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The retina is the
neurosensory tissue that lines the back inside wall of the eye. Similar to
the film in a camera, the retina records the light coming into our eye.
The retina converts the information into electrical signals and sends them
on to the brain, creating the perception of vision. When the retina
detaches, it separates from the back wall of the eye and is removed from
its blood supply and source of nutrition. The retina degenerates and loses
its ability to function if it remains detached too long.
Types
of Retinal Detachment
Because it can cause devastating damage to the vision if left untreated,
retinal detachment is considered an ocular emergency that requires
immediate medical attention and surgery. It's a problem that occurs
most frequently in the middle-aged and elderly.
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There are three
types of retinal detachments. The most common type occurs
because there is a hole or a tear in
the retina. Fluid that
normally fills the inside of the eye can go through these retinal
holes or tears and get behind the retina. This separates the retina
from the back of the eye, causing a detachment. Those who are very
nearsighted, have undergone eye surgery, or have experienced a
serious eye injury
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are at greater risk for this type of detachment. Nearsighted people
are more susceptible because their
retinas are
thinner and more fragile. |
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The second most
common type occurs when strands of vitreous or scar tissue create traction
on the retina, pulling it loose from the back of the eye. Patients
with diabetes are more likely to experience this type
since diabetes is the most common cause of traction retinal detachments.
The third type of
detachment
is due to leakage of fluid under the
retina, causing
it to separate from the back wall of the eye. This type usually
occurs in conjunction with another disease affecting the eye that causes
swelling or bleeding.
The fluid is called exudate. Tumors
and inflammatory disorders can create exudative detachments.
Signs
and Symptoms
The sudden appearance of spots or flashes can indicate a tear in the
retina. A sudden increase in the number and size of
floaters may also be a
warning that the retina is tearing. This is sometimes referred to as a
"shower of floaters."
 Wavy
or watery vision may also be a sign that the retina
is detaching. Sometimes people notice a dark shadow or
the appearance of a "curtain" being pulled over their field
of vision. This generally is experienced in the peripheral (side) vision,
which is where retinal detachment often begins. Blurred central vision
indicates that retinal detachment is progressing and the result is
significant, permanent vision loss unless it is repaired.
Detection and Diagnosis
Retinal detachments
are usually found because the patient calls the doctor’s office with one
or more of the symptoms mentioned above. The doctor usually makes the
diagnosis of a retinal detachment after thoroughly examining the retina
with an instrument called
an ophthalmoscope which lets the doctor look
inside the eye.
Ultrasound imaging of the eye is also very useful because it provides
additional detail as to the location of the retina relative to the back of
the eye.
If you have had a retinal detachment
in one eye, you are at an increased risk of developing one in the other
eye. But there is only about a one in ten chance of this happening.
Treatment
There are a number
of ways to treat retinal detachment. The appropriate treatment
depends on the type, severity and location of the detachment.
Pneumatic
retinopexy is one type of procedure to reattach the retina. After
numbing
the eye with a local anesthesia, the surgeon injects a small gas
bubble into the center
of the eye. The bubble presses against the
retina, flattening it against the back wall of the eye. Since the
gas rises, this treatment is most effective for detachments located
in the
upper portion of the eye. In order to manipulate the bubble into the
ideal location, the surgeon may ask the patient to keep his or her head in
a specific position.
The gas bubble
slowly absorbs over the next 1-2 weeks. At that time, an additional
procedure is usually performed to “tack down” the retina. This can
be done either with cryotherapy, a procedure that uses nitrous oxide to
freeze the retina, sealing it in place, or with laser. Local
anesthesia is used for both procedures.
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Some types of retinal detachments, because of their location or size,
are best treated |
with a procedure called a scleral buckle. With this technique, a
tiny sponge or band made of silicone is attached to the outside of the
eye, pressing inward and holding the retina in position. After
removing the vitreous gel from the eye with a procedure called a vitrectomy, the surgeon usually seals a few areas of the retina into
position with laser
or cryotherapy. The scleral buckle is not visible and remains
permanently attached to the eye. This technique of reattaching
the
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retina may elongate the eye, causing nearsightedness.
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In rare cases where
other types of retinal detachment surgeries are either inappropriate or
unsuccessful, silicone oil may be used to reattach the retina. The
vitreous gel is removed and replaced with silicone oil, which presses the
retina into place. While the oil is inside the eye, the vision is
extremely poor. After the retina has resealed itself against the
back of the eye, a second procedure may be performed to remove the oil.
What you
can do
 Early detection is
key in successfully treating retinal detachments and tears.
Awareness of the quality of your vision in each eye is extremely
important, especially if you are in a higher-risk group such as those who
are nearsighted or diabetic. Compare the vision of your eyes daily
by looking straight ahead and covering one eye and then the other.
It is critical
that symptoms are reported early to your eye doctor because early
treatment
can greatly improve the chance of restoring vision.
Notify your doctor
immediately if you notice any of the following:
- An obstruction
of your peripheral vision (veil, shadow, or curtain)
- Sudden shower of
floaters
- Light flashes
- Spider webs
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Sources: |
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Back to
Top |
| 1. Jules Stein Eye
Institute |
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| 2. University of
Michigan Medicine |
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| 3. St. Luke's Retina
Institute |
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