Definition: A retinal detachment is a very serious problem and can result in blindness if not treated. The retina is a thin tissue composed of cells that line the inside back wall of the eye. When a retinal detachment occurs, the retina pulls away from the inside wall of the eye, causing vision impairment or loss. Depending on the mechanism, retinal detachments traditionally have been classified into three types, called rhegmatogenous, tractional, and exudative. Once retinal tissue dies, the body cannot replace it, explaining the importance of prompt treatment for the best chance to restore eye sight. The retina does not work properly when detached.
Causes: Retinal detachments occur any time retinal tissue is lifted up, and /or fluid accumulates in the space between the retina and the underlying layer of tissue, separating them. They can also occur when fibrous membranes (essentially scarring processes) on the retina adhere to the vitreous material in the back cavity of the eye and produce mechanical traction, literally pulling the retina from the underlying layer, known as the retinal pigment epithelium (RPE). Other causes include trauma in which the eye is punctured, blood vessel obstructions, and diseases, like Proliferative Vitreo Retinopathy and Proliferative Diabetic Retinopathy, in which scar tissue forms on the retina and adheres to the vitreous.
As we age, the vitreous gel that fills the cavity of the eye changes from a gelatinous substance to a liquid. During this transformation, the gel can pull on your retina causing a tear, which allows fluids to leak behind the retina, lifting it off the wall, resulting in a retinal detachment.
Symptoms: Patients should report any of the following warning signs to their ophthalmologist immediately.
- Light “flashes” and blurred central vision
- The presence of a “veil”, or shadow, over part of the field of vision
- Large “floaters” or spots that travel across the field of vision, an
- indication of a partial retinal detachment or clumped vitreous collagen fibers
- Partial or complete loss of vision in one eye, it can be gradual or sudden
Treatment: Treatment for your retinal detachment is dependent on the severity of the detachment. If it is minor your ophthalmologist may treat the detachment in the office with a laser.
For larger detachments a vitrectomy, an outpatient surgical procedure, will be performed. During a vitrectomy the vitreous is removed and replaced with a gas bubble or silicone oil, which pushes the retina back against the inner eye wall. The gas bubble will be replaced by your own natural fluids over the next several weeks. The silicone oil will remain in your eye until surgically removed.
More severe detachments, or reoccurring detachments, are treated surgically with a procedure called scleral buckling. A scleral buckle is a tiny synthetic band that is implanted on the outside of the eyeball that gently pushes the wall of the eye against the detached retina.
Following surgery, vision will be blurry, taking several weeks to improve. The eye will be red and slightly sore for up to two months, and may water for several weeks. Severe pain is uncommon. Eye drops and ointment must be instilled post-operatively to prevent infection and to help make the eye feel more comfortable. Please bring these medications with you to all appointments while using them.
The primary concern during the postoperative period is that the retina remains attached, therefore the patient is asked to restrict physical activity for several weeks.