White without pressure is an unusual peripheral vitreoretinal phenomenon involving the vitreous base where the vitreous, sensory retina and retinal pigment epithelium are adherent to each other. The exact pathology of white without pressure is yet to be clarified, although it is commonly associated with posterior vitreous detachment or myopia. It appears to be more common in people of darker skin and may change in position in the fundus and extent with time. Its importance lies in the fact that giant retinal tears have been reported along the posterior margin of these areas. A similar appearance occurring on scleral indentation is known as white with pressure.
The condition itself is asymptomatic. Should a retinal break occur, the patient might present with flashes and floaters.
The involved retina takes on a grey-white somewhat translucent appearance. Most commonly observed between the equator and ora serrata, it may extend towards the posterior pole. Should an area of white without pressure surround a zone of normal retina, the latter can appear as a retinal break. The posterior border is typically clearly demarcated.
White without pressure is seen in approximately 3% of white patients and 30% of black and Asian patients.
White with pressure; Retinal breaks.
In most cases, no treatment is required and the patient can be followed on an annual basis.
As retinal tears have been noted in some patients, those who have had a retinal tear in the other eye may be considered for prophylactic treatment.
White-without-pressure with pseudoholes. Figure courtesy of Kanski JJ. Clinical Ophthalmology 5th edition, Butterworth-Heinemann, 2003.