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

Begin with the visual clue that is most specific. The complaint of a curtain or shutter coming down over part of the visual field is pathognomonic of the neurosensory retina peeling away from its bed. Because the detached portion of retina can no longer transduce light, the corresponding part of the visual field goes dark, and the patient describes this as a curtain.

Trace the sequence of events. First, the vitreous gel liquefies and tugs on the retina, producing flashes; then a tear forms and pigment plus a little blood disperse into the vitreous, seen as a sudden storm of floaters; finally fluid tracks under the retina and the curtain appears and advances.

Now test each distractor against this story. Eales disease (idiopathic retinal periphlebitis) bleeds into the vitreous and causes abrupt visual loss, but its signature is recurrent haemorrhage in a young adult male, not a marching curtain. Pure vitreous haemorrhage clouds vision globally and gives floaters, yet lacks the well-defined field defect. A macular hole degrades only central vision with distortion. None reproduces the peripheral curtain.

Hence the diagnosis is the separation of the sensory retina.
\[\boxed{\text{Retinal detachment}}\]