What is Retinal Detachment?
The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual signals through the optic nerve to the brain. Retinal detachment happens when the retina is lifted or pulled from its normal position.
How Does Retinal Detachment Occur?
A tear or break in the retina allows fluid in the eye to get under the retina and separate it from the underlying layer, the retinal pigment epithelium (RPE) which nourishes the retina. Rhegmatogenous (arising from rhegma, as rhegmatogenous detachment of the retina) retinal detachment is the most common retinological emergency threatening vision with an incidence of around 1 in 10 000 persons per year. Without treatment, blindness in the affected eye may result.
In a less common type of retinal detachment scar tissue on the surface of the retina may contract and pull the retina from the RPE. This is known as tractional retinal detachment.
During inflammatory conditions of the eye, fluid may leak into the area underneath the retina. In this situation known as exudative retinal detachment, there is no tear or break in the retina.
Who it Affects
Retinal detachment may occur at any age but is more common after the age of 40, particularly where an individual is:
- very nearsighted
- has had an eye injury or cataract surgery
- has retinal degeneration
- has had a RD in the other eye
- has a family history of RD
- has other eye disorders, such as uveitis or ritinoschisis.
Retinal Detachment Symptoms
There is no pain associated with RD. It may be heralded by the awareness of floaters in the eye. Sensations of flickering or flashes of light may indicate traction on the retina which could cause a retinal tear. Another symptom is the appearance of a curtain or dark shadow in the field of vision.
Anyone experiencing the symptoms of a retinal detachment must see an eye specialist immediately as retinal detachment is a medical emergency.
Treatment of Retinal Detachment
When the tear or break in the retina has produced a hole but the retina has not been significantly lifted by fluid it is possible to undertake laser surgery or a freezing technique (cryopexy). The tiny laser burns or freezing spots surround the tear and `weld` the retina into place.
An established retinal detachment will require more extensive surgery. This may necessitate anaesthesia and admission to hospital. Where fluid or vitreous (a gel like substance that fills the eye) has passed underneath the detached retina it may be necessary remove this fluid or gel and to apply a “buckle” to the outside of the eye to indent the wall of the eye in order to reattach the retina.
A vitrectomy may be required, during which a tiny incision is made in the sclera (the white of the eye) through which a small instrument is passed into the eye to remove the vitreous gel and fluid. Gas may be injected into the eye to replace the vitreous and to `float` the retina back into place. This gas will gradually be reabsorbed and replaced by fluid which is produced by the eye. Laser or cryopexy will be employed to `weld` the retina back in place.
Result of Treatment
Modern retinal detachment treatment is successful in over 90% of cases, but the visual outcome is largely dependent on early treatment and whether the macula (the center region of the retina responsible for detailed vision) has been detached.
It is essential to seek a specialist opinion immediately any symptom of retinal detachment occur.
Prevention of Retinal Detachment
Most cases of retinal detachment cannot be prevented. However its still important to have regular eye examinations to allow your eye doctor to look for signs that you might be more likely to have a retinal detachment.
Some eye injuries can damage the retina which can lead to detachment so taking appropriate safety measures which can help minimise any risks e.g. wearing safety glasses in environments or at work where your eyes maybe at risk of injury is a sensible precaution.
Having diabetes puts you at greater risk of developing diabetic retinopathy, which can lead to tractional retinal detachment. If you have diabetes, having regular eye examinations can help control and prevent eye problems.
- NHS Choices – Retinal Detachment: http://www.nhs.uk/Conditions/Retinal-detachment/Pages/Introduction.aspx
- RNIB, Retinal Detachment: http://www.rnib.org.uk/eye-health-eye-conditions-z-eye-conditions/retinal-detachment