Retinal detachment

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at June 30, 2016
StartDiseasesRetinal detachment

Retinal detachment is a rare medical emergency and can cause permanent damage to the eye (including vision loss) if not treated quickly. It most often occurs in individuals over the age of 50 but can happen to anyone. Especially susceptible are patients with cataracts and those suffering from head trauma that affects the eye area.

Contents

Definition & Facts

Retinal detachment is defined as a medical emergency where the retina (a thin layer of tissue) has separated from the back of the eye, allowing the vitreous fluid to leak out. The vitreous fluid is the gel-like substance that fills the eyeball and keeps it round. Retinal detachment occurs when the retina is torn, either from injury, age, or other medical complications. Retinal detachment involves the retina being pulled or lifted from its normal position.

Retinal detachment is a medical emergency, and should be treated as such. However, it is possible for the patient to fully recover from this emergency, although in some cases permanent damage, including blindness, is possible. 

Symptoms & Complaints

Symptoms may vary from person to person though complaints of flashes or floaters in the vision, cobwebs or a curtain-like appearance, or even specks are strong indications of retinal detachment. The eyes may also appear red and the pupils may appear dilated.

Although some patients experience floaters and/or flashes in their vision occasionally, an increase in this phenomena is cause for definite concern and should be evaluated by either an optician or ophthalmologist as soon as possible. If left untreated, the condition quickly causes permanent blindness.

Causes

The cause of retinal detachment vary depending on the type of retinal detachment an individual is experiencing. Rhegmatogenous retinal detachments are the most common type of detachment. These are caused by a tear in the retina allowing the vitreous fluid to get under or behind the retina. This in turn will cause the retina to further separate from the retinal pigment epithelium, which is the pigmented cell layer that keeps the retina healthy.

Tractional retinal detachment is caused by scar tissue on the surface of the retina, which contracts the retina and creates a separation from the retinal pigment epithelium. This condition is not as common.

Injuries or any type of trauma increase the likelihood of exudative retinal detachment. Retinal detachment can also occur if a patient has an autoinflammatory disease such as Coats’ disease, which is an abnormal development of blood vessels behind the retina. Other inflammatory disorders that can cause the retina to detach are rheumatoid arthritis (RA), which is a progressive disease that causes inflammation in the joints, or uveitis, which is an inflammation of the middle layer of the eye, also known as the uvea.

People with advanced diabetes can also experience retinal detachment, which is why it is vital to keep diabetes symptoms under control. If a patient has a high level of myopia (nearsightedness), they are at a greater risk of having retinal detachment because the retina is stretched due to the increased length of the eye.

Diagnosis & Tests

If it is suspected that the retina has detached, the doctor will test both the visual acuity (near and distance vision), as well as the peripheral vision. He or she will ask questions about any changes in vision such as an increase in floaters, specks, cobwebs, or an almost curtain-like vision loss or if there has been an abrupt change in visual acuity.

The doctor may also use an opthalmoscope to look into the eye after putting drops in to enlarge the pupil. This gives them the ability to see the back of the eye where the tears usually are. If the eye or the orbital or facial bone has been injured, or if an infection is suspected, the ophthalmologist may order an ultrasound, which is a device that uses high frequency sound waves to produce an image of the eye, in order to assist with diagnosis.

Treatment & Therapy

There are several different treatments for retinal detachment though according to the American Academy of Ophthalmology, nearly all retinal detachments require surgery. If there is a hole or tear in the retina and it is small, it is usually treated with either laser surgery or cryopexy.

If laser surgery is chosen, the laser makes tiny burns around the hole to weld the retina back into place. Cryopexy is a procedure that freezes the retina and choroid. It causes a chorioretinal scar to prevent fluid from getting into the retina. The choroid is the pigmented vascular layer of the eyeball situated between the retina and the sclera.

Sometimes a scleral buckle will be used. This device, which is a tiny band made from synthetic materials, is attached to the outside of the eyeball while the patient is under general anesthesia. The scleral buckle then gently pushes the wall of the eye against the part of the retina that has become detached.

If the surgeon also determines that a vitrectomy is necessary, this procedure will also be done while the patient is under anesthesia. A vitrectomy is a procedure where the doctor makes an incision in the sclera, commonly known as the white of the eye, and removes the vitreous, a gel-like substance that fills the eye. Once the vitreous is removed, a type of gas is then injected into the eyeball to help reattach the retina. The gas is eventually absorbed by the body as the eye makes more vitreous fluid to fill itself.

Prevention & Prophylaxis 

Knowing the risk factors for retinal detachment is important in preventing this condition. Cataract surgery, especially in patients over 50, is a major cause of retinal detachment. A person with a family history of retinal detachment is also more susceptible to the disease.

Diabetic retinopathy is a disease common in diabetics and can lead to retinal detachment, so it is especially important that diabetics schedule regular eye examinations and keep their blood sugar in the appropriate target range.

People with extreme myopia should also be vigilant about regular eye examinations. To the extent that retinal detachment is caused by injury, eye protection is important when engaging in sports or activities that involve hazards. Goggles and safety glasses are crucial.