The vast majority of patients with rhegmatogenous retinal detachments present with either acute or chronic symptoms. In these cases repair of the retinal detachment is almost always recommended to either improve vision or prevent further visual loss. In a small subgroup, rhegmatogenous retinal detachments were detected as incidental findings in asymptomatic patients. Such asymptomatic detachments are often caused by atrophic holes in lattice degeneration and are more commonly located in the inferior quadrants. Demarcation lines are often present. Asymptomatic retinal detachments also occur in a younger age group of patients when compared with symptomatic rhegmatogenous retinal detachments. The management of eyes with an asymptomatic retinal detachment is controversial. The risk of complications during surgical repair must be weighed against the chance that the retinal detachment will progress. Recently published clinical data suggest that the risk of progression of asymptomatic rhegmatogenous retinal detachments is small. Consequently, observation can be considered as a reasonable management option in reliable patients until progression is documented or symptoms occur. Patient education geared toward instruction on self-monitoring of the visual field and a review of the risks and benefits of retinal detachment repair versus observation are important in patients with asymptomatic retinal detachment.
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