Retina Detachment

What is Retina Detachment?

Retinal detachment is a serious eye condition in which the retina — the layer of tissue at the back of the eye — pulls away from the tissues that support it. Sudden changes such as floaters, flashing lights and a shadow in your peripheral vision are signs that this may be happening. A retinal detachment needs treatment as soon as possible.

Before Treatment

If your retina detaches or tears, you may see numerous floaters or dark spots and flashes of light, with blurred or distorted vision.

After treatment

If treated promptly, there should be no loss of vision and your sight will become clear again.

What is retinal detachment?

Retinal detachment is a serious eye condition that affects your vision and can lead to blindness if left untreated. It involves the retina — the layer of tissue lining the back of the eye — becoming separated from the tissues that support it. Symptoms include flashing lights, floaters or a shadow in your vision.

You may notice warning signs like these before the retina comes away — for example, when there is a retinal tear. Retinal detachment often occurs spontaneously and suddenly. Risk factors include age, myopia, a history of eye surgery or trauma, and a family history of retinal detachment.

Call your ophthalmologist or go to the emergency department immediately if you think you have a detached retina.

What does the retina do?

The retina senses light and sends signals to the brain so that we can see. When the retina detaches, it cannot do its job: your vision may become blurred, and you may lose sight permanently if the detachment is not repaired. Immediate treatment can save your eyesight.

Who is at risk of retinal detachment?

The risk of retinal detachment increases with age. You are also at higher risk if you have, or have had:

• An eye injury
• A family history of retinal detachment
• Intraocular surgery (any surgery involving the eye, such as cataract surgery)

Certain eye conditions also increase the risk of retinal detachment:

• Significant myopia
• Posterior vitreous detachment, where the vitreous pulls away from the retina
• Lattice degeneration
• A history of retinal tears or detachment in the other eye

If you are at high risk of retinal detachment, talk to your ophthalmologist.

How common is retinal detachment?

Retinal detachment is rare in people who have none of the risk factors listed here.

What causes retinal detachment?

The three causes of retinal detachment are:

Rhegmatogenous: The most common type of retinal detachment occurs when there is a small tear in the retina. The eye’s fluid, called the vitreous, can pass through the tear and collect behind the retina, pushing it away and detaching it from the back of the eye. This type of detachment usually occurs with age: as the vitreous shrinks and thins, it pulls on the retina and can tear it.

Tractional: Scar tissue on the retina can pull it away from the back of the eye. Diabetes is a common cause of this type of detachment: prolonged high blood sugar can damage the blood vessels of the eye, leading to the formation of scar tissue. The scars and areas of traction can enlarge, pulling on the retina and detaching it from the back of the eye.

Exudative: Fluid builds up behind the retina even though there is no retinal tear. As it collects, it pushes the retina away. The main causes are leaking blood vessels or swelling behind the eye, which can result from conditions such as uveitis (inflammation of the eye).

What are the symptoms of retinal detachment?

Some people notice no symptoms of retinal detachment at all, while others do. It depends on the severity: the larger the area of retina that has detached, the more likely you are to experience symptoms.

Symptoms of retinal detachment may appear suddenly and include:

• Seeing flashes of light.
• Seeing floaters — flecks, threads, dark spots and squiggly lines that drift across your vision. (Seeing a few here and there is normal and no cause for worry.)
• Blurring of your peripheral vision.
• A darkening or shadow covering part of your vision.

Does retinal detachment hurt?

Retinal detachment is usually painless, but it is a serious problem that can threaten your eyesight. Contact your ophthalmologist if you notice any symptoms.

How is retinal detachment diagnosed?

Retinal detachment is diagnosed with an ophthalmological examination. Your ophthalmologist will perform fundoscopy to check the retina, first putting drops in your eyes to dilate (widen) the pupils. After a few minutes, the retina can be examined in detail.

After the dilated eye examination, your ophthalmologist may recommend further tests:

• Optical Coherence Tomography (OCT): you are given dilating drops and then sit in front of the OCT machine.

Eye (Ocular) ultrasound: You will not need dilating drops for this examination. You sit in a chair and rest your head on a support to keep it still, and your ophthalmologist gently places a probe on the front of your eye to scan it. You then sit with your eyes closed while gel is applied to your eyelids, and move your eyes as the doctor scans them with the same instrument.

How is retinal detachment treated?

Your ophthalmologist will discuss the treatment options with you. A combination of treatments may be needed for the best result.

Treatments include:

Laser (thermal) treatment or cryopexy (freezing). Sometimes a retinal tear is diagnosed before the retina begins to detach. Your ophthalmologist uses a medical laser or a freezing probe to seal the tear; both create a scar that holds the retina in place.

Pneumatic retinopexy: Your ophthalmologist may recommend this approach if the detachment is less extensive. During pneumatic retinopexy:

• Your vitreoretinal specialist injects a small gas bubble into the vitreous, the fluid inside the eye
• The bubble presses against the retina, closing the tear
• Laser or cryopexy may then be needed to seal the tear
• The fluid that had collected under the retina is reabsorbed by the body, allowing the retina to settle back against the eye wall as it should. Eventually the gas bubble is reabsorbed too.

After surgery, your vitreoretinal surgeon will ask you to keep your head still for a few days to promote healing. You may also be told not to lie on your back.

Scleral buckle. During this procedure:

• Your surgeon places a silicone band around the eye
• The band holds the retina in place and stays there permanently
• The detached retina begins to heal
• Laser or cryopexy is used to seal the tear

Vitrectomy.  During a vitrectomy, your vitreoretinal surgeon:

• Surgically removes the vitreous
• Places a bubble of air, gas or oil in the eye to push the retina back into place

If your surgeon uses an oil bubble, it will be removed a few months later. Gas and air bubbles are reabsorbed naturally.

If you have a gas bubble, you may need to avoid certain altitudes, as a change in altitude can increase the size of the bubble and raise the pressure in your eye. You should avoid flying and travelling at high altitude; your surgeon will tell you when you can resume these activities.

What can I expect after retinal detachment surgery?

After retinal detachment surgery you may have some discomfort, which can last for a few weeks. Your surgeon will discuss painkillers and other forms of relief with you. You will also need to take things easy for a few weeks — talk to your surgeon about when you can exercise, drive and return to your normal activities.

Other things you can expect after surgery:

• Eye patch: Wear the patch for as long as your surgeon tells you it is needed
• Head position: If your surgeon placed a gas bubble in your eye, follow the positioning instructions carefully. Your surgeon will tell you what position to keep your head in, and for how long, to help the eye heal
• Eye drops: Your surgeon will show you how to use the drops that help your eye heal
• Improved vision: About four to six weeks after surgery you will begin to notice your vision improving. It may take a few months for the full effect to become apparent