Retinal detachment occurs when the retina (the layer of tissue that covers most of the back of the eye) separates from its anchorage. Eye trauma is the most common cause, in which symptoms — blurred vision and/or seeing floaters or flashing lights — are sudden. This condition is a true eye emergency and requires immediate treatment to avoid severe vision loss or blindness. An eye exam can identify the injury (and its risk factors) and confirm whether interventional surgery is needed to treat it.
Types of retinal detachment
The retina consists of a photosensitive layer of nerve cells that line the inside of the eyeball. Like a camera, the retina captures light and converts it into electrical impulses. These impulses travel along the optic nerve to the brain, where they are translated into pictures.
The retina sits on top of the choroid, the vascular tissue responsible for nourishing the retina. Retinal detachment occurs when the neurosensory retina separates from the retinal pigment epithelium. A serous retinal detachment occurs when subretinal fluid accumulates in this space.
There are three types of retinal detachment:
- Rhegmatogenous retinal detachment: This is the most common type.It is caused by a tear or hole in the retina called a retinal tear.
- Traction retinal detachment: This type of detachment occurs when scar tissue or other abnormal tissue grows on the surface of the retina, pulling the retina away from the layers below it.
- Exudative retinal detachment: This occurs when fluid or blood flows under the retina, separating it from the layers below. Exudative retinal detachment is often a complication of other conditions, including macular degeneration, ocular tumors, and high blood pressure.
retinal detachment symptoms
Retinal detachment usually involves one eye. Although this condition is uncommon, it can occur in both eyes at the same time. Some retinal detachments associated with retinal ruptures can occur suddenly. With retinal detachment, it does not cause pain but can permanently affect vision.
Common visual symptoms (often disturbing but subtle) of retinal detachment include:
- Floaters floating in your field of vision may appear as grey specks, strings or cobwebs
- What looks like a black curtain or veil moves across your entire field of vision
- blurred vision
- see shadows on one side of the field of view
Unless you cover one eye at a time, it may not be obvious that only one eye is affected.
You shouldn’t expect any pain in your eye due to retinal detachment itself. However, eye pain (as well as head or face pain and bruising) can be caused by a pathogenic injury.
When a chronic disease is the cause of retinal detachment, its effects instead occur gradually.
Seek immediate medical attention if you experience any symptoms of retinal detachment. Time is critical in the treatment of retinal detachment. Early treatment can improve the chances of restoring vision.
Retinal detachment is primarily caused by lattice degeneration, an anatomical finding in some patients, especially those with extreme myopia. Certain risk factors can make you more likely to develop retinal detachment if you have a blow or injury to the head, face, or eye that causes bleeding in your eye or severe eye movement (for example, hitting an airbag in a car accident).
But some retinal detachments occur spontaneously, with no recent trigger, due to slow changes affecting the eye or certain diseases and conditions:
- The vitreous is a gel-like fluid that fills the eye cavity and surrounds the retina. As you age, the vitreous liquefies and separates from the retina, making you prone to posterior vitreous detachment (PVD), which increases your risk of retinal detachment.
- Certain chronic diseases, such as diabetes and wet macular degeneration, can cause new blood vessel growth or scarring that can detach the retina from the choroid and vitreous.
Several factors can increase your risk of developing retinal detachment with or without trauma, including:
- Retinal detachment in one eye
- History of eye surgery, such as cataract surgery
- a history of eye trauma, even if it did not cause retinal detachment
- Weak areas in the periphery of the retina, called the lattice
- family history of retinal detachment
- tumor in the eye
- Inflammation near or within the choroid, which can be caused by problems such as eye infections, eye surgery, or eye tumors
- high myopia
Myopia is poor distance vision caused by the shape of the lens in the eye, and this elongated shape makes it easier for the retina to detach.
The diagnosis of retinal detachment requires a careful eye examination and usually involves diagnostic testing. These tests allow your healthcare provider to see the structures inside your eye so that detachment, blood vessel changes, inflammation, or other problems can be clearly seen.
Your optometrist or eye doctor may use eye drops to dilate your pupils. A binocular indirect ophthalmoscope can be used to obtain a three-dimensional view to examine the inside of your eye.
In some cases, blood can obstruct vision, making it difficult to examine your retina. Ultrasound equipment can be used to look at your eyes, especially if you have a lot of bleeding inside your eyes. The sound waves produced by the ultrasound device bounce off the back of the eye, forming an image that helps your healthcare provider see if your retinas are actually separating.
This condition requires interventional treatment, and the detachment cannot be repaired with drugs. There are several treatment options to consider and should be discussed with your healthcare provider.
The final treatment chosen depends on the type, severity, and location of the retinal detachment. For example, a detached retina may be associated with a retinal tear, especially in the case of trauma, and you may need to repair the tear as well as repair the detachment.
Procedures used to repair retinal detachments include:
- Laser: This procedure uses a laser to create small scars in your eye to repair retinal tears, or to help your retina adhere to the choroid in the event of a detachment.
- Cryotherapy: This procedure uses freezing to fix the retina back in place or repair retinal tears.
- Pneumatic Retinopexy: If you have this procedure, a bubble will be injected into your eye, which will press against the retina, putting it back into place. This may be an option for you if your retina is detached in the upper part of your eye.
- Vitrectomy: This procedure involves removing vitreous gel from your eye so that the retina can be pushed back into place, usually by placing silicone oil.
- Scleral Buckle: This is a procedure that attaches a small piece of silicone to the outside of the eye to hold the retina in place, allowing the retina to reconnect to the back lining. Once placed, the buckle is not visible without special inspection equipment.
Remember that procedures to repair a retinal detachment can help you avoid serious vision loss. That said, even after surgical repair, you may still experience some residual vision loss, and your vision may not return to normal.
Retinal detachment is a serious eye condition that requires immediate professional treatment. If left untreated, it can cause complete vision loss in the affected eye.
However, if early signs and risk factors for retinal detachment are identified, most detached retinas can be surgically reattached to partially or fully restore vision.