Risk Factors

There are a number of risk factors for retinal detachment. These include:

Cataract surgery
Diabetic retinopathy and retinopathy of prematurity
Family history
Myopia (nearsightedness)
PVD complicated by small tears (usually in patients over 50)
Retinal detachment in one eye increases risk for the other eye
Thinning of the retina
Traumatic injury to the eye

Symptoms
Initial symptoms of PVD are called flashes and floaters. As the vitreous
shrinks and condenses, it may "tug" on the retina. When this happens, people
often see a split-second flash of light, usually in their peripheral vision.
As the vitreous shrinks away from the retina, small fragments of the retina
may break off. The vitreous also condenses and may form opaque spots. The
fragments and opacities (floaters) appear as small circles, specks, or fine
threads in the vision field.
In most people with PVD, floaters become less noticeable as the vitreous
continues to detach from the retina. They generally settle to the bottom of
the eye, moving out of the field of vision. There is no treatment for floaters
and it may take several months for them to become less bothersome or
disappear completely. Surgical removal of floaters is controversial because the
risk outweighs any benefit.
The sudden appearance of spots or flashes can indicate a tear in the retina. A
sudden increase in the number and size of floaters may also be a warning
that the retina is tearing. This is sometimes referred to as a "shower of
floaters."
Wavy or watery vision may also be a sign that the retina is detaching.
Sometimes people notice a dark shadow or the appearance of a "curtain"
being pulled over their field of vision. This generally is experienced in the
peripheral (side) vision, which is where retinal detachment often begins.
Blurred central vision indicates that retinal detachment is progressing and
the result is significant, permanent vision loss unless it is repaired.
Retinal detachment usually develops gradually, causing noticeable symptoms,
but in some cases it occurs suddenly. This causes total vision loss in the
affected eye. Total vision loss can also be caused by a retinal tear that bleeds
into the vitreous.
Diagnosis
The earlier the diagnosis is made, the greater the chance to restore vision.
Diagnosis is based on symptoms and a thorough examination of the retina.

An ophthalmoscope is used to examine the retina. This is a small hand-held

instrument consisting of a battery-powered light and a series of lenses that is
held up to the eye. The doctor is able to see the retina and check for
abnormalities by shining the light into the eye and looking through the lens.
Eye drops are placed in the eyes to dilate the pupils and provide better
visualization. When this is done, an indirect ophthalmoscope is used. This
instrument is worn on the specialist's head and a lens is held in front of the
patient's eye. It allows a greater, wider view of the retina.
Examination with a slit lamp microscope may also be done. This
microscope enables the doctor to examine the different parts of the eye under
magnification. After instilling drops to dilate the pupil, the slit lamp is used to
detect retinal tears and detachment.
A visual acuity test may also be indicated to assess vision loss. This test
involves reading letters from a standard eye chart.

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Treatment
Surgical treatment for retinal detachment depends on type, severity, and
location of the detachment. Risks include infection, bleeding, cataract
development, and increased pressure inside the eye. However, without
intervention, retinal detachment usually causes permanent partial vision loss
or blindness.
The retina can be repaired in about 90% of cases. Approximately 33% of
patients with a successfully reattached retina have excellent vision within 6
months of surgery. Others achieve various degrees of vision. The success of
surgery depends on the size and location of the damage, the length of time
between the onset of detachment and the attempt to repair it, and other
complicating factors. Surgery is less effective if the retina has been detached
for a long time, if the detachment is severe, or if fibrous tissue has grown on
the retinas surface. In a small number of cases, the retina cannot be
reattached because of continuous vitreous shrinkage or fibrous growths on
the retina.

Laser Photocoagulation
If the retina is torn or the detachment is very slight, a laser can be used to
burn the edges of the tear and halt progression. The fine beam of light
produces scar tissue that seals (coagulates) the tear and prevents fluid from
passing through. If there is a very small detachment, the laser can seal the
retina against the choroid. Laser surgery is usually performed as an
outpatient procedure, under local anesthesia.
Cryopexy
Cryopexy uses nitrous oxide to freeze the tissue behind the retinal tear,
stimulating scar tissue formation that will seal the edges of the tear. It is
usually done as an outpatient procedure, under local anesthesia.
Pneumatic Retinopexy
Pneumatic retinopexy is most effective for detachments that occur in the
upper portion of the eye. The eye is numbed with local anesthesia and a small
gas bubble is injected into the vitreous body. The bubble rises and presses
against the retina, pushing it against the choroid. The gas bubble is slowly
absorbed over the next 1 or 2 weeks. Cryopexy or laser is used to seal the
retina into place.
Scleral Buckle
Scleral buckle treatment is the most common treatment for retinal
detachment in adults. It is more invasive than pneumatic retinopexy and the
success of the treatment depends on the size and location of the detachment.
In this procedure, a tiny sponge or silicon band is attached to the tough outer
membrane of the eye (sclera) to press against the retina and hold it in place.
The buckle is not visible and remains permanently attached to the eye, except
in the case of an infant when it must be replaced because of eye growth.
Because the scleral buckle elongates the eye, the patient may experience
myopia. Existing nearsightedness may worsen and existing farsightedness
may improve somewhat. Cryopexy or laser photocoagulation is usually
performed during scleral buckle surgery.
Vitrectomy
A vitrectomy may be performed if there is a large retinal tear, a retinal
detachment involving the macula, or a nonabsorbing vitreous hemorrhage
that is interfering with testing or treatment. In a vitrectomy, the vitreous is
removed and replaced with air or a saline solution, which exerts pressure that
pushes the retina against the wall of the eye. This procedure is usually
performed under local anesthesia in an outpatient setting.
In rare cases, silicone oil is used. However, the oil must be removed once the
retina is reattached because the oil interferes with vision. A second procedure
is needed to replace the oil with air or another fluid.
Prevention
Preventing retinal detachment is possible by having regular eye exams and
seeing an eye care practitioner immediately when early symptoms (floaters
and flashes) are experienced. In most cases, small tears can be repaired

easily and vision can be preserved. People at high risk should discuss the
frequency of eye exams with their practitioner.

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Do you have a personal health story that you would like to share with
others?
As a source of free patient education, our goal is to provide our users with
trustworthy information and support from others. That's why we've started
our "Living with..." sections.
Our "Living With..." support pages are a place to share experiences about
living with a certain condition, disease, disorder, or illness and for loved ones
of those dealing with health-related issues.
Many people, especially when newly diagnosed, find comfort in knowing that
others are having a similar experience.