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Retinal detachment is a serious eye disorder. This occurs when the retina, which is the layer of tissue at the back of the eye responsible for detecting light and transmitting visual signals to the brain, becomes separated from the surrounding supportive tissues. A detached retina affects the vision and can cause blindness.
The retina loses its blood supply when it separates from the tissues that support it. These tissues’ blood vessels deliver oxygen and nourishment to the retina. If left untreated for an extended period, the chances of experiencing permanent vision loss in the affected eye significantly increase.
Reduced vision, sudden appearance of floaters, and flashes of light are all potential warning symptoms of retinal detachment, and prompt treatment is essential to prevent potential vision loss. Treatment options may include laser therapy and surgery.
Symptoms
The signs and symptoms of retinal detachment depend on the severity of the symptoms. Some people don’t experience any symptoms, while some, especially if a larger portion of the retina detaches, may have symptoms. But before it happens or has progressed, there are often warning indicators, such as:
- Photopsia, or bright flashes of light
- The abrupt onset of numerous floaters
- The peripheral vision becomes darker or reduced
- Darkening or shadow covering part of the vision
- Blurry vision
If one observes an increase in the number of eye floaters, flashes of light, or the presence of a shadow in the vision, it is crucial to immediately contact an eye care provider or visit the emergency room. Urgent medical attention is necessary to prevent permanent vision loss.
Causes
The cause of retinal detachment may vary depending on its type. The types of retinal detachment include:
- Rhegmatogenous: This type of retinal detachment is the most common and usually happens as a person gets older. The gel-like fluid known as vitreous humor can pass through a small tear in the retina and gather behind the retina. The fluid exerts pressure, displacing the retina from the rear of your eye. As the vitreous undergoes age-related shrinking and thinning, it exerts a tug on the retina, resulting in tears.
- Tractional: The most common cause of this type of retinal detachments is diabetes. Long-term high blood sugar levels can damage the blood vessels in the retina and cause the scar tissue. Scar tissue that forms on the retina’s surface can cause the retina to pull away from the back of the eye.
- Exudative: Blood vessels that are leaking or swelling behind the eye, which can result from eye inflammation conditions such as uveitis, are the main causes of fluid buildup which can lead to exudative retinal detachment. When the fluid gathers behind the retina without a tear, it accumulates and pushes the retina away from its supportive tissue. Other causes include tumors, age-related macular degeneration, and eye injuries.
Risk factors
Several factors may contribute to one’s risk of developing retinal detachment, such as:
- Aging, particularly people over 50 are more
- Personal and family history of retinal detachment
- Eye injury
- Had an eye surgery
- Being very nearsighted
- Previous eye conditions such as retinoschisis, uveitis, or lattice degeneration or diabetes-related retinopathy
- Posterior vitreous detachment
- Certain inherited eye disorders
Diagnosis
The diagnosis of retinal detachment includes discussing the symptoms, assessing one’s personal and family medical history, and performing an eye exam and other tests.
- Retinal examination: The retina will be examined during a dilated eye exam. Eye drops are used to allow the pupil to dilate or enlarge. The healthcare provider can examine the retina closely after a few minutes. A device with bright light and special optics may be used to check the retina on the back of the eye, particularly to see any retinal holes, tears, or detachments by giving them a highly detailed view of the entire eye.
- Imaging tests: CT scan is frequently used if there’s a history of trauma or possible penetrating eye injury. If eye bleeding has occurred, ultrasound may be utilized.
If no tear is found during the examination, patients may be asked to come back in a few weeks to make sure there’s no delayed tear from the same vitreous separation. In most cases, both eyes are checked, even if only one has symptoms.
Treatment
Several treatment options are available to treat retinal detachment, and the most effective outcome may involve a combination of several treatments. In most cases, repairing a tear, perforation, or detachment in the retina usually requires surgery.
- Retinal tears: In some cases, a retinal tear may be identified prior to the actual detachment of the retina. In such cases, a medical laser or a freezing device may be used to close and seal the tear and maintain vision. These two treatments are both performed as outpatients. Refraining from eye-jarring activities, like running, for a few weeks following the treatment is advised.
- Photocoagulation (laser surgery). This surgery creates burns around the retinal tear, which results in scarring that typically bonds the retina to the tissue beneath it. This procedure uses a laser to send a beam into the eye via the pupil.
- Cryopexy (freezing). During the procedure, a freezing probe is placed onto the outer surface of the eye, directly covering the tear. The freezing action induces a scar formation that aids in anchoring the retina to the wall of the eye. This requires the administration of local anesthesia.
- Retinal detachment: The specific surgical approach will be determined based on various factors, including the extent of the detachment. Surgery is often recommended to undergo shortly after diagnosis, ideally within days.
Following the surgical procedure, it may take several months for the vision to show improvement. In some cases, a second surgery might be necessary to achieve successful treatment.- Pneumatic retinopexy: This is a surgical procedure where a small gas bubble is injected into the eye to apply pressure on the retina, closing a tear. Additional treatments like laser or cryopexy may be required to seal the tear. This process allows accumulated fluid under the retina to be reabsorbed, enabling the retina to reattach to the eye wall properly. The gas bubble will eventually be absorbed by the body.
Post-surgery, patients are typically advised to keep their head still for a few days and may receive recommendations on sleeping or lying positions to support healing. - Scleral buckle surgery: In scleral buckle surgery, a silicone band or sponge is surgically positioned around the eye, serving as a permanent support to hold the retina in place. The band remains unseen. To close the tear, a laser or cryopexy is used. Additionally, a gas bubble may be injected or remove the fluid from under the retina to facilitate its reattachment.
- Vitrectomy: This procedure may be done with scleral buckling surgery. In a vitrectomy procedure, the vitreous gel is removed from the eye and employs laser or freezing techniques to seal any retinal tears or holes. The vitreous space is then filled with air, gas, or silicone oil bubble to assist reposition the retina.
Patients with a gas bubble may need to avoid certain activities at high altitudes, as this can enlarge the bubble and increase eye pressure. Flying and traveling to high altitudes should be temporarily avoided. If an oil bubble is used, it will be removed a few months later.
- Pneumatic retinopexy: This is a surgical procedure where a small gas bubble is injected into the eye to apply pressure on the retina, closing a tear. Additional treatments like laser or cryopexy may be required to seal the tear. This process allows accumulated fluid under the retina to be reabsorbed, enabling the retina to reattach to the eye wall properly. The gas bubble will eventually be absorbed by the body.
