Retinal detachment

Definition
Retinal detachment is a separation of the retina from the back of the eye. If left untreated, retinal detachment can cause vision loss in the area where the detachment occurred and, in some cases, blindness in that eye.

Causes/associated factors
The retina is a thin, transparent tissue of light-sensitive nerve fibers and cells that lines the inside of the eye. The retina acts like film in a camera. As light passes through the lens of the eye, it's focused onto the retina. The retina "takes the picture" and transmits the image through the optic nerve to the brain. The retina is attached to the choroid (the membrane between the white part of the eye and the retina that feeds the retina with blood and nutrients). Most of the space inside the eye is filled with a jelly-like substance called vitreous.




Retinal detachment can be caused by:

a hole or tear in the retina (Fluid can pass through the tear, collect under the retina, and cause it to detach from the back of the eye.)
degenerative changes in the eye (The vitreous usually separates from the back of the eye with age. As it pulls away from the retina, it may cause a tear that can allow fluid to pass behind the retina.)
injury to the eye or head, such as a hard, solid blow
other eye diseases, such as tumors or severe inflammation, which may cause fluid buildup under the retina
a complication of diabetes
Although retinal detachment can happen at any age, it's most common for people older than age 50. You may be especially likely to develop retinal detachment if you are strongly nearsighted, have diabetes, have peripheral retinal degeneration, have had surgery to repair a cataract (a cloudy area in the lens of the eye), or have had other eye conditions, a previous retinal detachment or a family history of retinal detachment.


Signs/symptoms
The first symptoms, sometimes even before the detachment, are typically the sudden appearance of floaters (little spots that dance before the eyes like cobwebs), flashes of light and/or loss of peripheral vision. If you notice these signs, contact your ophthalmologist promptly.
Once retinal detachment occurs, painless vision loss is the main symptom. This is a medical emergency! If you have sudden vision loss, seek medical care immediately. If a large detachment occurs suddenly or progresses to the macula (a small area in the center of the retina that's responsible for central vision), you may have complete vision loss in the affected eye. If the retina is torn, bleeding in the vitreous fluid can cause rapid vision loss.

Other common symptoms include:

wavy or watery vision
blurred vision
a gradually enlarging dark shadow in some part of your vision
loss of peripheral vision (Your vision may be blocked from the top, bottom or one side.)

Diagnosis
To diagnose retinal detachment, an ophthalmologist will examine your eyes with special instruments. An indirect ophthalmoscope may be used to help the ophthalmologist view the periphery of the retina in the area where most detachments begin. Other special tests may include ultrasonography and visual field testing.

Treatment
With rapid treatment, many people regain excellent vision or most of the vision that was lost. In fact, the vast majority of all retinal detachment surgeries are successful. The amount of vision restored depends on:
how promptly you were treated
how much damage the retina sustained
whether there was a fibrous growth on the surface of the retina
The longer the retina was detached, the less dramatic the results. If the macula was involved (the small area in the center of the retina responsible for central vision), central vision may not be restored. Some vision will probably remain, however. If this happens, your doctor can recommend low-vision optical aids to help you maximize your remaining vision.

If the retina is torn, prompt treatment may prevent complete detachment. The exact approach chosen by the ophthalmologist will depend upon the location and size of the detachment. The following procedures are typically done on an outpatient basis under local anesthesia for some retinal holes:

Laser photocoagulation: The doctor uses a laser to place small burns around the edge of the tear. In turn, the burns produce scars that seal the edges and prevent fluid from passing through the tear and collecting under the retina.

Cryopexy: The doctor freezes the back wall of the eye behind the tear. The scars seal the edges of the tear.
Surgical repair
If the retina is separated from the back of the eye, surgical repair is often necessary. The type of surgery depends on the severity and location of the retinal detachment. Depending on the circumstances, surgery may be done on an outpatient basis under local or general anesthesia.

Pneumatic retinopexy: The doctor injects a long-acting gas bubble into the eye. The gas bubble seals the retinal tear by pushing against it. The patient must maintain a certain head position during and for a certain period after the procedure. Pneumatic retinopexy may not be appropriate for all types of retinal tears.

Scleral buckling: When a large area of the retina is detached, the doctor drains the fluid under the retina and settles it back onto the eye wall. A silicone band or pressure pad is often placed on the outside of the eye to gently push the wall of the eye against the retina until scarring seals the tear. Laser photocoagulation, cryopexy or diathermy may be used to seal the retinal tear.

Vitrectomy:This procedure is used for complex retinal detachments. The doctor cuts the connected bands of vitreous away from the retina and moves the shrunken vitreous body away from the eye wall. If the detached retina is severely shrunken and puckered, it may need to be pushed back to the wall of the eye by temporarily filling the vitreous cavity with air or gas. Eventually, clear fluid from the blood seeps into this space to fill it permanently.

Postprocedure care
After surgery, your doctor may prescribe eyedrops or ointments to use at home. Instructions for self-care will be provided, such as protecting your eyes from light with eye patches or dark glasses. You will probably also be asked to avoid rubbing your eyes, bending down, straining and heavy lifting. You may need to hold your head in a particular position for a few days. The healing process typically takes six to eight weeks. For some people, complete healing may take up to six months. After recovery, you may need to update your eyeglass or contact lens prescription for the clearest vision.

Complications
If you have a retinal detachment in one eye, there is an increased risk of retinal detachment in the other eye. If you have macular detachment (a breakdown of the macula that causes impaired vision) or proliferative vitreoretinopathy (damage to the retina that stimulates the growth of new blood vessels), you may experience partial or total vision loss.

Pregnancy-specific information
Rarely, preeclampsia (a condition characterized by pregnancy-induced high blood pressure, swelling and protein in the urine) and eclampsia (a life-threatening condition during pregnancy for both mother and baby) may be accompanied by retinal detachment. If this occurs and blood pressure is controlled, vision will usually return to normal within one week. Sometimes surgical repair is necessary.

Senior-specific information
The risk of retinal detachment increases over age 50 due to the normal changes in the eye that come with aging. To detect eye disorders, some experts recommend eye exams every one to two years beginning at ages 60 to 65.

Prevention
Early diagnosis and treatment of eye problems can help you save your vision. Get regular eye exams, and remember to tell your ophthalmologist about any changes in your vision. If you are at high risk for a retinal detachment, ask your ophthalmologist about any special precautions or exams you might need, and discuss with your doctor what to do if you suddenly notice symptoms.
If you engage in an activity that increases your risk of eye injury, be sure to wear safety glasses or goggles. During sports, wear sports glasses or goggles.