How should I differentiate between a retinal detachment and other ocular conditions presenting with similar symptoms?

To differentiate retinal detachment from other ocular conditions presenting with similar symptoms such as flashes, floaters, and visual disturbances, consider the following clinical features and examination requirements:

• Symptoms: Retinal detachment often presents with new-onset flashes and/or floaters, accompanied by visual field defects or a drop in visual acuity, which suggests macular involvement and a sight-threatening condition requiring urgent referral ¹.
• Visual field defects with preserved visual acuity suggest the macula is not yet detached, indicating an early stage where timely surgery can prevent progression ¹.
• Fundoscopic examination: Retinal detachment cannot be reliably excluded by direct ophthalmoscopy in primary care due to its narrow field of view; a dilated eye examination using slit lamp and indirect ophthalmoscopy is necessary to detect retinal breaks, pigment cells in the vitreous, vitreous haemorrhage, or detachment ¹.
• Referral urgency: Immediate referral to an ophthalmologist with retinal surgery expertise is required if there are signs of sight-threatening disease such as visual field loss, changes in visual acuity, or fundoscopic signs of retinal detachment or vitreous haemorrhage ¹.
• Differentiation from other conditions: Other ocular conditions like age-related macular degeneration, diabetic retinopathy, or glaucoma may present with visual symptoms but typically have different clinical signs and require specific imaging or tests (e.g., OCT, fluorescein angiography, intraocular pressure measurement) ²,³,⁴. These conditions usually do not present acutely with flashes and floaters combined with visual field loss.
• Patient advice: Patients with flashes and floaters but no visual field loss or acuity change should be assessed urgently within 24 hours by a practitioner skilled in slit lamp and indirect ophthalmoscopy to exclude retinal breaks or detachment ¹.

Summary: The key to differentiating retinal detachment from other ocular conditions lies in the acute symptom pattern (flashes, floaters, visual field loss), urgent dilated fundoscopy with slit lamp and indirect ophthalmoscopy, and prompt referral for specialist assessment if retinal detachment is suspected ¹.