Retinal detachment

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.