Expert Surgical Care

Retinal Detachment

What is a Retinal Detachment?

Retinal detachment is when the retina seperates from the underlying wall of the eye, and loses its function.  The retina is like the film in the camera of the eye, and if it is not in the right place, the human eye cannot see. The retina loses function when it is detached because it depends on the underlying tissue for oxygen and nutrition. If the retina remains detached for a long period, function loss is permanent. 

The retina is supported by a structure called the vitreous jelly. The vitreous contains collagen and  collagen fibrils and proteins that thin and pull away from the retina as ageing proceeds. 

This is part of the process called posterior vitreous detachment. A posterior vitreous detachment may cause a retinal tear in some people, this can then lead to a retinal detachment. 

What are the symptoms of Retinal Detachment?

Sometimes a retinal detachment is discovered during a routine examination by your optometrist or ophthalmologist. However, most patients develop a change in vision.

Common symptoms of posterior vitreous detachment include:

  • Flashes of light: bright and rapid flashes, caused by the vitreous gel pulling on the retina.

  • New floaters or a sudden increase in floaters. These may be tiny dots or larger clouds or cobwebs which move across the vision.

Common symptoms of retinal detachment include:

  • A dark shadow or curtain starting at the edge of the field of vision and moving centrally.

  • Blurred or distorted central vision if the macula becomes detached.

These symptoms do not always mean a retinal detachment is present.  However, you should see your ophthalmologist as soon as possible.

What are the causes of Retinal Detachment?

Sometimes the vitreous has a strong attachment to the retina, and the vitreous may pull hard enough to tear the retina in one or more places. The fluid inside the eye then passes through the retinal tear and lifts the retina off the back of the eye. 

 

Anyone can develop a retinal detachment at any time, however some people are more at risk of the condition:

 

Predisposing factors for retinal detachment include:

  • Age: posterior vitreous detachment occurs more commonly as we age and it is at the time of PVD that there is the greatest risk of retinal detachment.

  • Myopia: short-sightedness increases the risk of retinal detachment up to 10-fold, because a myopic eye is larger than average and the retina is thinner and weaker and more prone to develop a tear during PVD. Myopes also develop PVD at a younger age.

  • Family history of retinal detachment

  • Cataract surgery: previous intraocular surgery will slightly increase the risk.

  • Trauma: previous injury to the eye or head increases the risk.

  • Degenerative changes in the retina

 

If you have developed a retinal detachment in one eye, your fellow eye may be at risk. If weak areas of the retina or retinal tears are discovered in the fellow eye then preventive laser treatment may be necessary to reduce the risk to the fellow eye.

What is the treatment for Retinal Detachment?

Patients with retinal detachment require surgery to put the retina back into its proper position. An acute retinal detachment is a medical emergency. There is a limited window of time in which to repair the detachment before permanent loss of vision occurs. The aim is to perform surgery before the retinal detachment progresses to involve the central macula. If the macula is detached at the time of surgery then the central vision may never fully recover.

There are several different ways to repair a retinal detachment. The decision on which type of surgery is appropriate for you depends on the characteristics of your detachment. The principal of surgical repair is to reattach the retina to the eye wall by draining the fluid from under the retina, and using laser surgery or cryotherapy to seal the tear.

The two major types of surgical repair for a detached retina are vitrectomy and scleral buckle. In complex retinal detachment cases both approaches may be necessary for a successful result.

 

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©2018 BY DR RAHUL DUBEY.
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