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Retinal detachmentBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/retinal-detachment/DS00254
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Retinal detachment describes an emergency situation in which a critical layer of tissue (the retina) at the back of the eye pulls away from the layer of blood vessels that provides it with oxygen and nourishment.
Retinal detachment leaves the retinal cells lacking oxygen. The longer retinal detachment goes untreated, the greater your risk of permanent vision loss in the affected eye.
Fortunately, retinal detachment often has symptoms that are clear warning signs. Early diagnosis and treatment of retinal detachment can save your vision. If you suspect you may have a retinal detachment, contact an eye specialist (ophthalmologist) as soon as warning signs appear.
Retinal detachment itself is painless, but retinal detachment warning signs and symptoms almost always appear before it occurs or has advanced. Retinal detachment symptoms may include:
- The sudden appearance of many floaters — small bits of debris in your field of vision that look like spots, hairs or strings and seem to float before your eyes
- Sudden flashes of light in the affected eye
- A shadow or curtain over a portion of your visual field that develops as the detachment progresses
When to see a doctor
Because retinal detachment is an emergency situation in which you can permanently lose your vision, you should always seek immediate medical attention if you notice any of its symptoms.
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|Anatomy of the eye|
Retinal detachment can occur as a result of:
- Shrinkage or contraction of the vitreous (VIT-ree-us) — the gel-like material that fills the inside of your eye. This can create tugging on the retina and a retinal tear, leading to a retinal detachment.
- Advanced diabetes
- An inflammatory eye disorder
How retinal detachment occurs
Retinal detachment can occur when the gel-like material (vitreous) leaks through a retinal hole or tear and collects underneath the retina.
Reasons for holes or tears include:
Aging or retinal disorders can cause the retina to thin. Retinal detachment due to a tear in the retina typically develops when there is a sudden collapse of the vitreous, causing tugging on the retina with enough force to create a tear.
Fluid inside the vitreous then finds its way through the tear and collects under the retina, peeling it away from the underlying tissues. These tissues contain a layer of blood vessels called the choroid (KOR-oid). The areas where the retina is detached lose this blood supply and stop working, so you lose vision.
- In certain inflammatory conditions or other disorders, fluid also can accumulate beneath the retina without a tear or break.
Aging-related retinal tears that lead to retinal detachment
As you age, your vitreous may change in consistency and shrink or become more liquid. Eventually, the vitreous may separate from the surface of the retina — a common condition called posterior vitreous detachment (PVD). It's also called vitreous collapse.
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, fluid from the vitreous cavity can pass through the tear into the space behind the retina, causing the retina to become detached.
PVD can cause visual symptoms. You may see flashes of sparkling lights (photopsia) when your eyes are closed or when you're in a darkened room. New or different floaters may appear in your field of vision.
The following factors increase your risk of retinal detachment:
- Aging — retinal detachment is more common in people older than age 40
- Previous retinal detachment in one eye
- A family history of retinal detachment
- Extreme nearsightedness (myopia)
- Previous eye surgery, such as cataract removal
- Previous severe eye injury or trauma
- Previous other eye disease or disorder
Preparing for your appointment
See an ophthalmologist if you have any sudden changes in your vision. If he or she suspects or concludes you have a retinal tear or retinal detachment, you will likely be urgently referred to an ophthalmologist who is also a retinal specialist.
Because there's often a lot of ground to cover at your appointment, it's a good idea to be well prepared. Here's some information to help you get ready and what to expect from your doctor:
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
- Write down any symptoms you're experiencing. Include even those that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information. Include any major stresses or recent life changes.
- Make a list of all your medications. Also include any vitamins or supplements you're taking.
- Take along a family member or friend. Sometimes it can be difficult to take in all the information provided during an appointment. Someone who accompanies you may remember something you missed or forgot.
- Write down all your questions.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For retinal detachment, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What kinds of tests do I need?
- Is my vision loss likely temporary or ongoing?
- What is the best course of action?
- What are the alternatives to the first approach that you're suggesting?
- I have some other health conditions. How can I best manage them together?
- Are there any restrictions I need to follow?
- Should I see another specialist?
- Are there any brochures or other printed material I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
- If I need surgery, how long will recovery take?
- Will I be able to travel after surgery? Will it be safe to travel by plane?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover points you want to address. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- Have you had any symptoms in your other eye?
- Have you ever had an eye injury?
- Have you ever experienced eye inflammation?
- Have you ever had eye surgery?
- Do you have any other medical conditions, such as diabetes?
- Have any of your family members ever had a retinal detachment?
