Question

A patient presented with sudden onset of floaters and a sensation of a curtain falling in front of the eye. Which one of the following is the appropriate diagnosis?

• A. Retinal detachment
• B. Eales disease
• C. Vitreous haemorrhage
• D. Macular hole

Hint:

A descending curtain plus flashes and floaters means the sensory retina has peeled off.

Answer 1

The Correct Option is A

Step 1: Identify the hallmark symptoms. Sudden floaters and a curtain or veil descending across the field of vision are the classic warning symptoms of rhegmatogenous retinal detachment.
Step 2: Understand the mechanism. A retinal break allows liquefied vitreous to pass beneath the neurosensory retina, separating it from the underlying retinal pigment epithelium. As the detachment extends, the patient perceives a progressively advancing shadow or curtain.
Step 3: Note the prodrome. Photopsia (flashes of light) from vitreoretinal traction and a sudden shower of floaters from pigment or blood release typically precede the curtain effect.
Step 4: Exclude the other options. Eales disease causes recurrent vitreous haemorrhage in young males but presents mainly with sudden painless loss of vision, not a fixed curtain. Isolated vitreous haemorrhage gives floaters and haze but a diffuse blur rather than a sharp descending curtain. A macular hole causes central metamorphopsia and a central scotoma, not a peripheral curtain.
Step 5: Conclude. The triad of floaters, flashes, and a curtain over the vision points to retinal detachment.