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Posterior Vitreous Detachment

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Overview

Posterior vitreous detachment (PVD) describes the separation of the vitreous membrane from the retina and is a cause of sudden and painless losses in vision. Its presentation is very similar to that of a retinal detachment.

In simple terms, as people age the vitreous humour shrinks and pulls away from the retina, bringing the vitreous membrane with it towards the centre of the eye. This may cause retinal tears which can allow vitreous humour to seep through and cause retinal detachment.

Epidemiology

  • Most common cause of flashes/floaters
  • Prevalence increases with age
  • Affects females more than males

Risk Factors

  • Increasing age
  • Myopia
  • Family history
  • Uveitis
  • Trauma
  • Eye surgery

Presentation

Patients have a painless sudden onset of floaters and flashing lights in their vision. Other features may be:

  • Blurred vision
  • Cobwebs across the vision
  • Vision loss is similar to that of a curtain or veil coming down – the presence of vision loss suggests an associated retinal detachment

Differential Diagnoses

Central retinal vein occlusion (CRVO)

Retinal detachment

  • May have flashes and floaters preceding visual loss
  • The presence of vision loss suggests associated retinal detachment
  • Vision loss may be described as a curtain or veil coming down over the vision

Investigations

  • Fundoscopy:
    • May not show any signs unless there is a large associated retinal detachment
  • Slit-lamp examination:
    • May show a Weiss ring – ring-shaped floater seen due to thickened posterior vitreous that has become visible as it has pulled away
    • May show associated vitreous haemorrhage due to retinal vessels being torn during vitreous separation
  • Ultrasound scan over the closed eye – if haemorrhages seen
    • To assess haemorrhages

Management

  • Immediate referral (within 24 hours) to ophthalmology
  • Most patients are observed and managed conservatively
  • If retinal tear/detachment seen: surgery

Patient Advice

  • Patients should seek help if there are new or further floaters/flashes or if there is any reduction in visual acuity

Complications

  • Haemorrhage associated with PVD
    • Due to retinal vessel tearing during vitreous separation
  • Retinal tears
    • Allows leakage of vitreous humour and this may cause retinal detachment
  • Retinal detachment

Prognosis

  • Most patients become asymptomatic after a few months
  • Most patients usually become tolerant of floaters and flashes quickly
  • The flashes tend to resolve as the vitreous stops pulling on the retina, however, in some severe cases, vitrectomy is considered 

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