Health

Retinal Detachment

Overview.

A detached retina happens when the retina peels away or detaches from its underlying layer of support tissue at the back of the eye. The retina is a thin layer of light-sensitive nerve cells at the back of the eye. We need a healthy retina to be able to see clearly.

At first, detachment might only affect a small part of the retina, but, without treatment, the whole retina may peel off, and vision will be lost from that eye.

A detached retina, or retinal detachment, usually only occurs in one eye. It is a medical emergency.

People with severe myopia, those with diabetes, patients who have had complicated cataract surgery, and anybody who has received a blow to the eye are all more susceptible to the condition.

What Is a Detached Retina?

A detached retina is when the retina lifts away from the back of the eye. The retina does not work when it is detached, making vision blurry. A detached retina is a serious problem. An ophthalmologist needs to check it out right away, or you could lose sight in that eye.

How Do You Get a Detached Retina?

As we get older, the vitreous in our eyes starts to shrink and get thinner. As the eye moves, the vitreous moves around on the retina without causing problems. But sometimes the vitreous may stick to the retina and pull hard enough to tear it. When that happens, fluid can pass through the tear and lift (detach) the retina.

What does the retina do?

The retina senses light and sends signals to the brain so we can see. When the retina detaches, it can’t do its job. Your vision might become blurry. And you might lose vision permanently if the detachment isn’t repaired. Getting prompt treatment can save your eyesight.

Who Is at Risk for a Retinal Detachment?

You are more likely to have a detached retina if you:

▪️ need glasses to see far away (are nearsighted).

▪️ have had cataract, glaucoma, or other eye surgery.

▪️ take glaucoma medications that make the pupil small (like pilocarpine).

▪️ had a serious eye injury.

▪️ had a retinal tear or detachment in your other eye.

▪️ have family members who had retinal detachment.

▪️ have weak areas in your retina (seen by an eye doctor during an exam).

Symptoms.

Retinal detachment itself is painless. But warning signs almost always appear before it occurs or has advanced, such as:

▪️ The sudden appearance of many floaters — tiny specks that seem to drift through your field of vision.

▪️ Flashes of light in one or both eyes (photopsia).

▪️ Blurred vision.

▪️Gradually reduced side (peripheral) vision.

▪️ A curtain-like shadow over your visual field.

Causes.

There are three different types of retinal detachment:

▪️ Rhegmatogenous (reg-ma-TODGE-uh-nus). These types of retinal detachments are the most common. Rhegmatogenous detachments are caused by a hole or tear in the retina that allows fluid to pass through and collect underneath the retina, pulling the retina away from underlying tissues. The areas where the retina detaches lose their blood supply and stop working, causing you to lose vision.

The most common cause of rhegmatogenous detachment is aging. As you age, the gel-like material that fills the inside of your eye, known as the vitreous (VIT-ree-us), may change in consistency and shrink or become more liquid. Normally, the vitreous separates from the surface of the retina without any complications — a common condition called posterior vitreous detachment (PVD). One complication of this separation is a tear.

As the vitreous separates or peels off the retina, it may tug on the retina with enough force to create a retinal tear. Left untreated, the liquid vitreous can pass through the tear into the space behind the retina, causing the retina to become detached.

▪️ Tractional. This type of detachment can occur when scar tissue grows on the retina’s surface, causing the retina to pull away from the back of the eye. Tractional detachment is typically seen in people who have poorly controlled diabetes or other conditions.

▪️ Exudative. In this type of detachment, fluid accumulates beneath the retina, but there are no holes or tears in the retina. Exudative detachment can be caused by age-related macular degeneration, injury to the eye, tumors or inflammatory disorders.

Risk factors.

Factors that may increase the risk of developing retinal detachment include:

▪️ genetics, for example, if a close family relative has had retinal detachment.

▪️ middle and older age.

▪️ extreme nearsightedness.

▪️ previous cataract surgery, especially if it was complicated.

▪️ previous retinal detachment.

▪️ eye conditions, such as uveitis, degenerative myopia, lattice degeneration, and retinoschisis.

▪️ trauma, for example, a blow to the eyediabetes, especially if the diabetes is poorly controlled.

▪️ Anyone with these risk factors should be aware of the possibility of a detached retina.

How is retinal detachment diagnosed?

You need an eye exam to diagnose retinal detachment. Your eye care provider will use a dilated eye exam to check your retina. They’ll put eye drops in your eyes. The drops dilate, or widen, the pupil. After a few minutes, your provider can get a close look at the retina.

Your provider may recommend other tests after the dilated eye exam. These tests are noninvasive and won’t hurt. They help your provider see your retina clearly and in more detail:

▪️ Optical coherence tomography (OCT): You get dilating eye drops for this imaging. Then you sit in front of the OCT machine. You rest your head on a support, so it stays still. The machine scans your eye but doesn’t touch it.

▪️ Eye (ocular) ultrasound: You won’t need dilating drops for this scan, but your provider may use drops to numb your eyes so you won’t feel any discomfort. You sit in a chair and rest your head on a support, so it stays still. Your provider gently places an instrument against the front of your eye to scan it. Next, you sit with your eyes closed. Your provider puts gel on your eyelids. With your eyes closed, you move your eyeballs as your doctor scans them with the same instrument.

How is retinal detachment treated?

Your eye care provider will discuss treatment options with you. You may need a combination of treatments for the best results.

Treatments include:

▪️ Laser (thermal) therapy or cryopexy (freezing). Sometimes, your provider will diagnose a retinal tear before the retina starts pulling away. Your provider uses a medical laser or a freezing tool to seal the tear. These devices create a scar that holds the retina in place.

▪️ Pneumatic retinopexy. Your provider may recommend this approach if the detachment isn’t as extensive. During pneumatic retinopexy:

1. Your provider injects a small gas bubble into the vitreous, the fluid in the eye.

2. The bubble presses against the retina, closing the tear.

3. You may need laser or cryopexy to seal the tear.

4. The fluid that collected under the retina gets reabsorbed by the body. The retina can now stick to the eye wall like it should. Eventually, the gas bubble also gets reabsorbed.

After surgery, your provider will recommend that you keep your head still for a few days to promote healing. You also may be told not to lie on your back.

▪️ Scleral buckle.

During this procedure:

1. Your provider surgically places a silicone band (buckle) around the eye.

2. The band holds the retina in place and stays there permanently. You can’t see the band.

3. The detached retina starts healing.

4. Laser or cryopexy are used to seal the tear.

▪️ Vitrectomy.

During a vitrectomy, your provider:

1. Surgically removes the vitreous.

2. Places a bubble of air, gas or oil in the eye to push the retina back in place.

If your provider uses an oil bubble, you’ll have it removed a few months later. Gas and air bubbles get reabsorbed.If you have a gas bubble, you may have to avoid activities at certain altitudes. The altitude change can increase the size of the gas bubble and the pressure in your eye. You’ll have to avoid flying and traveling to high altitudes. Your provider will tell you when you can start these activities again.

Reference :

Retinal Detachment/https://my.clevelandclinic.org/health/diseases/10705-retinal-detachment

Retinal Detachment/https://www.aao.org/eye-health/diseases/detached-torn-retina

Retinal Detachment/https://www.mayoclinic.org/diseases-conditions/retinal-detachment/symptoms-causes/syc-20351344

What you need to know about a detached retina/https://www.medicalnewstoday.com/articles/170635

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