Peripheral Retinoschisis

Peripheral Retinoschisis
SYMPTOMS Typically asymptomatic
Rarely, patient may report central vision loss if the peripheral retinoschisis involves the macula
An absolute visual field defect correlating to the location of the retinoschisis will be noted
SIGNS Typically unilateral (can be bilateral 30% of the time)
Typically found in the inferior temporal quadrant of the peripheral retina
Transparent, smooth, and dome-shaped area of the retina that is stationary or jiggles with eye movement. Other signs include Dark retinal vasculature that appears to be floating, Vascular sheathing, Gunn dots, Inner retinal breaks, Outer retinal breaks
A retinoschisis that balloons or bulges out more than a typical retinoschisis is bullous (a bullous retinoschisis is more prone to develop outer retinal breaks and inner retinal breaks)
Outer retinal breaks tend to be larger than inner retinal breaks and are more likely to develop into a rhegmatogenous retinal detachment than inner retinal breaks. Outer retinal breaks can be seen in about 25% of retinoschisis cases. RPE pigment can be seen around outer retinal breaks which is an indication of stability and chronicity
WORK-UP Full eye exam with dilated retinal exam, Scleral depression (typically a retinoschisis will not flatten when depressed), Peripheral 90D, Gonioscopy 3-mirror (using retina mirrors), OCT, Peripheral visual field (kinetic is a better choice than static), B-scan ultrasound
TREATMENT Typically, no treatment is needed and retina needs to be monitored with the following: Peripheral retinoschisis without any evidence of retinal breaks / Peripheral retinoschisis not encroaching or progressing towards the posterior pole
Refer to a retinal specialist ASAP if patient presents with the following: Peripheral retinoschisis with evidence of retinal breaks (especially outer retinal breaks) / Peripheral retinoschisis that is encroaching or progressing towards the posterior pole
FOLLOW-UP If monitoring peripheral retinoschisis, the patient should be seen back every 6-12 months
If patient was seen and treated by a retinal specialist and the retina is stable, the patient should be seen back in 6-12 months
ADDITIONAL LAB | TESTS None
ETIOLOGY Idiopathic splitting of the neurosensory retina which often is associated with peripheral cystoid degeneration
A typical retinoschisis involves splitting of the outer plexiform layer while a bullous retinoschisis involves splitting of the retinal nerve fiber layer
DIFFERENTIAL DX Retinal detachment, Choroidal melanoma, Retinal cyst, Varices of a vortex vein ampulla
NOTES About 1.5-7% of patients over the age of 40 years old have a peripheral retinoschisis
A peripheral retinoschisis can enlarge and progress closer to the posterior pole (this occurs less than 15% of the time)
A retinoschisis really should not be associated with any RPE proliferation. If present, outer retinal breaks an/or a retinal detachment should be suspected
Cataract surgery and posterior vitreous detachments have not been shown to affect a retinoschisis
Peripheral Retinoschisis: Optos photo demonstrating a bullous retinoschisis progressing to the posterior pole https://www.ijo.in/viewimage.asp?img=IndianJOphthalmol_2019_67_10_1734_267408_f1.jpg

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