What is retinal detachment?

Retinal detachment occurs when the retina lifts away from the layer of blood vessels (choroid) underneath it. The retina is the light-sensitive tissue that is the inner lining of the back of the eye.

Detachment of the retina is a serious problem that may occur at any age without apparent cause. However, it most often appears in middle-aged and older persons.

Retinal detachment should be repaired as soon as possible. If the retina is not reattached to the choroid, which feeds it blood and nutrients, the retina will die. Your loss of vision will be permanent.

How does it occur?

Retinal detachment may occur:

• as a result of degenerative changes in the retina, which cause it to become thin

• when a tear or hole has formed in the retina because the vitreous humor (the jellylike substance in the center of the eyeball) has pulled away from the retina and torn it

• as a result of other diseases in the eye such as:
  • tumors

  • severe swelling

  • complications of diabetes
• as a result of an injury to the eye.

Retinal detachment is more common in people who:

• are very nearsighted

• have had cataract surgery

• have a family history of retinal detachment

• are older adults.

What are the symptoms?

The main symptom is painless loss of vision in the affected eye. Your healthy eye may take over for the eye in which the retina is detaching. Therefore, you may not notice early problems with your vision. Signs of a detached retina include:

• flashes of light, which often occur when there is a tear in the retina

• floaters, which are black spots or cobweblike shapes that may appear after a tear has formed

• loss of peripheral (side) vision, in which part of the vision may be blocked off from the top, bottom, or one side of the eye

• blurred or distorted vision, which occurs as the detachment gets worse.

How is it diagnosed?

A detached retina cannot be seen without special instruments. Therefore, you should see an ophthalmologist (a medical eye doctor) as soon as you think you may have a problem with your vision.

What is the treatment?

The only treatment is some form of surgery. Almost all retinal detachments can be corrected. You may need more than one operation. Your doctor will choose one or more surgical procedures, depending on how severe the detachment is. The various types of surgery include:

• Laser photocoagulation. This procedure may be used when there are small holes or tears in the retina but there is little or no detachment. The laser seals the holes so that fluid cannot pass through them.

• Diathermy. Heat from an electric current is applied through a needle to seal a retinal tear.

• Cryopexy (freezing). Freezing the back wall of the eye behind a tear in the retina will seal the tear. Freezing requires local anesthesia to numb the eye.

• Pneumatic retinopexy. If the tear or tears that caused the detachment are located in the upper part of the eye, a gas or air bubble can be injected into the eye to push the retina back in place. The tears are sealed with cryopexy or laser photocoagulation.

• Scleral buckling. If more of the retina is detached, it is often necessary to drain fluid from under the retina and place a silicone band or sponge on the outside wall of the eye to push it against the retina. This procedure (scleral buckling) may be done along with cryopexy, laser photocoagulation, or diathermy to seal retinal tears.

• Vitrectomy. In this procedure, the vitreous humor is cut away from the retina to relieve traction or pulling on the retina. In some cases, when the detached retina is shrunken and puckered, your doctor may fill the eyeball with air or gas to push the detached retina back against the wall of your eye.

Most of these procedures can be performed on an outpatient basis. Eyedrops and ointments are generally the only medications required after you go home. Your doctor may want you to keep your head in a certain position for a few days to a few weeks, and your activities may be limited for a few days. After the eye is completely healed (6 to 8 weeks), it may be necessary to change your glasses to obtain the best vision.

How long will the effects of retinal detachment last?

If a detached retina is not treated promptly, you may lose your vision permanently. Usually the condition will not heal itself without treatment. Surgery to repair a detached retina is successful in most cases, but because the retina is a very delicate and complex tissue, there is almost always some degree of permanent damage.

How can I take care of myself?

Retinal detachment should be repaired promptly. If you have any of the symptoms of retinal detachment, call your ophthalmologist immediately. Your doctor will examine your eye and recommend treatment.

After a retinal detachment, there is an increased risk of retinal detachment in the other eye. See your ophthalmologist regularly so that any minor problems in your other eye can be corrected before they become serious.

What can be done to help prevent this from occurring?

If you are very nearsighted or have a family history of retinal detachments, it is important to have periodic eye exams by your ophthalmologist. Your doctor can diagnose changes in your eyes and if necessary treat retinal problems that may cause a detachment, such as retinal holes or tears.