Ophthalmology
Detached Retina
A detached retina is a medical emergency that occurs when the thin layer of retinal tissue comes away from the supportive wall at the back of the eye. If not treated quickly, the condition can cause blindness.
Overview
The retina plays an important role in vision. It is a transparent layer of nerve tissue in the back of the eye that functions like the film in a camera. It converts the light that the eye has captured into neural signals, and then sends these signals to the brain for visual recognition.
If any part of the retina is pulled from its normal position, it is considered detached. In such cases, the retina cells do not receive important oxygen and nutrients. The longer that a retinal detachment goes untreated, the greater the risk of it worsening and causing permanent vision loss.
What is a Retinal Tear or Hole?
Retinal tears and holes are small breaks in the retina that can sometimes lead to a retinal detachment. Your eye doctor may recommend sealing the retinal holes or tears to prevent detachment. This may be done with laser surgery (photocoagulation) or a freezing treatment called cryopexy. Both of these procedures are done on an outpatient basis.
5Common Symptoms
- Sudden onset or increase of “floaters” (small spots or web-like lines that drift through your vision)
- Flashes of light
- Blurred vision
- A curtain-like shadow over your field of vision
- Gradual loss of peripheral vision
Types and Causes of Retinal Detachment
There are three types of retinal detachment.
Rhegmatogenous: This is the most common type of retinal detachment. It happens gradually over time. It occurs when there is a tear or hole in the retina, which allows fluid to build up underneath the retina and peel it away from the underlying tissue.
Aging is a common cause of this type of detachment. As we age, the gel-like material inside the eye (vitreous) may shrink or change in consistency. Sometimes, as it shrinks, the vitreous can separate from the retina with enough force to create a tear. Left untreated, this can lead to retinal detachment.
Other risk factors for rhegmatogenous retinal detachment include previous eye injuries, eye surgery, and extreme nearsightedness.
Tractional: This occurs when scar tissue forms on the retina and pulls it away from the back of the eye. This type of detachment is often seen in patients with poorly controlled diabetes.
Exudative: This occurs when fluid accumulates under the retina, but there are no holes tears. Exudative retinal detachment is usually caused by leaking blood vessels or swelling in the back of the eye, which may be related to age-related macular degeneration, eye injury, eye tumors, or inflammation inside the eye.
Potential Risk factors
Anyone can experience a retinal detachment, but some factors may increase your risk.
- Aging (more common in people over age 50)
- Previous retinal detachment
- Family history of retinal detachment
- Previous eye surgery (such as cataract removal)
- Extreme nearsightedness
- Previous severe eye injury
- History of diabetic retinopathy, posterior vitreous detachment, retinoschisis, uveitis, or lattice degeneration
Diagnosis
Retinal exam: This is a simple and painless exam. Your doctor will give you eye drops to dilate your pupil. Then they will an instrument with a bright light and several lenses to see if you have any retinal tears, holes, or detachments.
Ultrasound imaging: If bleeding as occurred, it may be difficult to see your retina during a dilated eye exam. In such cases, your doctor may use ultrasound imaging.
Treatment
Treatment depends on the type and severity of your retinal detachment. If you have a retinal or tear or hole, your doctor may also use a laser or a freezing probe to seal the retina back together and prevent a second detachment.
During this eye surgery, a flexible band is sutured to the outside of your eye to reduce the pressure that may be pulling on the retina. Your surgeon may also drain the fluid under the retina, allowing the detached retina to settle back into its normal position. The buckle will always be placed in a way that does not affect your vision.
During this procedure, your doctor will inject a bubble of air or gas into the vitreous part of your eye. This creates extra pressure, and pushes the detached part of the retina back to the back wall of the eye. The retina will eventually reattach on its own, and the gas will be absorbed into your body.
