Retinal Detachment

Overview

Retinal detachment is a medical emergency in which a thin layer of tissue at the back of the eye, known as the retina, separates from its normal position. The retina is responsible for transmitting images to the brain, and when it detaches, the cells become separated from the layer of blood vessels that provide oxygen and nourishment to the eye. If left untreated, retinal detachment can lead to permanent vision loss in the affected eye. The two most common types of retinal detachment are rhegmatogenous (reg-ma-TODGE-uh-nus) and tractional. Rhegmatogenous detachments occur when a hole or tear in the retina allows fluid to pass through and collect underneath the retina, causing it to detach. This type of detachment is typically associated with aging and is the most common cause. Tractional detachments, on the other hand, occur when scar tissue grows on the retina's surface, causing the retina to pull away from the back of the eye.

Understanding the disease

Symptoms

Symptoms of retinal detachment may include the sudden appearance of many floaters (tiny specks that seem to drift through your field of vision), flashes of light in one or both eyes, blurred vision, gradually reduced side (peripheral) vision, and a curtain-like shadow over your field of vision. Retinal detachment itself is painless, but these warning signs almost always appear before it occurs or has advanced. If you experience any of these symptoms, it's essential to seek immediate medical attention as retinal detachment is a medical emergency that can lead to permanent vision loss.

Risk Factors

Risk factors for developing retinal detachment include:

1. Aging: Retinal detachment is more common in people over 50 years old.
2. Previous retinal detachment in one eye: Having experienced retinal detachment in one eye increases the risk of developing it in the other eye.
3. Family history of retinal detachment: A family history of retinal detachment may increase the risk.
4. Extreme nearsightedness (myopia): High levels of nearsightedness can stretch the retina, making it more susceptible to detachment.
5. Previous eye surgery, such as cataract removal: Eye surgeries can potentially cause retinal detachment.
6. Previous severe eye injury: Injuries to the eye can increase the risk.
7. Previous other eye disease or disorder, including retinoschisis, uveitis, or thinning of the peripheral retina (lattice degeneration): Existing eye diseases or disorders can make the retina more vulnerable to detachment.

Development

Retinal detachment can develop into three different types: rhegmatogenous, exudative, and tractional.

1. Rhegmatogenous (reg-ma-TODGE-uh-nus): This is the most common type of retinal detachment. It occurs when there is a hole or tear in the retina, allowing fluid to pass through and collect underneath the retina. This fluid accumulation causes the retina to pull away from the underlying tissues, leading to vision loss. Rhegmatogenous detachment often results from age-related changes in the vitreous gel.
2. Exudative: In this type of detachment, fluid accumulates beneath the retina without any holes or tears in the retina. Exudative detachments can be caused by age-related macular degeneration, injury to the eye, tumors, or inflammatory disorders.
3. Tractional: Tractional detachment occurs when scar tissue grows on the retina's surface, causing the retina to pull away from the back of the eye. Tractional detachment is typically seen in people with poorly controlled diabetes or other conditions that affect the eye's blood vessels or tissues. Each type of retinal detachment develops differently but can result in vision loss if left untreated. It is essential to seek immediate medical attention if you experience any symptoms of retinal detachment, as prompt treatment can help preserve your vision.

Assessment and Diagnosis

Triage

You should see a doctor immediately if you suspect retinal detachment due to the sudden appearance of many floaters, flashes of light in one or both eyes, blurred vision, gradually reduced side (peripheral) vision, or a curtain-like shadow over your field of vision. Retinal detachment is a medical emergency that can lead to permanent vision loss if left untreated.

Diagnosis

Retinal detachment can be diagnosed through a retinal examination using an instrument with a bright light and special lenses to examine the back of your eye, including the retina. This test provides a highly detailed view of your whole eye, allowing the doctor to see any retinal holes, tears, or detachments. If bleeding has occurred in the eye, making it difficult to see the retina, your doctor may use ultrasound imaging to confirm the diagnosis. It's essential to have both eyes examined, even if symptoms are present in only one, as a delayed tear may occur in the other eye due to the same vitreous separation.

Management and Treatment

Complications

Retinal detachment can lead to several potential complications, including:

1. Permanent vision loss: If left untreated, retinal detachment can result in permanent vision loss or even blindness in the affected eye.
2. Increased risk of second detachment: People who have experienced a retinal detachment are at a higher risk of experiencing a second detachment, particularly if the initial detachment was not treated promptly or if there are underlying conditions that cause a detachment.
3. Glaucoma: Retinal detachment can sometimes cause increased pressure within the eye, leading to glaucoma, a condition that can further damage the optic nerve and lead to vision loss.
4. Macular damage: The macula, the central part of the retina responsible for sharp, detailed vision, can be affected by retinal detachment. Prolonged detachment may cause macular damage and impact the ability to read, drive, or recognize faces, among other vision-related tasks.
5. Nerve damage: Retinal detachment can lead to damage of the optic nerve, which transmits visual information from the eye to the brain. This can result in further vision loss and potential complications. Prompt medical attention and treatment are crucial in preventing these complications and preserving vision.

Home Remedies

While there are various home remedies that may be helpful for other eye conditions, retinal detachment is a medical emergency that requires immediate attention from an eye specialist. It is essential to seek professional medical help to prevent permanent vision loss.

Treatment

Treatment for retinal detachment typically involves surgery to repair the detached retina. The type of surgery depends on the severity of the detachment and other factors. Two common surgical procedures for retinal detachment include:

1. Pneumatic retinopexy (injecting air or gas into the eye): In this procedure, a bubble of air or gas is injected into the vitreous cavity, which pushes the detached retina against the eye wall, stopping the fluid flow into the space behind the retina. Your doctor may also use cryopexy during the procedure to repair the retinal break.
2. Scleral buckling: This procedure involves sewing a piece of silicone material to the white of your eye (sclera) over the affected area. The buckle indents the wall of the eye and relieves the force caused by the vitreous tugging on the retina. If you have several tears or holes or an extensive detachment, your surgeon may create a scleral buckle that encircles your entire eye like a belt. The buckle is placed in a way that doesn't block your vision and usually remains in place permanently. It is important to consult an eye surgeon for proper diagnosis and treatment recommendations, as they will determine the best procedure or combination of procedures based on your specific situation.

Preparing for medical consultation

To prepare for an appointment for retinal detachment, it is important to be aware of any pre-appointment restrictions and inquire about any necessary preparations at the time of scheduling the appointment. Additionally, it would be helpful to:

1. List any symptoms you're experiencing, including those that may seem unrelated to the reason for the appointment.
2. Mention any major stresses or recent life changes.
3. Make a list of all medications, vitamins, and supplements you're currently taking, including doses.
4. Bring a family member or friend with you to the appointment, especially if you may need someone to drive you home if your eyes are dilated during the exam.
5. Prepare a list of questions to ask your doctor, such as:
   • What's the most likely cause of my symptoms?
   • What are other possible causes of my symptoms?
   • What tests do I need? Do they require any special preparation?
   • Is my condition likely temporary or ongoing?
   • What are my treatment options, and which do you recommend?
   • What are the alternatives to the first approach you're suggesting?
   • How can I best manage any other medical conditions I may have alongside retinal detachment?
   • Do I need to restrict my activities in any way?
   • Do I need to see another specialist? Remember to discuss any concerns or questions you may have with your doctor during the appointment.