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, the appearance of something like 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.
After examining you, the doctor may conclude that you are suffering from a retinal tear. If this retinal tear has not yet developed into a retinal detachment, the surgical procedure you need will be simpler. If the doctor does not think the retina is likely to detach, you may not even require treatment.
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. If at all possible, you should see a doctor within a matter of hours. The longer you wait to seek treatment, the greater the chances are that the damage to your vision will be permanent. When the retina is detached, its cells do not receive the oxygen they need, and they begin to die, which may lead to permanent blindness.
The prognosis is usually good, however, if the injury is treated before the detachment spreads to the macula (the part of the retina that processes the central part of your field of vision). If retinal detachment surgery is performed before the macula has detached, your vision can probably be saved.
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)
- 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. This shrinkage can cause pulling where the gel attaches to the retina, and can lead to a retinal tear.
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.
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 it, forcing it up and away from the underlying eye tissues.
Am I at Risk for Retinal Detachment?
While retinal detachment can happen to anyone, certain factors can increase your risk:
- 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, in order to look 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. Over 90 percent of people who experience a detached retina are treated successfully.
Different Types of Retinal Detachment Surgery
There are no non-surgical treatments for retinal tears or retinal detachment. Fortunately, however, many retinal detachment surgeries can be performed on an outpatient basis, with no need for general anesthesia. Depending on the extent of your injury, you are likely to need one of these surgeries performed:
Scleral buckle surgery: The surgeon sews a piece of plastic or silicone sponge into place on the outer layer of eye tissue, beneath the conjunctiva. This pushes the wall of the eye against the detached retina, allowing it to re-attach. In most cases the scleral buckle will be left permanently in place, although it may sometimes be removed if necessary.
Cryopexy: 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 and thereby seal the area surrounding the tear, a surgical procedure known as cryopexy. In some cases, a scleral buckle is permanently attached around the eyeball to compress it slightly, which allows the retina to contact the back of the eye again.
This procedure is effective for treating retinal tears, but not for repairing a retina that has fully detached.
Laser photocoagulation: This procedure involves using a laser beam to form a “seal” around a retina tear or limited retina detachment. As the burns heal, they form scars, which block fluid that would otherwise collect underneath the retina and cause further detachment.
Pneumatic retinopexy: The surgeon will inject a tiny bubble of gas into your eye and position you so that the bubble floats up against the retina, sealing the tear and eventually allowing the retina to reattach. Sometimes a laser or cryoplexy is then used to seal the tear.
Vitrectomy is sometimes necessary in conjunction with retinal detachment surgery to reattach a torn retina. This procedure involves removing some or all of the vitreous humor, the clear gel that fills the back of the eyeball and gives the eye its shape. This allows the surgeon better access to the back of the eye, where the retina is located.
Following surgery, the patient must remain in position as directed by the physician to keep the gas bubble oriented at the tear site. The gas bubble dissolves into the eye tissue within a few weeks, and patients must not get on an airplane or travel into high altitudes during this recovery period.
What to Expect After Retinal Detachment Surgery
As noted above, your movements will be somewhat restricted following pneumatic retinopexy surgery for retinal detachment. In most cases vision can be restored completely if the retinal detachment has not advanced to the macula. If the macula has detached, partial restoration of your vision is still possible, but you are likely to suffer at least some permanent impairment.
Risks of Retinal Detachment Surgery
As with any invasive medical procedure, there are some risks associated with retinal detachment surgery, such as bleeding, infection, cataract, double vision, or an increase in intraocular pressure. There is also a chance that the first operation will not be successful, and that multiple procedures will be required.
Contact your doctor immediately if you experience any of these symptoms following retinal detachment surgery:
- Discharge from eye
- Worsening vision
- Flashes, floaters, or any other significant vision abnormalities
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 administered in a timely manner, but treatment is not always effective, and vision loss can sometimes occur. Blindness in the affected eye is the most common complication of a detached retina. Retinal detachment surgery carries risks such as:
- 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?
- 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?
- Will I be able to have my retinal detachment surgery in your office, or will I need to go to the hospital?
- How quickly should my surgery be scheduled?
- Is it too late to restore my full vision?
- Will I be put under local or general anesthesia?
- What are the chances I will need to come back and have this operation performed a second time?
- How likely is it I will eventually go blind?
- 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