Ben is diagnosed with a retinal detachment at the inner aspect of the right eye. Into which position would the nurse place the client?
A. Fowler's position
B. Supine with a small pillow
C. Right-side lying
D. Left-side lying
Correct Answer: D. Left-side lying
When retinal detachment occurs, the client is positioned so that the area of detachment is dependent. For this client, the left-side lying position is used. Positioning the client in the Fowler, supine, or right-side lying position would not place the detached area in a dependent position. Management of rhegmatogenous and tractional retinal detachments is typically surgical. Exudative macular detachments usually have nonsurgical management. The recommendation is that the patient work with a retinal specialist, an ophthalmologist with additional training in evaluation and surgical treatment of the posterior portion of the eye.
Option A: The increased popularity of pneumatic retinopexy and vitrectomy have made postoperative positioning more important in the care of patients with retinal detachment due to the use of intraocular gas as a tamponade. Decisions surgeons must make regarding positioning include: 1) the actual desired head position; and 2) the duration of positioning. Positioning may vary during the postoperative period.
Option B: Early (initial six to 24 hours) postoperative positioning is often important in the management of subretinal fluid and to avoid complications related to retinal detachment repair. Later (after 24 hours) positioning is more important in achieving adequate tamponade necessary to ensure anatomic success.
Option C: To achieve successful reattachment, the gas must tamponade all of the retinal breaks while the chorioretinal adhesion matures. The location of the retinal breaks dictates the choice of position. Gas can cover superior retinal breaks in a head-up position. Inferior retinal breaks require a face-down or head-inferior position. Horizontal retinal breaks can be supported with a combination of head-tilt and lateral decubitus positioning.
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