Retinal Tears and Detachment
What is a Retinal Detachment?
A retinal detachment occurs when the retina is pulled away from its normal position, lining the back of the eye. The retina is unable to function normally when detached, which can cause severe vision loss. Prompt treatment by an ophthalmologist is necessary.
What causes a retinal detachment?
A clear gel called vitreous fills the inside cavity of the eye. As we age, the vitreous may pull away from its normal attachments to the retina. Usually this separation happens without causing any problems. Unfortunately, the vitreous may be very tightly adherent to the retina, and may pull hard enough against the retina and cause it to tear in one or more places. Fluid may pass between the retinal tear and the back of the eye, causing the retina to “peel off” the back of the eye, like wall paper peeling off of a wall.
The following conditions increase the chance of retinal detachment:
Previous cataract surgery
Previous detachment in the other eye
Family history of retinal detachment
thin areas in the retina as diagnosed by your ophthalmologist
What are the warning symptoms of a retinal detachment?
The following symptoms may indicate a retinal tear or detachment:
A shadow in the periphery (side) of your vision
A gray curtain moving across your field of vision
These symptoms do not always indicate a retinal detachment is present; however, you should see your ophthalmologist should you experience any of the above.
What treatment is needed?
Most tears of the retina can be treated with laser surgery or cryotherapy (freezing), which both seal around the retinal tear. Treatment usually repairs the tear and can prevent retinal detachment from developing. However, new tears and or detachments can occur in other areas of the retina. It is therefore important to have follow-up visits with you ophthalmologist following surgery.
Almost all patients with retinal detachment require surgery to reposition the retina.
Types of surgery:
There are several ways to repair a detached retina. The decision about which type of surgery and anesthesia (local vs. general), depends upon the characteristics of the detachment.
In all types of surgery, your surgeon will identify the retinal tears and treat them with either laser or cryotherapy.
This surgical treatment involves placing a flexible band (scleral buckle) around the eye to counteract the forces pulling the retina out of position.
During this procedure, a gas bubble is placed/injected into the vitreous cavity, in combination with laser or cryotherapy. The gas bubble pushes the retinal tear back against the eye wall. This procedure may be performed in the office. You will be required to maintain a certain head position following surgery for several days. The gas bubble dissolves on its own over time.
This surgery is commonly performed and is done in an operating room. The vitreous gel is removed for the eye and usually replaced with a gas bubble to hold the retina in position. On occasion, an oil bubble may be used.
Normal fluid will eventually replace the gas bubble as it dissovles. If an oil bubble is used, additional surgery will be required for its removal.
Sometimes vitrectomy is combined with a scleral buckle.
The eye will be uncomfortable after surgery, especially in the setting of a scleral buckle.
Flashing lights and floaters may persist for some time following surgery.
If a gas bubble was used, you will be required to maintain a certain head position following surgery.
Airplane travel is prohibited until the gas bubble is gone. A rapid rise in altitude can cause a dangerous rise in the eye pressure. Your surgeon will tell you when it is safe to fly.
All surgery has associated risks. However, an untreated detachment usually results in severe and permanent vision loss.
Surgical risks include but are not limited to:
High pressure in the eye
Most surgeries are successful, although additional surgery may be necessary in some cases.
Some retinal detachments cannot be fixed, but fortunately this is rare.
After surgery, the vision may take months to stabilize and improve. In some cases, visual recovery may be limited for a variety of factors. Unfortunately, some patients do not recover any vision.
Click on the following link to the American Academy of Ophthalmology EyeSmart page for more information:
(*the above information was adapted from the handout “Detached and Torn Retina, A closer Look”, provided by the American Academy of Ophthalmology)