Comments and Conclusions

  • Retinoschisis is typically characterized by the splitting of the neurosensory retinal layers which is consistent with histological findings.1 The splitting of the retina is usually found at the outer plexiform layer.1 In comparison, a retinal detachment is the separation of the neurosensory retina from the underlying RPE.1
  • Differentiating between a retinoschisis and retinal detachment is extremely important due to the difference in management of each disorder. The majority of patients with retinoschisis present without symptoms and rarely affect vision. Very few progress, so often the best management is careful follow-up and observation.3 In contrast, retinal detachments accompanied by retinal tears and rare cases of retinoschisis require immediate invasive surgical procedures.3
  • Retinal detachment is considered in the differential diagnosis when a retinoschisis is presented.1 Binocular indirect ophthalmoscopy, laser photocoagulation, and B-scan ultrasound have all been used in the differentiation between retinoschisis and retinal detachment.1 However, all three tests have limitations in their ability to distinguish the two disorders.
  • Binocular indirect ophthalmoscopy is often an initial method used to differentiate a retinoschisis and retinal detachment. A retinoschisis is often less fluid with fewer surface wrinkles and the lesion appears more transparent than a retinal detachment.1 BIO is a subjective test and inconsistency in exams can lead to misdiagnosis without further testing.1