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  • FIRST POST
    • Mr Costcutter
    • By Mr Costcutter 14th Oct 16, 12:03 PM
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    Mr Costcutter
    Retinal Examination Using A Slit Lamp
    • #1
    • 14th Oct 16, 12:03 PM
    Retinal Examination Using A Slit Lamp 14th Oct 16 at 12:03 PM
    I was wondering whether it is possible to detect a retinal tear without pupil dilation?

    Additionally, is pupil size a factor when determining whether a pupil should be dilated?

    Many thanks for reading and any replies greatly appreciated.
Page 1
    • DomRavioli
    • By DomRavioli 14th Oct 16, 6:30 PM
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    DomRavioli
    • #2
    • 14th Oct 16, 6:30 PM
    • #2
    • 14th Oct 16, 6:30 PM
    I was wondering whether it is possible to detect a retinal tear without pupil dilation?
    Potentially possible, but you would likely have to pay for a specialist private ophthalmologist, if anyone would do it without dilation.

    Additionally, is pupil size a factor when determining whether a pupil should be dilated? They dim the lights, so that really isn't relevant.

    Many thanks for reading and any replies greatly appreciated.
    Originally posted by Mr Costcutter
    What's your beef with dilation? Its cheap, simple and effective. If you have a retinal tear you need to seek urgent diagnosis and possible treatment, as you can lose part or all of your sight if not treated (worst case).
    Observe, Adapt, Overcome.
    SPC 2015 #497
    • Mr Costcutter
    • By Mr Costcutter 14th Oct 16, 6:40 PM
    • 210 Posts
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    Mr Costcutter
    • #3
    • 14th Oct 16, 6:40 PM
    • #3
    • 14th Oct 16, 6:40 PM
    What's your beef with dilation? Its cheap, simple and effective. If you have a retinal tear you need to seek urgent diagnosis and possible treatment, as you can lose part or all of your sight if not treated (worst case).
    Originally posted by DomRavioli
    Thank you for your reply.

    I don't have any problem with my eyes or the prospect of having them dilated if the need arose. I wasn't asking for medical advice.
    • BucksLady
    • By BucksLady 14th Oct 16, 6:48 PM
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    BucksLady
    • #4
    • 14th Oct 16, 6:48 PM
    • #4
    • 14th Oct 16, 6:48 PM
    A couple of years ago my mother experienced flashes in her eye and an examination of the retina was made to exclude tears etc. The pupil was dilated and my understanding is that it has to be to see the minute detail necessary. I'm not an optician though - so may be wrong . It would be interesting to know for sure.
    • theoretica
    • By theoretica 14th Oct 16, 11:40 PM
    • 4,474 Posts
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    theoretica
    • #5
    • 14th Oct 16, 11:40 PM
    • #5
    • 14th Oct 16, 11:40 PM
    I was wondering whether it is possible to detect a retinal tear without pupil dilation?
    Originally posted by Mr Costcutter
    Is that the question you mean to ask? A retinal tear may be detectable without pupil dilation - being confident there is no retinal tear when one is suspected is a different and more exacting matter.
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    • fireblade28
    • By fireblade28 15th Oct 16, 1:53 PM
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    fireblade28
    • #6
    • 15th Oct 16, 1:53 PM
    • #6
    • 15th Oct 16, 1:53 PM
    I read that as rectal. Then was confused where the pupil was!
    • DomRavioli
    • By DomRavioli 15th Oct 16, 11:14 PM
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    DomRavioli
    • #7
    • 15th Oct 16, 11:14 PM
    • #7
    • 15th Oct 16, 11:14 PM
    Thank you for your reply.

    I don't have any problem with my eyes or the prospect of having them dilated if the need arose. I wasn't asking for medical advice.
    Originally posted by Mr Costcutter
    Perhaps next time speak to your optician, or ophthalmologist if you have one, instead of an internet forum. WAB.
    Observe, Adapt, Overcome.
    SPC 2015 #497
    • GlasweJen
    • By GlasweJen 16th Oct 16, 9:09 AM
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    GlasweJen
    • #8
    • 16th Oct 16, 9:09 AM
    • #8
    • 16th Oct 16, 9:09 AM
    The answer is "it depends". If you have naturally massive pupils and an experience ophthalmologist then yes, it's easy. If you have tiny pupils or are light sensitive or have a fairly new junior doctor or a doctor who is on call and possibly not a retinal specialist you'll need dilated.

    Where I work anyone with a suspected tear or detachment is dilated before getting near a doctor by one of the nurses. The reason being is we are a teaching hospital so the junior doctors and medical students will likely be invited to look and see if they can see your tear. Then you'll get OCT or medical photographs taken to help plan your treatment and the bright flash in one eye will make the other pupil constrict so it affects the photo quality.

    I imagine if you go private you could ask the doctor to give you drops to speed up the dilating drops coming out your system but in the NHS we would only offer these if the pressure in your eye shot up as a result of the pupils being dilated.
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    • BucksLady
    • By BucksLady 16th Oct 16, 12:22 PM
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    BucksLady
    • #9
    • 16th Oct 16, 12:22 PM
    • #9
    • 16th Oct 16, 12:22 PM
    Perhaps next time speak to your optician, or ophthalmologist if you have one, instead of an internet forum. WAB.
    Originally posted by DomRavioli
    Some people (like myself) will have found the OP's general question quite interesting. The fact that GlasweJen was able to provide such an informed answer was a bonus. I'm not sure why you felt the necessity to tell the OP what not to do - if he wishes to post on this forum - why shouldn't he. He wasn't asking for medical advice and so did not breach any forum rules.
    • Mr Costcutter
    • By Mr Costcutter 16th Oct 16, 2:03 PM
    • 210 Posts
    • 468 Thanks
    Mr Costcutter
    GlasweJen - many thanks for taking the time to reply and your clear explanation of matters. I am extremely grateful to you.
    • GlasweJen
    • By GlasweJen 16th Oct 16, 6:52 PM
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    GlasweJen
    GlasweJen - many thanks for taking the time to reply and your clear explanation of matters. I am extremely grateful to you.
    Originally posted by Mr Costcutter
    You're welcome.
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    • kirtondm
    • By kirtondm 18th Oct 16, 12:06 PM
    • 94 Posts
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    kirtondm
    Just to add

    If it is a big enough tear then you could see without dilation. Any suspeceted tear gets dilated as a peripherial tear will not be visible without dilation.

