Retinal detachment

Definition

Retinal detachment is a separation of the light-sensitive membrane in the back of the eye (the retina) from its supporting layers.

Causes

The retina is a transparent tissue in the back of the eye. It helps you see the images that are focused on it by the cornea and the lens. Retinal detachments are often associated with a tear or hole in the retina through which eye fluids may leak. This causes separation of the retina from the underlying tissues.

Retinal detachment often occurs on its own without an underlying cause. However, it may also be caused by trauma, diabetes, an inflammatory disorder. Sometimes it may be caused by a related condition called posterior vitreous detachment.

During a retinal detachment, bleeding from small retinal blood vessels may cloud the interior of the eye, which is normally filled with vitreous fluid. Central vision becomes severely affected if the macula, the part of the retina responsible for fine vision, becomes detached.

The risk factors are previous eye surgery, nearsightedness, a family history of retinal detachment, uncontrolled diabetes, and trauma. Approximately 10,000 people per year have a retinal detachment.

Symptoms

• Bright flashes of light, especially in peripheral vision
• Translucent specks of various shapes (floaters) in the eye
• Blurred vision
• Shadow or blindness in a part of the visual field of one eye

Exams and Tests

Tests to determine the integrity of the retina may include:

• Direct and indirect ophthalmoscopy
• Visual acuity
• Refraction test
• Color defectiveness determination
• Pupillary reflex response
• Slit-lamp examination
• Intraocular pressure determination
• Ultrasound of the eye
• Retinal photography
• Fluorescein angiography
• Electroretinogram (a record of the electrical currents in the retina produced by visual stimuli)

Treatment

Laser surgery may be used to seal the tears or holes in the retina, which generally precede detachment.

Another technique, the application of intense cold with an ice probe (known as cryopexy), leads to the formation of a scar that holds the retina to the underlying layer. This technique is used in combination with the injection of a gas bubble and the maintenance of specific head positions to prevent the re-accumulation fluid behind the retina.

If the retina is already detached, surgery is required. Some detachments can be repaired by placing a gas bubble in the eye to float the retina back into place (pneumatic retinopexy), followed by laser surgery to permanently fix it in place. This is often done in the office. More extensive detachments may require surgery in the operating room. The goal of such surgery may be to indent the wall of the eye (scleral buckle) or remove vitreous gel or scar tissue pulling on the retina using microsurgery (vitrectomy).

Outlook (Prognosis)

The outcome depends upon the location and extent of the detachment and early treatment. If the macula has not detached, the results of treatment can be excellent. Most retinal detachments can be repaired, but not all of them.

Possible Complications

The unsuccessful reattachment of the retina results in loss of vision.

When to Contact a Medical Professional

A retinal detachment is an urgent problem that requires medical attention within 24 hours of the first symptoms.

Prevention

Use protective eye wear to prevent eye trauma. Control your blood sugar carefully if you have diabetes. See your eye care specialist at least yearly, especially if you have risk factors for retinal detachment.

Yanoff M, Duker JS, Augsburger JJ, et al. Ophthalmology. 2nd ed. St. Louis, Mo: Mosby; 2004:786-791.

Costarides AP. Elevated intraocular pressure following vitreoretinal surgery. Ophthalmol Clin North Am. Dec 2004; 17(4): 507-12, v.

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