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Definition
Retinal detachment is a medical emergency requiring prompt surgical treatment to
preserve vision.
The retina is the light-sensitive tissue that lines the inside back wall of your eye. In
retinal detachment, the retina is pulled away from the underlying choroid — a thin
layer of blood vessels that supplies oxygen and nutrients to the retina.
Retinal detachment leaves retinal cells deprived of oxygen. The longer the retina and
choroid remain separated, the greater the risk of permanent vision loss in the affected
eye.
Fortunately, retinal detachment often has clear warning signs. If you go to an eye
specialist (ophthalmologist) as soon as warning signs appear, early diagnosis and
treatment of retinal detachment can save your vision.
Symptoms
Retinal detachment is painless, but visual symptoms almost always appear before it
occurs. Warning signs of retinal detachment include:
The sudden appearance of many floaters — small bits of debris in your field of
vision that look like spots, hairs or strings and seem to float before your eyes
Sudden flashes of light in one or both eyes
A shadow or curtain over a portion of your visual field
A sudden blur in your vision
Unfortunately, many people don't appreciate the urgency of the warning signs of
retinal detachment, and they tend to put off seeing a doctor in the hope that symptoms
will disappear. In some cases, symptoms temporarily diminish only to be followed by
a loss of vision over the next few days or weeks, caused by advanced retinal
detachment. At this stage, retinal detachment can't always be successfully repaired
with surgery, and vision loss may be permanent. So it's best to see your doctor at the
earliest signs of retinal detachment.
Causes
Trauma
Advanced diabetes
An inflammatory disorder, such as sarcoidosis or cytomegalovirus retinitis
Sagging or shrinkage of the jelly-like vitreous that fills the inside of your eye
As liquid collects underneath it, the retina can peel away from the underlying layer of
blood vessels (choroid). Over time these detached areas may expand, like wallpaper
that, once torn, slowly peels off a wall. The areas where the retina is detached lose
their blood supply and stop functioning, so you lose vision.
PVD usually doesn't cause serious problems, but it can cause visual symptoms. If the
vitreous pulls on the retina as it shifts and sags, you may see flashes of sparkling
lights (photopsia) when your eyes are closed or when you're in a darkened room. The
shifting or sagging vitreous may also make new or different floaters appear in your
field of vision. These spots, specks, hairs and strings are actually the shadows cast on
the retina by small clumps of gel, fibers and cells floating in the vitreous.
If the sagging vitreous pulls too strongly, the retina can tear, leaving what looks like a
small, jagged flap. Most retinal tears caused by PVD lead to retinal detachment if left
untreated. Detachments that go undetected and untreated can progress and eventually
involve the entire retina, causing complete loss of vision in the affected eye.
Risk factors
The following factors increase your risk of retinal detachment:
If blood in your vitreous cavity blocks the view of your retina, ultrasound examination
may be useful. Ultrasonography is a painless test that sends sound waves through your
eye to bounce off the retina. The returning sound waves create an image of your retina
and other eye structures on a video monitor. This test usually provides the information
your doctor needs to determine whether your retina is detached.
The type, size and location of any retinal detachment will determine which surgical
approach your eye surgeon recommends. In general, these surgeries can successfully
treat more than 90 percent of cases of retinal detachment, although a second treatment
is sometimes necessary.
First your surgeon treats the retinal tears or holes with cryopexy. Then he or
she attaches a small piece of silicone sponge or a firmer piece of silicone
rubber to the white of your eye (sclera) over the affected area. The silicone
material indents the wall of the eye, creating a buckling effect and reducing
traction of the vitreous on the retina. When you have several tears or holes or
an extensive detachment, your surgeon may create an encircling scleral buckle
around the entire circumference of your eye.
The scleral buckling material is stitched to the outer surface of the sclera.
Before tying the sutures that hold the buckle in place, the surgeon may make a
small cut in the sclera and drain any fluid that has collected under the detached
retina. The buckle usually remains in place for the rest of your life. Some
surgeons may choose a temporary buckle for simple retinal detachments, using
a small rubber balloon that's inflated and later removed.
First the surgeon inserts delicate instruments — a light probe, a cutter and an
infusion tube — into your eye's interior through tiny incisions in the sclera.
Guided by a light from the probe, the surgeon removes scar tissue or opaque
areas of vitreous with the cutter, while the infusion tube replaces the volume
of removed tissue with a balanced salt solution to maintain the normal
pressure and shape of the eye.
After completing the vitrectomy, your surgeon also may perform a scleral
buckling procedure and fill the inside of your eye with air, gas or silicone oil
to help seal the retina against the wall of your eye.
Results of surgery
Surgery isn't always successful in reattaching the retina. Also, a reattached retina
doesn't guarantee normal vision. How well you see after surgery depends in part on
whether the central part of the retina (macula) was affected by the detachment before
surgery, and if it was, for how long. Your sight isn't likely to return to normal if the
macula was detached.
Your vision may take many months to improve after repair of a complicated retinal
detachment. Some people don't recover any lost vision.
Prevention
There's no way to prevent retinal detachment. However, being aware of the warning
signs of a detached retina — an increased number of floaters, bright flashes of light,
or a shadow or curtain that seems to fall across your visual field — could help save
your vision. If you notice any of the warning signs of retinal detachment, particularly
if you're over age 40, you or a family member has had a detached retina, or you're
extremely nearsighted, contact your ophthalmologist immediately.