Retinal Detachment

What is retinal detachment?

The retina is a light-sensitive membrane located at the back of the eye. When light passes through your eye, the lens focuses an image on your retina.
The retina converts the image to signals that it sends to your brain through the optic nerve. The retina works with the cornea, lens, and other parts of your eye and brain to produce normal vision.
Retinal detachment occurs when the retina separates from the back of your eye. This causes loss of vision that can be partial or total, depending on how much of the retina is detached. When your retina becomes detached, its cells may be seriously deprived of oxygen. Retinal detachment is a medical emergency. Call your doctor right away if you suffer any sudden vision changes.
There’s a risk of permanent vision loss if retinal detachment is left untreated or if treatment is delayed.

Symptoms

Symptoms of retinal detachment

There’s no pain associated with retinal detachment, but there are usually symptoms before your retina becomes detached. Primary symptoms include:

• blurred vision
• partial vision loss, which makes it seem as if a curtain has been pulled across your field of vision, with a dark shadowing effect
• sudden flashes of light that appear when looking to the side
• suddenly seeing many floaters, which are small bits of debris that appear as black flecks or strings floating before your eye

Types and causes

Types and causes of retinal detachment

There are three types of retinal detachment:

• rhegmatogenous
• tractional
• exudative

Rhegmatogenous retinal detachment

If you have a rhegmatogenous retinal detachment, you have a tear or hole in your retina. This allows fluid from within your eye to slip through the opening and get behind your retina. The fluid separates the retina from the retinal pigment epithelium, which is the membrane that provides your retina with nourishment and oxygen, causing the retina to detach. This is the most common type of retinal detachment.

Tractional retinal detachment

Tractional retinal detachment occurs when scar tissue on the retina’s surface contracts and causes your retina to pull away from the back of your eye. This is a less common type of detachment that typically affects people with diabetes mellitus. Poorly controlled diabetes mellitus can lead to issues with the retinal vascular system, and this vascular damage can later lead to scar tissue accumulation in your eye that could cause retinal detachment.

Exudative detachment

In exudative detachment, there are no tears or breaks in your retina. Retinal diseases such as the following cause this type of detachment:

• an inflammatory disorder causing fluid accumulation behind your retina
• cancer behind your retina
• Coats’ disease, which causes abnormal development in the blood vessels such that they leak proteins that build up behind your retina

Risk factors

Who is at risk for retinal detachment?

Risk factors for retinal detachment include:

• posterior vitreous detachment, which is common in older adults
• extreme nearsightedness, which causes more strain on the eye
• a family history of retinal detachment
• trauma to your eye
• being over 50 years old
• prior history of retinal detachment
• complications from cataract removal surgery
• diabetes mellitus

Diagnosis

Diagnosis of retinal detachment

To diagnose retinal detachment, your doctor will perform a thorough eye exam. They’ll check:

• your vision
• your eye pressure
• the physical appearance of your eye
• your ability to see colors

Your doctor might also test the ability of your retina to send impulses to your brain. They may check the blood flow throughout your eye and specifically in your retina.
Your doctor may also order an ultrasound of your eye. This is a painless test that uses sound waves to create an image of your eye.

Treatments

Treating retinal detachment

In most cases, surgery is necessary to repair a detached retina. For minor detachments or tears of the retina, a simple procedure may be done in your doctor’s office.

Photocoagulation

If you have a hole or tear in your retina but your retina is still attached, your doctor may perform a procedure called photocoagulation with a laser. The laser burns around the tear site, and the resulting scarring affixes your retina to the back of your eye.

Cryopexy

Another option is cryopexy, which is freezing with intense cold. For this treatment, your doctor will apply a freezing probe outside of your eye in the area over the retinal tear site, and the resulting scarring will help hold your retina in place.

Retinopexy

A third option is pneumatic retinopexy to repair minor detachments. For this procedure, your doctor will put a gas bubble in your eye to help your retina move back into place up against the wall of your eye. Once your retina is back in place, your doctor will use a laser or freezing probe to seal the holes.

Scleral buckling

For more severe detachments, you’ll need to have eye surgery in a hospital. Your doctor may recommend scleral buckling. This involves placing a band around the outside of your eye to push the wall of your eye into your retina, getting it back into place for proper healing. Scleral buckling may be done in combination with a vitrectromy. Cryopexy or retinopexy is performed during the scleral buckle procedure.

Vitrectomy

Another option is vitrectomy, which is used for larger tears. This procedure involves anesthesia and is often performed as an outpatient procedure, but may require an overnight stay in the hospital. Your doctor will use small tools to remove abnormal vascular or scar tissue and vitreous, a gel-like fluid from your retina. Then they’ll put your retina back into its proper place, commonly with a gas bubble. Cryopexy or retinopexy is performed during the vitrectomy procedure.

Outlook

Outlook for people with retinal detachment

The outlook depends on the severity of the condition and how quickly you get expert medical care. Some people will recover completely, especially if their macula isn’t damaged. The macula is the part of the eye responsible for the clearest vision and is located near the center of the retina. However, some people may not regain full vision. This can occur if their macula is damaged and treatment isn’t sought quickly enough.

Prevention

Preventing retinal detachment

In general, there’s no way to prevent retinal detachment. However, you can take steps to avoid retinal detachment that results from an injury by wearing protective eyewear when playing sports or using tools. If you have diabetes, control your blood sugar and see your doctor regularly. Get yearly eye exams, especially if you have risks for retinal detachment.
It’s important to know the symptoms of retinal detachment. Recognizing when you may have a retinal problem and seeking medical care immediately can save your vision.