Retinal detachment

Answer 1

Definition

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

Causes, incidence, and risk factors

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. It is most often 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.

Symptoms

• Bright flashes of light, especially in peripheral vision
• Blurred vision
• Floaters in the eye
• Shadow or blindness in a part of the visual field of one eye

Signs and tests

Tests will be done to check the retina and pupil response and your ability to see colors properly. These may include:

• Electroretinogram (a record of the electrical currents in the retina produced by visual stimuli)
• Fluorescein angiography
• Intraocular pressure determination
• Ophthalmoscopy
• Refraction test
• Retinal photography
• Test to determine your ability to see colors properly (color defectiveness)
• Visual acuity
• Slit-lamp examination
• Ultrasound of the eye

Treatment

Most patients with a retinal detachment will need surgery, either immediately or after a short period of time. (However, surgery may not be needed if you do not have symptoms or have had the detachment for a while.)

Types of surgery include:

• Cryopexy (intense cold applied to the area with an ice probe) to help a scar form, which holds the retina to the underlying layer
• Laser surgeryto seal the tears or holes in the retina
• Pneumatic retinopexy (placing a gas bubble in the eye) to help the retina float back into place

Laser surgey is performed after pneumatic retinopexy to permanently fix it in place. This is often done in a doctor's office.

More extensive detachments may require surgery in an operating room. Such procedures include:

• Scleral buckle to indent the wall of the eye
• Vitrectomy to remove gel or scar tissue pulling on the retina

See also: Retinal detachment repair

Expectations (prognosis)

What happens will depend on 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.

Complications

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

Calling your health care provider

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.

References

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

Fay A. Diseases of the Visual System. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 449.

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

Answer 2

Retinal detachments are associated with a tear or hole in the retina through which the internal fluids of the eye may leak, causing separation of the retina from underlying tissues.

Reviewed By

Review Date: 09/16/2008

Paul B. Griggs, MD, Department of Ophthalmology, Virginia Mason Medical Center , Seattle , WA . Review provided by VeriMed Healthcare Network.

Answer 3

Definition

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

Causes, incidence, and risk factors

The retina is the clear tissue in the back of the eye. It helps you see the images that are focused on it by the cornea and the lens.

• The most common type of retinal detachments are often due to a tear or hole in the retina. Eye fluids may leak through this opening. This causes the retina to seperate from the underlying tissues, much like a bubble under wallpaper. This is most often caused by a condition called posterior vitreous detachment. However, it may also be caused by trauma and very bad nearsightedness. A family history of retinal detachment also increases your risk.
• Another type of retinal detachment is called tractional detachment. This is seen in people who have uncontrolled diabetes, previous retinal surgery, or have chronic inflammation.

When the retina becomes detached, bleeding from area blood vessels may cloud the inside 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.

Symptoms

• Bright flashes of light, especially in peripheral vision
• Blurred vision
• Floaters in the eye
• Shadow or blindness in a part of the visual field of one eye

Signs and tests

Tests will be done to check the retina and pupil response and your ability to see colors properly. These may include:

• Electroretinogram (a record of the electrical signals in the retina produced when you see things)
• Fluorescein angiography
• Intraocular pressure measurement
• Ophthalmoscopy
• Refraction test
• Retinal photography
• Test to determine your ability to see colors properly
• Visual acuity
• Slit-lamp examination
• Ultrasound of the eye

Treatment

Most people with a retinal detachment will need surgery. Surgery may be done immediately or after a short period of time.

Surgery may not be needed if you do not have symptoms or have had the detachment for a while.

Some types of retinal detachment surgery can be done in your doctor's office.

• Lasers may be used to seal tears or holes in the retina before a retinal detachment occurs.
• If you have a small retinal detachment, the doctor may place a gas bubble in the eye. This is called pneumatic retinopexy. It helps help the retina float back into place. The hole is seals with a laser.

More severe detachments may require surgery in a hospital operating room. Such procedures include:

• Scleral buckle to gently push the eye wall up against the retina
• Vitrectomy to remove gel or scar tissue pulling on the retina, used for the largest tears and detachments.

Tractional retinal detachments may be watched for a while before surgery. If surgery is needed, a vitrectomy is usually done.

See also: Retinal detachment repair

Expectations (prognosis)

How well you do after a retinal detachment depends on the location and extent of the detachment and early treatment. If the macula was not damaged, the outlook with treatment can be excellent.

Most retinal detachments can be repaired, but not all of them. You may not get back your all of your vision after surgery.

Complications

A retinal detachment causes loss of vision. Surgery to repair it may help restore some or all of your vision.

Calling your health care provider

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.

References

Connolly BP, Regillo CD. Rhegmatogenous Retinal Detachment. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 23.

Williams GA, Aaberg Jr. TM. Techniques of Scleral Buckling. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 59.

Sanislo SR, Blumenkranz MS. Diabetic Vitrectomy. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology. 15th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009:chap 57.

Reviewed By

Review Date: 09/16/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Franklin W. Lusby, MD, Ophthalmologist, Lusby Vision Institute, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.