What are the key features of acute retinal detachment?

• A. Gradual blurred vision and metamorphopsia.
• B. Painful red eye with photophobia.
• C. Sudden onset of painless vision loss, often described as a 'curtain' over the visual field.
• D. Intermittent flashes of light with floaters.

Answer: (C)

The key feature being tested is that acute retinal detachment presents with a sudden, painless loss of vision in one eye, often described by patients as a curtain coming down over the visual field. This happens because the retina begins to separate from the underlying tissue, so photoreceptors lose their support and function in the affected area, leading to a rapid loss of vision. Patients may also notice brief flashes (photopsias) and floaters as the vitreous pulls on the retina or as detachment progresses.

This is distinct from gradual blurred vision with metamorphopsia, which points more to macular or epiretinal conditions; a painful red eye with photophobia suggests inflammatory or infective processes or acute angle-closure glaucoma; and intermittent flashes with floaters can occur with vitreous changes or a retinal tear, but the classic hallmark of an acute retinal detachment is the sudden, painless curtain-like loss of vision. This condition is an ophthalmic emergency, requiring urgent evaluation and intervention to reattach the retina and preserve vision.