Retinal detachment

Retinal detachment

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Retinal detachment

Retinal detachment is an eye problem that happens when your retina (a light-sensitive layer of tissue in the back of your eye) is pulled away from its normal position at the back of your eye.

There are 3 types of retinal detachment:

  • Rhegmatogenous (“reg-ma-TAH-juh-nus”)
  • Tractional
  • Exudative
Retinal detachment
Image from retinaconsultantsofaustin.com

Most cases of retinal detachment are due to development of one or more peripheral retinal tears or holes (rhegmatogenous retinal detachment). This is usually spontaneous, related to degenerative changes in the vitreous, and generally occurs in persons over 50 years of age. Nearsightedness and cataract extraction are the two most common predisposing causes. It may also be caused by penetrating or blunt ocular trauma.

Tractional retinal detachment occurs when there is preretinal fibrosis, such as in proliferative retinopathy due to diabetic retinopathy or retinal vein occlusion or as a complication of rhegmatogenous retinal detachment.

Exudative retinal detachment happens when fluid builds up behind your retina, but there aren’t any tears or breaks in your retina. If enough fluid gets trapped behind your retina, it can push your retina away from the back of your eye and cause it to detach.

Risk factors

Anyone can have a retinal detachment, but some people are at higher risk. You are at higher risk if:

  • You or a family member has had a retinal detachment before
  • You’ve had a serious eye injury
  • You’ve had eye surgery, like surgery to treat cataracts

Some other problems with your eyes may also put you at higher risk, including:

  • Diabetic retinopathy (a condition in people with diabetes that affects blood vessels in the retina)
  • Extreme nearsightedness (myopia), especially a severe type called degenerative myopia
  • Posterior vitreous detachment (when the gel-like fluid in the center of the eye pulls away from the retina)
  • Certain other eye diseases, including retinoschisis (when the retina separates into 2 layers) or lattice degeneration (thinning of the retina)

If you’re concerned about your risk for retinal detachment, talk with your eye doctor.

Symptoms

If only a small part of your retina has detached, you may not have any symptoms.

But if more of your retina is detached, you may not be able to see as clearly as normal, and you may notice other sudden symptoms, including:

  • A lot of new floaters (small dark spots or squiggly lines that float across your vision)
  • Flashes of light in one eye or both eyes
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  • A dark shadow or “curtain” on the sides or in the middle of your field of vision

Retinal detachment is a medical emergency. If you have symptoms of a detached retina, it’s important to go to your eye doctor or the emergency room right away.

The symptoms of retinal detachment often come on quickly. If the retinal detachment isn’t treated right away, more of the retina can detach — which increases the risk of permanent vision loss or blindness.

Treatment

Treatment of rhegmatogenous retinal detachments is directed at closing all of the retinal tears and holes by forming a permanent adhesion between the neurosensory retina, the retinal pigment epithelium, and the choroid with laser photocoagulation to the retina or cryotherapy to the sclera.

The following may be required to achieve apposition of the neurosensory retina to the retinal pigment epithelium while the adhesion is developing: indentation of the sclera with a silicone sponge or buckle, subretinal fluid drainage via an incision in the sclera, or injection of an expansile gas or silicone oil into the vitreous cavity following intraocular surgery to remove the vitreous (pars plana vitrectomy).

Certain types of uncomplicated retinal detachment may be treated by pneumatic retinopexy, in which an expansile gas is injected into the vitreous cavity followed by positioning of the patient’s head to facilitate reattachment of the retina. Once the retina is repositioned, the defects are sealed by laser photocoagulation or cryotherapy; these two methods are also used to seal retinal defects without associated detachment.

In complicated retinal detachments, particularly traction retinal detachments, retinal reattachment can be accomplished only by pars plana vitrectomy, direct manipulation of the retina, and internal tamponade of the retina with air, expansile gas, or silicone oil. (The presence of an expansile gas within the eye is a contraindication to air travel, mountaineering at high altitude, and nitrous oxide anesthesia. Such gases persist in the globe for weeks after surgery.) Treatment of exudative retinal detachments is determined by the underlying cause.

Prognosis

About 90% of uncomplicated rhegmatogenous retinal detachments can be cured with one operation. The visual prognosis is worse if the macula is detached or if the detachment is of long duration

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