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Retinal detachment

 

Retinal detachment is a separation of the light-sensitive membrane (retina) in the back of the eye from its supporting layers.

Causes

The retina is the clear tissue in the back of the eye. It helps you see the images that are focused on it by the cornea and the lens.

  • The most common type of retinal detachment is often due to a tear or hole in the retina. Eye fluid may leak through this opening. This causes the retina to separate from the underlying tissues, much like a bubble under wallpaper. This is most often caused by a condition called posterior vitreous detachment. It can also be caused by trauma and very bad nearsightedness. A family history of retinal detachment also increases your risk.
  • Another type of retinal detachment is called tractional detachment. This type occurs in people who have uncontrolled diabetes, had retinal surgery before, or have chronic inflammation.

When the retina becomes detached, bleeding from nearby blood vessels can cloud the inside of the eye so that you may not see clearly or at all. Central vision becomes severely affected if the macula becomes detached. The macula is the part of the retina responsible for sharp, detailed vision.

Symptoms

 

Symptoms of detached retina can include:

  • Bright flashes of light, especially in peripheral vision
  • Blurred vision
  • Floaters in the eye
  • Shadow or blindness in a part of the visual field of one eye

 

Exams and Tests

 

The ophthalmologist (eye doctor) will examine your eyes. Tests will be done to check the retina and pupil:

  • Using special dye and camera to look at blood flow in the retina (fluorescein angiography)
  • Checking pressure inside the eye ( tonometry )
  • Examining the back part of the eye, including the retina ( ophthalmoscopy )
  • Checking eyeglass prescription ( refraction test )
  • Checking color vision
  • Checking the smallest letters that can be read ( visual acuity )
  • Checking structures at the front of the eye ( slit-lamp examination )
  • Ultrasound of the eye

 

Treatment

 

Most people with a retinal detachment need surgery . Surgery may be done right away or within a short time after diagnosis. Some types of surgery can be done in your doctor's office.

  • Lasers may be used to seal tears or holes in the retina before a retinal detachment occurs.
  • If you have a small detachment, the doctor may place a gas bubble in the eye. This is called pneumatic retinopexy. It helps the retina float back into place. The hole is sealed with a laser.

Severe detachments require surgery in a hospital. These procedures include:

  • Scleral buckle to gently push the eye wall up against the retina.
  • Vitrectomy to remove gel or scar tissue pulling on the retina, used for the largest tears and detachments.

Tractional retinal detachments may be watched for a while before surgery. If surgery is needed, a vitrectomy is usually done.

 

Outlook (Prognosis)

 

How well you do after a retinal detachment depends on the location and extent of the detachment and early treatment. If the macula was not damaged, the outlook with treatment can be excellent.

Successful repair of the retina does not always fully restore vision.

Some detachments cannot be repaired.

 

Possible Complications

 

A retinal detachment causes loss of vision. Surgery to repair it may help restore some or all of your vision.

 

When to Contact a Medical Professional

 

A retinal detachment is an urgent problem that requires medical attention within 24 hours of the first symptoms of new flashes of light and floaters.

 

Prevention

 

Use protective eye wear to prevent eye trauma. Control your blood sugar carefully if you have diabetes. See your eye care specialist once a year. You may need more frequent visits if you have risk factors for retinal detachment. Be alert to symptoms of new flashes of light and floaters.

 

 

Open References

References

American Academy of Ophthalmology Retina Panel. Preferred Practice Pattern Guidelines. Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration. www.aao.org/preferred-practice-pattern/posterior-vitreous-detachment-retinal-breaks-latti-6 . Accessed September 10, 2015.

Bowling B. Retinal detachment. In: Bowling B, ed. Kanski's Clinical Ophthalmology . 8th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 16.

Rao RC, Shah GK. Rhegmatogenous retinal detachment. In: Yanoff M, Duker JS, eds. Ophthalmology . 4th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 6.38.

 
  • Eye

    Eye - illustration

    The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle tunic layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

    Eye

    illustration

  • Slit-lamp exam

    Slit-lamp exam - illustration

    A slit-lamp, which is a specialized magnifying microscope, is used to examine the structures of the eye (including the cornea, iris, vitreous, and retina). The slit-lamp is used to examine, treat (with a laser), and photograph (with a camera) the eye.

    Slit-lamp exam

    illustration

    • Eye

      Eye - illustration

      The eye is the organ of sight, a nearly spherical hollow globe filled with fluids (humors). The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. The middle tunic layer (choroid, ciliary body and the iris) is vascular. The innermost layer (the retina) is nervous or sensory. The fluids in the eye are divided by the lens into the vitreous humor (behind the lens) and the aqueous humor (in front of the lens). The lens itself is flexible and suspended by ligaments which allow it to change shape to focus light on the retina, which is composed of sensory neurons.

      Eye

      illustration

    • Slit-lamp exam

      Slit-lamp exam - illustration

      A slit-lamp, which is a specialized magnifying microscope, is used to examine the structures of the eye (including the cornea, iris, vitreous, and retina). The slit-lamp is used to examine, treat (with a laser), and photograph (with a camera) the eye.

      Slit-lamp exam

      illustration

    A Closer Look

     

      Tests for Retinal detachment

       
       

      Review Date: 8/11/2015

      Reviewed By: Franklin W. Lusby, MD, ophthalmologist, Lusby Vision Institute, La Jolla, CA. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

       
       
       

       

       

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