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Retinal Detachment

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A retinal detachment is a separation of the retina from the inside of the eye. A good analogy is wallpaper peeling away from drywall.

Most retinal detachments are a complication of a retinal hole or tear. These defects often occur when vitreous gel shifts forward with age. The vitreous is normally a clear gel that fills the main cavity of the eye in front of the retina. Vitreous shifting may exert traction on the retina and cause a tear. Most retinal breaks are not a result of trauma. Retinal tears are sometimes accompanied by bleeding if a retinal blood vessel is damaged by the tear. Only a small percentage of spontaneous vitreous separations (PVD) result in retinal tears and detachments.

Liquefied vitreous gel can pass through a hole or tear and accumulate behind the retina. The buildup of fluid behind the retina is what separates (detaches) the retina from the back of the eye. The extent of detachment depends on the balance of fluid accumulation to the pumping capacity of specialized pigment cells under the retina. A retinal detachment usually affects only one eye at a time. The second (or fellow) eye, however, must be checked thoroughly for any signs of predisposing factors that may lead to detachment in the future. A total retinal detachment may develop over time if not treated.

How common is Retinal Detachment and what are the risks?

The incidence of retinal detachments caused by tears in the retina is fairly low, affecting approximately one in 10,000 people each year. Many retinal tears do not progress to retinal detachment. Risk factors for developing retinal detachments include certain diseases of the eyes, cataract surgery, and trauma. Retinal detachments can occur at any age. They occur most commonly in younger adults (25-50 years of age) who are nearsighted (myopic) and in older people following cataract surgery.

What are the symptoms of Retinal Detachment?

Flashing lights (photopsias) and floaters may be the initial symptoms of a retinal detachment or of a retinal tear that precedes detachment itself. Anyone who experiences these symptoms should see an eye doctor for a dilated exam. The symptoms of flashes and floaters may be unassociated with a tear or detachment. Normal shifting of the vitreous is called a posterior vitreous detachment (PVD). Associated traction on the retina commonly generates photopsias with a decreasing (improving) trend.

These are often described as brief lightning streaks in peripheral vision. Floaters are caused by condensations (small solidifications) of vitreous gel and frequently are described by patients as spots, strands, or little flies. Floaters are usually not associated with tears of the retina.

If the patient experiences a shadow or curtain that affects any part of vision a retinal tear may have progressed to a detached retina. In this situation, one should consult an eye doctor without undue delay. Patients should not eat, drink, or take blood thinners until cleared to do so. The goal for the ophthalmologist is to make the diagnosis and treat the retinal tear or detachment before the central macular area of the retina detaches.

Can Retinal Detachment cause irreparable blindness?

Yes, if not treated expeditiously.

If one eye develops Retinal Detachment will it happened to the other eye?

Detachment is more likely to occur if the second (fellow) eye has the condition associated with retinal detachment in the first eye. (e.g. lattice degeneration).

What treatments are used for Retinal Detachment repair?

Surgery is required to repair a retinal tear, hole or detachment. Your retinal ophthalmologist can educate you on the various risks and benefits of your treatment options. Together you can determine what treatment is best for you.

  • Outpatient procedure for retinal tears.
    When a retinal break (tear or hole) hasn't progressed to detachment, your eye surgeon may suggest an outpatient procedure which can usually prevent retinal detachment and preserve almost all vision.
    Options include:

    Laser retinopexy (photocoagulation). Laser is applied through a contact lens or head-mounted ophthalmoscope designed for this procedure. The laser makes small burns around the retinal tear, and the adhesions that result "weld" the retina to the underlying tissue.

    Freezing (cryopexy). Intense cold spots are applied to the external surface of the eye in a location corresponding to the internal retinal tear. These generate adhesions around retinal breaks and secure the retina to the eye wall.

    Patients are usually placed on activity restrictions for approximately one week after a retinopexy procedure while the adhesions between the retina and eye wall strengthen.

  • Surgery for retinal detachment
    Surgery in an operating room is generally required to repair retinal detachments. The type, size and location of the retinal detachment will determine which surgical approach your eye surgeon recommends.
    Procedures include:

    Pneumatic Retinopexy. This strategy involves injecting a bubble of air or gas into the vitreous cavity. The gas bubble expands, sealing the retinal tear by pushing against it and the detached area that surrounds the tear. With no new fluid passing through the retinal tear, fluid previously collected under the retina is absorbed and the retina is able to reattach. Patients are required to hold their head in a certain position for several days in order to keep the bubble in place over the causative break(s).

    Scleral Buckling. This procedure involves suturing a piece of silicone rubber or sponge to the white of your eye (sclera) to support the affected area. The material indents the wall of the eye, relieving vitreous traction on the retina. An encircling scleral buckle goes around the entire circumference of the eye similar to a belt. The buckle, which is not visible externally, usually remains permanently.

    Vitrectomy. This procedure removes the gel-like fluid in the main cavity of the eye, along with any scar tissue exerting on the retina. Air, gas or special "heavy" liquids are injected into the vitreous cavity to reattach the retina. A vitrectomy may be combined with a scleral buckling procedure.

    Surgery isn't always successful in reattaching the retina. Further, a reattached retina doesn't guarantee normal vision. How well an eye sees 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 months to improve after repair of a retinal detachment. Progression of other eye conditions such as cataract may further limit functional recovery.

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