Detached Retina

Useful Terms

Retina = a light sensitive tissue that lines the back of the inner eye; it is responsible for converting images that come from the lens into electrical signals and sending them through the optic nerve and into the brain for interpretation and analysis; can be thought of as having a function similar to the film in a camera

Vitreous = clear gel that fills the middle of the eye and is attached to the retina; it is the pulling of the fibers linked within the vitreous on the retina that is responsible for the retina’s detachment

Common Symptoms

  • The sudden appearance and subsequent increase in the size and number of floaters

    • Floaters are any small dots, spots, hairs, specks, strings, or clouds that move and float within the patient’s field of vision
    • These are pretty common and may not always be indicative of retinal detachment
  • Sudden flashes of light within the affected eye (s)

    • This could be the first sign that the condition is there
    • As with floaters, these are common and do not always signify the occurrence of retinal detachment
  • The appearance of a shadow in the peripheral (side) vision
  • The appearance of a curtain over a certain portion of the patient’s field of vision
  • An abrupt decrease in visual acuity and clarity

Risk Factors

  • Hereditary = can be passed on to children and future descendants
  • Advanced age = more common in those people are over the age of 40 years
  • History of retinal detachment in one of the eyes
  • An extreme case of nearsightedness that amounts to the occurrence of myopia
  • History of cataract surgery
  • History of severe eye injury, trauma, or disease
  • Glaucoma = increase pressure within the eye (s)
  • Weakness within portions of the retina = can be detected in an eye exam

Causes

  • Rhegmatogenous

    • The most common type of retinal detachment
    • Throughout the aging process, the vitreous degenerates into a more liquid form or can change its consistency and shrink
    • The vitreous may then be able to separate from the retinal surface in a process known as vitreous collapse

      • As the vitreous separates from the retina, it can pull on the retina with force sufficient enough to create a tear
      • The fluids within the cavities can leak into the tear and collect under the retina, which gets torn away from its underlying tissues

        • Within these tissues is a layer of blood vessels known as the choroid
        • As the retina becomes detached, it loses blood supply from these areas and stop working, which results in the loss of vision
      • Vitreous collapse may cause sudden flashes of light           when in a darkened room or the eyes are closed
      • Floaters may also unexpectedly appear
  • Tractional

    • A less common type of retinal detachment
    • Scar tissue on the retinal surface contracts, causing the retina to separate from the retinal pigment epithelium, which is a pigmented layer of cells underneath the retina that nourishes it
    • There does not need to be a tear or break to cause detachment
    • This type of retinal detachment is usually caused by proliferative retinopathy, which is directly caused by an advanced state of diabetes
  • Exudative

    • Inflammation or swelling, or extreme nearsightedness of the myopia variety can cause the vitreous to pull away and cause the retinal detachment
    • Other disorders can also result in an accumulation of fluid underneath the retina without requiring a tear or break to cause the detachment

Diagnosis

  • Check for medical history of retinal detachment in the family
  • Routine Eye Examination

    • Some detachments may be found just be doing a regular eye exam
    • This reinforces the importance of coming in for regular eye examinations with the ophthalmologist, so as to catch many eye conditions and diseases early in order to significantly increase the odds of successful treatment
  • Ophthalmoscope

    • As with cataracts, the ophthalmoscope can be used to illuminate the eye and then magnify the images of the inside of the eye
    • The instrument provides a very detailed, three-dimensional view to let the ophthalmologist look for any signs of holes, tears, breaks, or detachments
  • Ultrasonography

    • Sound waves are generated and sent to travel throughout the eye and bounce off of various structures within, such as the retina, in order to create a detailed image that can be seen on a video monitor
    • These highly detailed images can be inspected to look for any of the usual signs of retinal detachment

Treatment

  • Torn Retina Surgery

    • In those cases in which there are tears, breaks, or holes in the retina that have not yet resulted in detachment, the ophthalmologist may recommend an outpatient procedure
    • These procedures could completely prevent retinal detachment and save almost all of the vision
    • Laser Surgery

      • Also called photocoagulation, this procedure utilizes a laser beam to produce burns around the tears, breaks, or holes, and scar the retina in such a way that it becomes welded to the tissues underneath
    • Freezing

      • In this procedure, also called cryopexy, a freezing probe is applied to the external surface of the eye and over the imperfection
      • The area around the defect is frozen, producing a scar similar to the one generated from photocoagulation in that the retina is welded to the eye wall
    • It is recommended to refrain from performing any vigorous activities for a period of about two weeks or so to allow this welding to fortify and strengthen
  • Detached Retina Surgery

    • In those cases in which the retina has become detached, there are surgical procedures to repair it that can be used in conjunction with laser therapy and freezing
    • If left untreated, the retina may lost its ability to function permanently and blindness could result
    • The treatment option needed to fix the detachment depends on the nature of the detachment
    • It may not always prove to be successful in reattaching the retina

      • Even if the retina is reattached, normal vision is not a guarantee
      • Visual acuity and clarity post-surgery depend on how affected the macula was by the detachment, if applicable, and for how long
      • Vision may take several months post-surgery to improve
      • There are some people who are unfortunate enough not to recover any of the vision that they’ve lost as a result of the detachment

        • The more severe the detachment, the less vision there is that can be recovered
    • Scleral Buckling

      • A piece of silicone rubber or sponge is sewn to the sclera, which is the white part of the eye, and over the area of the eye affected by the detachment
      • This buckle of sorts helps to relieve the stress and force that results from the vitreous pulling on the retina

        • This is done by indenting the wall of the eye
      • If there are multiple tears, breaks, or holes, or an extensive detachment, then it’s necessary to create a scleral buckle that circles the entire eye as a kind of belt

        • This kind of scleral buckle needs to remain in place for the remainder of the patient’s life
    • Pneumatic Retinopexy

      • A gas bubble is injected into the space of vitreous within the eye
      • As the bubble floats against the defect and the area that surrounds it, then the defect is sealed

        • This directly prevents the leakage of any more fluids into and/or behind the retina
      • Any fluid that was already underneath the retina before the procedure is absorbed by itself and the retina is then able to reattach itself to the back wall of the eye
      • The head may need to be held in a certain position to keep the injected bubble in place to do its work

        • This may take up to several days to do
      • After some time, the bubble will disappear on its own
    • Vitrectomy

      • The vitreous and any tissue that is pulling on the retina are removed and replaced with air, gas, or liquids as a means of reattaching the retina to the back wall of the eye

        • In this respect, it is similar in idea and execution to pneumatic retinopexy
      • These injected materials will eventually be absorbed and the space of vitreous will be refilled with fluids produced by the body

        • If an oil bubble is used instead, then the oil has to be surgically removed several months later after insertion
      • This surgical procedure is usually done in combination with scleral buckling