reduce font size
increase font size
 

font size

Disease

Retinal Detachment

 

 

 

Definition: When the retina detaches, it separates from the back wall of the eye and is removed from its blood supply and source of nutrition. The retina will degenerate and lose its ability to function if it remains detached. Central vision will be lost if the macula remains detached.  

Causes: 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, or an inflammatory disorder.

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 previous eye surgery, nearsightedness, a family history of retinal detachment, uncontrolled diabetes, and trauma. Approximately 10,000 people per year have a retinal detachment.

Types of Retinal Detachments:

Rhegmatogenous Retinal Detachment

Rhegmatogenous retinal detachment is the most common type of retinal detachment. It occurs when a break (tear or hole) in the retina allows fluid from the vitreous humor to enter the potential space beneath the retina. This causes the retina to separate from the layer beneath, known as the retinal pigment epithelium (RPE). This type of retinal detachment represents an emergency, and surgery is typically scheduled urgently (within 24 hours of diagnosis). 

Most cases of rhegmatogenous retinal detachment are associated with a posterior vitreous separation, which is a natural part of aging. This is due to the natural contraction, or shrinkage, of the vitreous humor, which occasionally creates traction on the retina, producing a retinal break (hole or tear). The process of posterior vitreous separation is often accelerated by cataract surgery, trauma, YAG laser capsulotomy following cataract surgery (for a hazy capsule behind the lens implant), diabetes, vitreous hemorrhage, and uveitis (inflammation inside the eye). Certain other conditions predispose one to retinal detachment, such as high myopia (nearsightedness), a peripheral retinal degeneration known as lattice degeneration , and a number of different inherited syndromes. 

 

 

Tractional Retinal Detachment

Tractional retinal detachment occurs when fibrous membranes (essentially scarring processes) in the vitreous humor and retina produce mechanical traction on the retina, literally pulling the retina from the underlying layer, known as the retinal pigment epithelium (RPE). This type of retinal detachment is most common in the advanced stages of diabetic retinopathy, known as proliferative diabetic retinopathy. Retinopathy of prematurity and sickle cell retinopathy are other conditions that may be associated with tractional retinal detachment.

 

 

Exudative Retinal Detachment

Exudative retinal detachment occurs with conditions that disturb the blood-retinal barrier, i.e., conditions that allow the build-up of fluid beneath the retina. Many conditions may cause exudative retinal detachment. Inflammatory conditions such as Vogt-Koyanagi-Harada syndrome, collagen-vascular diseases, and posterior scleritis are often implicated. Other conditions such as tumors of the eye (e.g.,choroidal melanoma), congenital abnormalities (e.g., Coat's syndrome), and nanophthalmos (extremely small eyes) may also be associated with exudative retinal detachment. 

Signs & 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

Diagnostic Testing: 

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).