    The last retinal detatchment I dealt with I did not dilate as I could see it clearly without!

    It would not be advisable to not dilate a px c/o flashers or floaters as you may miss a tear.
    • Mr Costcutter
    • By Mr Costcutter 18th Oct 16, 1:37 PM
    • 210 Posts
    • 468 Thanks
    Mr Costcutter
    Kirtondm,

    Many thanks for your reply - very interesting. A friend recently had the misfortune of being diagnosed with a detached retina - hence my interest in this matter.
    • DomRavioli
    • By DomRavioli 18th Oct 16, 1:46 PM
    • 2,850 Posts
    • 4,755 Thanks
    DomRavioli
    Some people (like myself) will have found the OP's general question quite interesting. The fact that GlasweJen was able to provide such an informed answer was a bonus. I'm not sure why you felt the necessity to tell the OP what not to do - if he wishes to post on this forum - why shouldn't he. He wasn't asking for medical advice and so did not breach any forum rules.
    Originally posted by BucksLady
    Quite simply because I have lost 60% of my vision - and if in any doubt you should see a qualified expert/specialist.

    Perhaps remove the chip off your shoulder - it is for a specialist to answer, and it is usually on a case by case basis (which you obviously know), which renders "general information" pretty useless.
    Observe, Adapt, Overcome.
    SPC 2015 #497
    • kirtondm
    • By kirtondm 18th Oct 16, 5:10 PM
    • 94 Posts
    • 55 Thanks
    kirtondm
    Interestingly dilation is mandatory in Scotland for all over 60's for routine NHS eyetests.
    • Mr Costcutter
    • By Mr Costcutter 18th Oct 16, 5:49 PM
    • 210 Posts
    • 468 Thanks
    Mr Costcutter
    Interestingly dilation is mandatory in Scotland for all over 60's for routine NHS eyetests.
    Originally posted by kirtondm
    I hadn't realised that. However, a friend who lives in the USA reports that he's had dilation since aged 40 and says it's not unusual. He hasn't any eye problem - just specs for reading.
    • BucksLady
    • By BucksLady 18th Oct 16, 6:05 PM
    • 306 Posts
    • 726 Thanks
    BucksLady
    I hadn't realised that. However, a friend who lives in the USA reports that he's had dilation since aged 40 and says it's not unusual.
    Originally posted by Mr Costcutter
    Can't see that happening on the NHS .
    • C_Mababejive
    • By C_Mababejive 21st Nov 16, 10:02 AM
    • 9,910 Posts
    • 9,042 Thanks
    C_Mababejive
    If you xperience even the slightest hint of loss of vision, usually at the periphery,large amount of floaters or flashing lights in your eyes, more noticeable in ther dark/when eyes closed, get your eyes checked as a matter of urgency. At the very least, attend an optometrist who has in his room an ocular coherence tomography 3d scanner. If you are definitely losing vision, go directly to your nearest eye emergency facility no matter what time of day/night it is.

    I am no expert but i would not rely solely on a slit lamp examination to spot a retinal tear. In any case, full dilation by droplet infusion would be necessary.
    Last edited by C_Mababejive; 22-11-2016 at 8:14 AM.
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    • no1catman
    • By no1catman 21st Nov 16, 12:43 PM
    • 2,232 Posts
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    no1catman
    Any opinions on how long 'flashes' should last? My Partner was told at eye medical that could last two-three months, but if any problems with peripheral go straight to A & E.
    Trouble is - it's almost a year now, and there are still occurring - fortunately still no problems with peripheral.
    Does have a Hospital appointment pending - not looking forward to.

    Any informative comments welcome.
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    • nedmundo
    • By nedmundo 21st Nov 16, 10:32 PM
    • 1,147 Posts
    • 526 Thanks
    nedmundo
    If you xperience even the slightest hint of loss of vision, usually at the periphery,large amount of floaters or flashing lights in your eyes, more noticeable in ther dark/when eyes closed, get your eyes checked as a matter of urgency. At the very least, attend an optometrist who has in his room an ocular coherence tomography 3d scanner. If you are definitely losing vision, go directly to your nearest eye emergency facility no matter what time of day/night it is.

    I am no expert but i would not rely solely on a slit lamp examination to spot a retinal tear. In any case, full dilution by droplet infusion would be necessary.
    Originally posted by C_Mababejive
    Whilst well meaning, a lot of this is wrong. Irrespective of the amount, any suddon onset floaters need to be checked out, along with any visual disturbance, whether it is peripheral or not.

    Most retinal tears occur in the peripheral retina, whereas OCTs mostly examine the central retina and a slit lamp retinal examination is one of the best ways of viewing the retina - dilating with drops improves the view - regardless of the technique.

    Also - don't just go straight to your local Eye Casualty - most probably won't see you without a referral from a GP or Optician.

    As to the OP - whether drops are required to detect a retinal tear depends on several factors including pupil size, clinician skill and presence of optical opacities such as cataracts. That said, if a retinal break is suspected, then dilating drops are considered essential to detect those retinal breaks that would otherwise be missed.
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