Retinal detachment

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 membrane at the back of the eye, which processes 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 the internal fluids of the eye may leak. This causes separation of the retina from the underlying tissues.

Retinal detachment may be caused by trauma, the aging process, severe diabetes, or an inflammatory disorder, but it frequently occurs spontaneously. In pre-term babies, retinal detachment can be caused by retinopathy of prematurity (abnormalities of the retina associated with being born prematurely).

During a 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 nearsightedness, a family history of retinal detachment, uncontrolled diabetes and trauma. Approximately 10,000 people per year are affected by retinal detachments.

Symptoms

• Bright flashes of light, especially in peripheral vision
• Translucent specks of various shapes (floaters) in the eye
• Blurred vision
• Shadow or blindness in a part of the visual field of one eye

Signs and tests

Tests to determine the integrity of the retina may include:

• Direct and indirect ophthalmoscopy
• Visual acuity
• Refraction test
• Color defectiveness determination
• Pupillary reflex response
• Slit-lamp examination
• Intraocular pressure determination
• Ultrasound of the eye
• Retinal photography
• Fluorescein angiography
• Electroretinogram (a record of the electrical currents in the retina produced by visual stimuli)

Treatment

Laser surgery may be used to seal the tears or holes in the retina, which generally precede detachment.

Another technique, the application of intense cold with an ice probe (known as cryopexy), leads to the formation of a scar that holds the retina to the underlying layer. This technique is used in combination with the injection of a gas bubble and the maintenance of specific head positions to prevent the re-accumulation fluid behind the retina.

If the retina is already detached, surgery is required.Some detachments can be repaired by placing a gas bubble in the eye to float the retina back into place (pneumatic retinopexy), followed by laser surgery to permanently fix it in place.This is often done in the office.More extensive detachments may require surgery in the operating room. The goal of such surgery may be to indent the wall of the eye (scleral buckle) or remove vitreous gel or scar tissue pulling on the retina using microsurgery (vitrectomy).

Expectations (prognosis)

The outcome depends upon 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 a medical emergency requiring immediate evaluation.

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.

Illustrations

Eye	Slit-lamp exam

Page Content:

retinal detachment; retinal detachment symptom; retinal detachment surgery; retinal detachment treatment; cause of retinal detachment; rhegmatogenous retinal detachment