachment
Recognizing whether a retinal detachment is exudative is crucial because, unlike with other types of retinal detachment, the management of exudative retinal detachment is usually nonsurgical. Exudative detachment occurs when either retinal blood vessels leak or the RPE is damaged, allowing fluid to pass into the subretinal space (Fig 16-17). Neoplasia and inflammatory diseases are the leading causes of large exudative detachments.
Figure 16-17 Color fundus photograph of an exudative retinal detachment that resulted from metastatic breast carcinoma.
(Courtesy of Hermann D. Schubert, MD.)
The presence of shifting fluid strongly suggests a large exudative retinal detachment. Because the subretinal fluid responds to the force of gravity, it detaches the area of the retina in which it accumulates. For example, when the patient is sitting, the inferior retina is detached. However, when the patient becomes supine, the fluid moves posteriorly in a matter of seconds or minutes, detaching the macula. Another characteristic of exudative detachments is the smoothness of the detached retinal surface, in contrast to the corrugated appearance in eyes with RRDs. Included in the differential diagnosis is the rhegmatogenous inferior bullous detachment, which may shift and is connected to a superior tear (see Fig 16-13, rule 4). Fixed retinal folds, which usually indicate PVR, are rarely, if ever, present in exudative detachments. Occasionally, the retina is sufficiently elevated in exudative detachments to be visible directly behind the lens (eg, in Coats disease), a rare occurrence in RRDs.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.