Posterior Segment
Degenerative Retinoschisis
Also known as: retinoschisis, degenerative retinoschisis, acquired retinoschisis, senile retinoschisis, peripheral retinoschisis, bullous retinoschisis, reticular retinoschisis, schisis-detachment
Filed as: Routine
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
An acquired splitting of the peripheral neurosensory retina, usually bilateral and inferotemporal, found by chance in an older adult. It appears as a smooth, transparent, immobile elevation that stays elevated on scleral indentation. Most cases are stable and are reviewed annually. Breaks in the outer layer can cause a schisis-detachment, and breaks in both the inner and outer layers can cause a rapidly progressive rhegmatogenous detachment that needs prompt same-day referral. The main task is to tell it apart from a retinal detachment.
Recognition
Symptoms: what patients report
- Usually none; found at a dilated examination.
- An absolute field defect over the area of splitting, rarely noticed by the patient.
- New flashes, floaters or a spreading shadow are not expected from stable retinoschisis and need same-day assessment.
Signs: what the examination shows
- Flat (typical) form: smooth, slightly elevated transparent retina, often with white surface dots, anterior to the equator.
- Bullous (reticular) form: a well-circumscribed, immobile, transparent dome, often with a pitted surface; sheathed vessels in a reticular pattern that may show aneurysmal change, telangiectasia or sclerosis.
- Usually bilateral and most often inferotemporal.
- Stays elevated on scleral indentation; a detachment flattens against the indenter.
- OCT (where the lesion can be reached): splitting within the retina — at the outer plexiform layer in the flat form and at the nerve fibre layer in the bullous form.
- No pigment cells in the anterior vitreous.
- Schisis-detachment: outer layer break with rolled edges on OCT and a neurosensory detachment; a pigmented demarcation line suggests it has been stationary for more than 3 months.
What OptoGuide™ covers for degenerative retinoschisis
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting