What sign on exam suggests retinal detachment?

• A. Red conjunctiva
• B. Macular edema on OCT
• C. Optic disc pallor
• D. Visualization of retinal breaks or a detached retina on dilated fundus examination; or a horseshoe tear

Answer: (D)

Direct visualization of the retina being detached or of a retinal break on a dilated fundus examination is the sign that points to retinal detachment. Seeing the detached retina itself, often with subretinal fluid, or finding a retinal tear (such as a horseshoe tear) confirms the diagnosis, because RD is defined by the separation of the neurosensory retina from the underlying pigment epithelium. Other signs like red conjunctiva, macular edema on OCT, or optic disc pallor are not specific to RD and point to other conditions. Retinal detachment is an emergency, so recognizing a visible detachment or tear on exam prompts urgent management.