View source for Posterior vitreous detachment

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{{Infobox_Disease |
  Name           = Posterior vitreous detachment |
  Image          = Schematic diagram of the human eye en.svg |
  Caption        = Schematic diagram of the human eye. |
  DiseasesDB     = 31271 |
  ICD10          = |
  ICD9           = |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID         = |
}}
A '''posterior vitreous detachment (PVD)''' is a condition of the eye in which the [[vitreous humour]] separates from the [[retina]].

==Causes==
The vitreous humor fills the [[eye]] behind the [[Lens (anatomy)|lens]]. At [[birth]] it is attached to the [[retina]]. Over time the vitreous changes, shrinking and developing pockets of liquefaction, similar to the way a [[gelatin]] dessert shrinks, or detaches, from the edge of a pan over time. At some stage the vitreous may peel away from the retina. This is usually a sudden event.

Several studies have found a broad range of incidence  PVD, from 20% of autopsy cases to 57% in a more elderly population of patients (average age was 83.4 years).  Age and refractive error play a role in determining the onset of PVD in a healthy person. PVD is rare in [[emmetropic]] people under the age of 40 years, and increases with age to 86% in the 90's.  
People with [[myopia]] (nearsightedness) greater than 6 [[diopters]] are at higher risk of PVD at all ages.

==Symptoms==
When this occurs there is a characteristic pattern of symptoms:

* Flashes of light ([[photopsia]]) 
* A sudden dramatic increase in the number of [[floaters]]
* A ring of floaters or hairs just to the [[Temple (anatomy)|temporal]] side of the central vision

As a posterior vitreous detachment proceeds, adherent vitreous may pull on the retina.  While there are no pain fibers in the retina, vitreous traction may stimulate the retina, with resultant flashes that can look like a perfect circle.{{Citation needed|date=June 2009}}

==Presentation, associated conditions, and prognosis==
The vitreous is more firmly attached to the retina [[Anatomical terms of location#Anterior_and_posterior|anteriorly]], at a structure called the vitreous base. The vitreous does not normally detach from the vitreous base, although it can be detached with extreme trauma. 
  
However, the vitreous base may have an irregular posterior edge. When the edge is irregular, the forces of the vitreous peeling off the retina can become concentrated at small posterior extensions of the vitreous base. Similarly, in some people with retinal lesions such as lattice retinal degeneration or chorio-retinal scars the vitreous may be abnormally adherent to the retina. If enough traction occurs the retina may tear at these points. If there are only small point tears, these can allow [[glial cell]]s to enter the vitreous and proliferate to create a thin [[epiretinal membrane]] that distorts vision.   In more severe cases, [[vitreous fluid]] may seep under the tear, separating the retina from the back of the eye, creating a [[retinal detachment]]. Trauma can be any form from a blunt force trauma to the face such as a boxer's [[Punch (strike)|punch]] or even in some cases has been known to be from extremely vigorous blowing of the nose.
If a retinal vessel is torn, the leakage of blood into the vitreous cavity is often perceived as a "shower" of floaters. Retinal vessels may tear in association with a retinal tear, or occasionally without the retina being torn. 

The risk of retinal detachment is greatest in the first 6 weeks following a vitreous detachment, but can occur over 3 months after the event. 

Prompt examination of patients experiencing vitreous floaters combined with expeditious treatment of any retinal tears has been suggested as the most effective means of preventing certain types of retinal detachments.<ref name="Byer">Byer NE. "Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment." ''Ophthalmology''. 1994 Sep;101(9):1503-13; discussion 1513-4. PMID 8090453.</ref> The risk of retinal tears and detachment associated with vitreous detachment is higher in patients with [[myopic retinal degeneration]], [[lattice degeneration]], and a familial or personal history of previous [[retinal tear]]s/detachment.

==References==
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==See also==
* [[Central serous retinopathy]]
* [[List of eye diseases and disorders]]
* [[Epiretinal membrane]]
* [[Vitrectomy]]

[[Category:Ophthalmology]]

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