Retinal Detachment

What is Retinal Detachment?

Retinal Detachment is a serious eye emergency that involves the retina detaching or peeling away from the back of the eye in much the same way an orange peel comes off the fruit. A retina detaches when it is torn in a way that allows fluid to collect between the retina and the back of the eye.

There are three different types of retinal detachment:

  • Rhegmatogenous: as described above, this is a tear or break in the retina; it is the most common type of retinal detachment.
  • Tractional: this less common type of retinal detachment occurs when scar tissue on the retina’s surface contracts and causes the retina to separate from the eye.
  • Exudative: this is usually the result of retinal disease, inflammatory disorders, or injury to the eye. Fluid leaks into the area under the retina, but there are no tears or breaks in the retina.

Retinal Detachment Symptoms

Symptoms of retinal detachment may include eye floaters, light flashes (especially in peripheral vision), very blurred vision, a veil or curtain blocking your vision, or a sudden dramatic decrease in vision. Patients with these symptoms should contact their eye doctor immediately and be seen for an exam the same day if possible. Typically there is no pain associated with a detached retina, since the retina does not contain any pain receptors, although if the retinal detachment was caused by an injury, some pain may be felt in other parts of the eye.

This type of eye problem is an emergency; therefore, treatment from an eye doctor should not be delayed. The sooner a retinal detachment is diagnosed, the better the chances of saving your vision.

What do I do if my Retina Detaches?

If you have sudden symptoms of a detached retina, the first thing you should do is try to remain calm. Lie flat on your back and try your best to avoid sudden head and eye movements. Lying flat on your back may encourage the retina to fall back into place until treatment can be sought. If someone is near you and can take you to the hospital or your eye doctor’s office, lie as flat as possible for the car ride. An immediate exam by an eye doctor is of the utmost importance, since the longer a retina is detached, the more likely the damage is to be permanent. If at all possible, you should see a doctor within a matter of hours.

What Causes Retinal Detachment?

Retinal detachment can occur for various reasons:

  • Spontaneous detachment (perhaps due to an underlying anatomical abnormality)
  • Complication of cataract surgery (this only occurs in about one out of 2,500 cataract surgery patients)
  • Diabetes
  • Inflammatory disorder
  • Eye injury

One possible cause of retinal detachment is shrinkage of the vitreous, the gel-like substance that fills the eye. As the eyes age, the collagen fibers which make up the vitreous cavity condense or shrink, causing the vitreous gel to “pull forward.” Patients typically complain of seeing central floaters and/or flashes of light, usually in their peripheral vision. This is a normal age-related phenomenon, but in some patients it can be associated with a retinal tear or detachment. This shrinkage can cause a pulling where the gel attaches to the retina, and can lead to a retinal tear. Various retinal disorders can cause the retina to become thinner and more fragile, making it vulnerable to tearing and subsequent detachment (age can also have this effect). Once the retina has been torn or develops a hole, fluid can accumulate underneath the retina, forcing it up and away from the underlying eye tissues.

Who is at Risk for Retinal Detachment?

Because the most common cause is blunt or penetrating injury to the eye, retinal detachment can happen to anyone. Certain factors can increase your risk of developing retinal detachment, such as:

  • Age (people 24–45 years old are at greater risk)
  • Gender (retinal detachment is more common among males than females)
  • History of any intraocular surgery
  • Myopia (nearsightedness)
  • Trauma, especially in children
  • Aphakia (absence of lens)
  • Pseudophakia (after cataract surgery with replacement lens)
  • Retinal detachment in other eye (this increases risk by 10%)
  • Diabetic retinopathy
  • Metabolic disorders
  • Connective tissue disorders such as Wegener’s disease
  • Sickle cell retinopathy
  • Severe retinopathy of prematurity (ROP)

Retinal detachment is more common in people with severe myopia (above 5–6 diopters), in whom the retina is more thinly stretched. As a nearsighted eye develops it actually grows longer, but the retina doesn’t grow; it has to stretch to cover the longer eye, making it more vulnerable to tears

Diagnosing Retinal Detachment

If symptoms of retinal detachment suddenly appear, it is critical that you seek medical attention immediately to prevent vision loss. The eye doctor will ask you questions about your symptoms and the activities leading up to those symptoms. Your eye doctor will then perform a thorough eye examination. He or she will want to test your vision and the overall condition of the retina. Tests to diagnose retinal detachment may include:

  • Visual acuity test: this test determines how well you can read letters at a distance, usually fourteen to twenty feet.
  • Ophthalmoscopy examines the back portion of the eye.
  • Slit-lamp examination is done with a special microscope that checks all parts of the front portion of eye.
  • Ultrasound uses high frequency sound waves to image the eye.
  • Color defectiveness test: tests ability to see colors.
  • Retinal photography: photos taken of retina to check for damage
  • Refraction test: measures prescription for eyeglasses or contact lenses.
  • Intraocular pressure test: tests pressure inside eye; also used in glaucoma screenings.
  • Fluorescein angiography: dye is injected into a vein in your arm and makes its way to the retina. Photos are then taken of the retina looking for leaks.

Retinal Detachment Treatment

In most cases the retina can be reattached surgically if treatment is sought quickly. In general, the method of treatment will be determined by the severity of the tear or hole in the retina. If the hole is small, a laser can be used to seal it. If the tear is large and has caused the retina to begin peeling away from the eye, a freezing probe will be used to reattach the retina in a surgical procedure known as cryopexy. In some cases, a scleral buckle is permanently attached around the eyeball to slightly compress it, which allows the retina to contact the back of the eye again.

In some cases, a procedure called a pneumatic retinopexy is performed. This treatment involves injecting a small gas bubble into the vitreous portion of the eye. The gas bubble pushes the retina back into place.

Over 90 percent of people who experience a detached retina are treated successfully. See our article about retinal detachment surgery to read about the subject in more detail.

Retinal Detachment Prevention

Retinal detachment is not easily prevented, but there are steps that can be taken to reduce your risk. If you participate in high-impact sports such as football or hockey, make sure you wear a face mask that completely covers your eyes. If you have diabetes, control your blood sugar levels. Always see your eye doctor at least once a year or as often as they recommend, especially if any of the risk factors for retinal detachment apply to you.

Retinal Detachment Complications

Complications rarely occur if treatment is received in a timely manner, but treatment is not always effective, and vision loss can occur. A detached retina can result from some types of eye surgery. Blindness in the affected eye is the most common complication of a detached retina. Retinal detachment surgery carries risks such as:

  • Bleeding
  • Infection
  • Inflammation
  • Trouble with eye pressure
  • Cataract formation
  • Change in glasses prescription
  • Loss of vision
  • Loss of the eye

Talking to Your Eye Doctor

Here are some questions to ask your eye doctor about retinal detachment:

  • How severely is my retina torn?
  • Which treatment option is most appropriate for my type of retinal detachment?
  • How long should I wait to contact you if treatment does not seem to work?
  • What can I do to prevent this from recurring or happening to the other eye?
  • How likely is it I will eventually go blind?
References:
  • J. Weizer, MD, J. Stein, MD, MS “Reader’s Digest Guide to Eye Care” (Quantum Publishing Ltd 2009) 66-69
  • J. Anshel “Smart Medicine for Your Eyes” (SquareOne Publishers, 2011) 137-138
  • OSN SuperSite, Microincision techniques make combined cataract, retinal detachment procedures safer, easier, May 16th, 2011 http://www.osnsupersite.com/view.aspx?rid=83637
  • J. Anshel “Smart Medicine for Your Eyes” (SquareOne Publishers, 2011) 303-305
This article was last updated on 11/2014