Tests and diagnosis
Your doctor may use the following tests, instruments and procedures to diagnose retinal detachment:
- Ophthalmoscope. The doctor may use an instrument with a bright light and a special lens to examine the inside of your eyes. The ophthalmoscope provides a highly detailed 3-D view, allowing the doctor to see any retinal holes, tears or detachments.
- Ultrasonography. This test uses sound waves to create a picture on a video monitor. The sound waves travel through your eye and bounce off your retina and other structures within the eye to create the image.
Treatments and drugs
Surgery is almost always used to repair a retinal tear, hole or detachment. Your ophthalmologist can tell you about the various risks and benefits of your treatment options. Together you can determine what treatment is best for you.
When a retinal tear or hole hasn't yet progressed to detachment, your eye surgeon may suggest an outpatient procedure, which can usually prevent retinal detachment and preserve almost all of your vision.
- Laser surgery (photocoagulation). The surgeon directs a laser beam at the retinal tear. The laser makes burns around the tear, creating scarring that usually "welds" the retina to underlying tissue.
- Freezing. In this process, called cryopexy (KRY-o-pek-see), the surgeon applies a freezing probe to the outer surface of the eye directly over the retinal defect and freezes the area around the hole, resulting in a scar that helps secure the retina to the eye wall.
After your procedure, you likely will be advised to refrain from vigorous activity for the next two weeks or so to allow time for the bonds created by your procedure to strengthen.
If your retina has detached, doctors will also use surgical procedures to repair it. These procedures may be done along with photocoagulation or cryopexy. The specifics of your retinal detachment will determine which approach your surgeon recommends. Sometimes people need a second surgery for successful treatment.
Injecting air or gas into your eye. In this procedure, called pneumatic retinopexy (RET-ih-no-pek-see), your doctor injects a bubble of air or gas into the vitreous. When the bubble is successfully placed to float against the retinal tear and the area surrounding the tear, it seals the tear. This stops further flow of fluid into the space behind the retina.
Fluid that had collected under the retina is absorbed by itself, and the retina can then reattach itself to the back wall of your eye. You may need to hold your head in a certain position for up to several days to keep the bubble in place. The bubble eventually will also be reabsorbed on its own.
Indenting the surface of your eye. This procedure, called scleral (SKLEER-ul) buckling, involves the doctor sewing (suturing) a piece of silicone rubber or sponge to the white of your eye (sclera) over the affected area. The silicone material indents the wall of the eye and relieves some of the force caused by the vitreous tugging on the retina.
If you have several tears or holes or an extensive detachment, your surgeon may create a scleral buckle that circles your entire eye like a belt. The buckle usually remains in place for the rest of your life.
Draining and replacing the fluid in the eye. In this procedure, called vitretomy (vih-TREK-tuh-me), the doctor removes the vitreous along with any tissue that is tugging on the retina. Air, gas or liquids are then injected into the vitreous space to reattach the retina.
Eventually the air, gas or liquid will be absorbed and the vitreous space will refill with body fluid. However, if the retinal detachment repair uses a silicone oil, the oil is often surgically removed months later.
A vitrectomy is often combined with a scleral buckling procedure.
Surgery doesn't always work to reattach the retina. Also, a reattached retina doesn't guarantee normal vision. How well you see after surgery depends in part on whether the central part of the retina (macula) was affected by the detachment before surgery and, if it was, for how long. Your vision may take many months to improve after repair of a retinal detachment. Some people don't recover any lost vision.
Coping and support
Retinal detachment may cause you to lose vision in the portion of your field of vision that corresponds to the detached part of the retina. Depending on your degree of vision loss, your lifestyle might change significantly. Yet there are many things you can do to cope with impaired vision:
- Check into transportation. Investigate vans and shuttles, volunteer driving networks, or ride shares available in your area for people with impaired vision.
- Get special glasses. Optimize the vision you have with glasses that are specifically prescribed for the effects of retinal detachment. You may also be prescribed other visual devices.
- Get help from technology. Digital talking books and computer screen readers can help with reading, and other new technology continues to advance.
- Brighten your home. Have proper light in your home for reading and other activities.
- Make your home safer. Eliminate throw rugs and place colored tape on the edges of steps. Consider installing motion-activated lights.
- Enlist the help of others. Tell friends and family members about your vision problems so they can help you.
- Talk to others with impaired vision. Take advantage of online networks, support groups and resources for people with impaired vision.
There is no way to prevent retinal detachment. However, being aware of the following typical warning signs of a detached retina could help save your vision:
- Sudden increase in floaters
- Bright flashes of light
- A shadow or curtain that seems to advance across your visual field
If you notice any of these signs — particularly if you're older than age 40, you or a family member has had a detached retina, or you're extremely nearsighted — you should seek immediate medical attention.
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