Retinal detachment

Definition

Retinal detachment is a separation of the light-sensitive membrane in the back of the eye (the retina) from its supporting layers.

Causes, incidence, and risk factors

The retina is a transparent tissue in the back of the eye. It helps you see the images that are focused on it by the cornea and the lens. Retinal detachments are often associated with a tear or hole in the retina through which eye fluids may leak. This causes separation of the retina from the underlying tissues.

Retinal detachment often occurs on its own without an underlying cause. However, it may also be caused by trauma, diabetes, an inflammatory disorder. It is most often caused by a related condition called posterior vitreous detachment.

During a retinal detachment, bleeding from small retinal blood vessels may cloud the interior of the eye, which is normally filled with vitreous fluid. Central vision becomes severely affected if the macula, the part of the retina responsible for fine vision, becomes detached.

The risk factors are previous eye surgery, nearsightedness, a family history of retinal detachment, uncontrolled diabetes, and trauma.

Symptoms

• Bright flashes of light, especially in peripheral vision
• Blurred vision
• Floaters in the eye
• Shadow or blindness in a part of the visual field of one eye

Signs and tests

Tests will be done to check the retina and pupil response and your ability to see colors properly. These may include:

• Electroretinogram (a record of the electrical currents in the retina produced by visual stimuli)
• Fluorescein angiography
• Intraocular pressure determination
• Ophthalmoscopy
• Refraction test
• Retinal photography
• Test to determine your ability to see colors properly (color defectiveness)
• Visual acuity
• Slit-lamp examination
• Ultrasound of the eye

Treatment

Most patients with a retinal detachment will need surgery, either immediately or after a short period of time. (However, surgery may not be needed if you do not have symptoms or have had the detachment for a while.)

Types of surgery include:

• Cryopexy (intense cold applied to the area with an ice probe) to help a scar form, which holds the retina to the underlying layer
• Laser surgery to seal the tears or holes in the retina
• Pneumatic retinopexy (placing a gas bubble in the eye) to help the retina float back into place

Laser surgey is performed after pneumatic retinopexy to permanently fix it in place. This is often done in a doctor's office.

More extensive detachments may require surgery in an operating room. Such procedures include:

• Scleral buckle to indent the wall of the eye
• Vitrectomy to remove gel or scar tissue pulling on the retina

See also: Retinal detachment repair

Expectations (prognosis)

What happens will depend on the location and extent of the detachment and early treatment. If the macula has not detached, the results of treatment can be excellent. Most retinal detachments can be repaired, but not all of them.

Complications

The unsuccessful reattachment of the retina results in loss of vision.

Calling your health care provider

A retinal detachment is an urgent problem that requires medical attention within 24 hours of the first symptoms.

Prevention

Use protective eye wear to prevent eye trauma. Control your blood sugar carefully if you have diabetes. See your eye care specialist at least yearly, especially if you have risk factors for retinal detachment.

References

Costarides AP. Elevated intraocular pressure following vitreoretinal surgery. Ophthalmol Clin North Am. Dec 2004; 17(4): 507-12, v.

Fay A. Diseases of the Visual System. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 449.

Yanoff M, Duker JS, Augsburger JJ, et al. Ophthalmology. 2nd ed. St. Louis, Mo: Mosby; 2004:786-791.