Retinal Detachment

What is retinal detachment?

Retinal detachment is separation of the retina from the tissues under it. (The retina is the light-sensitive tissue at the back of the eye.) A retinal detachment caused by a tear or a hole in the eye is the most common type. This type, if not treated, will cause blindness. If your central vision is still good, it is important to treat the detachment with surgery within a day to save your vision. If your central vision is already decreased by the retinal detachment, having the surgery within a day will not improve the result. In this case, you should usually have the surgery within a week.

Sometimes retinal detachment occurs without a hole or a tear in the retina. This type of detachment is treated differently than when it is caused by a tear or a hole.

How does it occur?

A detachment that occurs because of a tear or hole is called rhegmatogenous retinal detachment. Changes in the clear gel in the center part of the eye can pull on the retina and cause a tear or a hole. If the fluid inside the eye gets under the retina through a hole or a tear, the retina will lift off the wall of the eye and detach. Eye problems that may increase the risk of retinal holes and tears include nearsightedness, eye injuries, and some types of eye surgery, such as cataract surgery.

Another type of retinal detachment is called exudative retinal detachment. This happens when fluid leaks into the space between the wall of the eye and the retina. Inflammation, infection, tumor, abnormal blood vessels, and other rare conditions can cause leakage of fluid under the retina.

Traction retinal detachment occurs because scar tissue inside the eye pulls the retina off the wall of the eye. This can happen in diabetes, with long-lasting inflammation, from an eye injury, or from previous surgery.

What are the symptoms?

If you have a retinal detachment caused by holes or tears, the first symptom is seeing a lot of new flashes and floaters. Many people have a gradual loss of peripheral (side) vision without pain. Often the loss of vision appears like a curtain that is slowly being pulled down in front of the eye. If not treated, your vision becomes dark all over. This may take hours or days.

In the other types of retinal detachment, you may have a gradual vision loss over a long period of time.

How is it diagnosed?

Your eye doctor will ask about your symptoms. He or she will dilate your pupils using drops and examine your eyes through an ophthalmoscope (a lighted instrument for seeing inside the eye), using a special lens.

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

In some cases, an ultrasound of the eye is needed.

How is it treated?

Exudative retinal detachment is treated by treating the underlying disease and usually does not need surgery.

Rhegmatogenous retinal detachment is usually treated with surgery. There are 3 main ways to treat the problem.

• Pneumatic retinopexy. The eye surgeon injects a gas bubble into the eye to push the retina back in place. Different types of gas bubbles last different lengths of time. Be sure to ask your doctor if it is safe for you to fly if you have this procedure done. The tears in the retina are sealed later with cryopexy (freezing) or a laser. Although this is the least invasive procedure with the quickest recovery, the success rate is low for most detachments. It is not used very often.
• Scleral buckling. A silicone band or sponge can be placed under the muscles. This makes the eye wall push against the retina. This is a more painful procedure, done in an operating room, and it has some risks. However, it is successful most of the time.
• Vitrectomy. The vitreous (clear gel inside the eye) may be pulling the retina away from the eye. In the operating room, after giving you an anesthetic, the eye surgeon will cut the vitreous away from the retina to stop the pulling. The surgeon then fills the eyeball with air, gas, or silicone oil to push the retina back against the wall of your eye. Over time, the air or gas is replaced with the eye's own fluids. If silicone oil is used, it needs to be removed during a second operation several weeks or months later. This has a success rate similar to scleral buckling. Some surgeons combine vitrectomy with scleral buckling to increase the chance of success in some cases.

Traction retinal detachment may also be repaired with surgery.

When you have surgery, your eye is numbed and you may be given a sedative or be put in a deep sleep with a general anesthetic. For most of the procedures, you can go home the same day. While you recover, you will usually need to keep your head in a specific position (such as face down or to one side) for several days or weeks to help your eye heal. Your doctor will tell you what position to rest your head in, how long you need to do this each day, and for how many days. There are companies that sell special furniture that can help you keep your head positioned comfortably--ask your doctor for more information.

You may need other minor procedures as well. Your eye doctor will check your eyes often.

How long will the effects last?

Your vision will probably be very blurry after surgery for retinal detachment. It may take several weeks for the blurriness to go away.

Surgery to repair a detached retina is successful in most cases. However, because the retina is very delicate and complex, there is almost always some degree of permanent damage.

Around 10% of people who have surgery will need more surgery. Sometimes scar tissue forms or there is trouble with recovery. If your vision gets worse or you start having new peripheral (side) vision problems after surgery, let your doctor know.

How can I take care of myself?

Follow your doctor's instructions after surgery to help your eye heal. You will need to:

• Use the eyedrops or ointment prescribed by your doctor.
• Limit your activities for a few days.
• Keep your head in the position recommended by your doctor for a few days to a few weeks.

Several weeks after surgery, after your eye has completely healed, have your eyeglasses prescription checked to see if you need to change it.

If you have had retinal detachment in one eye, your risk of retinal detachment in the other eye is greater. See your eye doctor regularly so that any problems in your other eye can be corrected before they become more serious.

How can I help prevent retinal detachment?

If you are very nearsighted or have a family history of retinal detachments, see your eye doctor regularly. While you cannot prevent some changes in your eyes, you can help prevent them from seriously damaging your vision. Treating holes and tears promptly helps prevent retinal detachment.