On fundoscopy, which finding is most indicative of retinal detachment?

On fundoscopy, which finding is most indicative of retinal detachment?

• A. Flapping retinal tissue in the vitreous with Shafer's sign
• B. Cherry‑red spot in the macula
• C. Cotton-wool spots
• D. Optic disc pallor

Answer: (A)

Retinal detachment shows a detached, mobile retina on fundoscopy; you can often see tissue that appears to flap as the eye moves. Shafer's sign—pigmented particulates in the inferior vitreous, known as tobacco-dust sign—occurs when pigment from the retinal pigment epithelium is shed into the vitreous and is highly indicative of a retinal tear with detachment. Together, the flapping retina and pigment in the vitreous point to detachment specifically. The other findings point to different conditions: a cherry-red spot at the macula is classic for central retinal artery occlusion; cotton-wool spots reflect microinfarcts from diabetic or hypertensive retinopathy; optic disc pallor suggests optic neuropathy or glaucoma. Thus, the combination of a mobile, detached retina with Shafer's sign best indicates retinal detachment.

Retinal detachment shows a detached, mobile retina on fundoscopy; you can often see tissue that appears to flap as the eye moves. Shafer's sign—pigmented particulates in the inferior vitreous, known as tobacco-dust sign—occurs when pigment from the retinal pigment epithelium is shed into the vitreous and is highly indicative of a retinal tear with detachment. Together, the flapping retina and pigment in the vitreous point to detachment specifically.

The other findings point to different conditions: a cherry-red spot at the macula is classic for central retinal artery occlusion; cotton-wool spots reflect microinfarcts from diabetic or hypertensive retinopathy; optic disc pallor suggests optic neuropathy or glaucoma. Thus, the combination of a mobile, detached retina with Shafer's sign best indicates retinal detachment.