Retinal Detachment

What is retinal detachment?

A retinal detachment occurs when the retina separates from the outer layers of the eye. The retina is the innermost layer at the back of the eye that detects light, and helps to form visual images, similar to the layer of film at the back of a camera. If not treated early, retinal detachment may lead to partial or complete permanent loss of vision.

Normal vision                                               Vision with retinal detachment

What are the types of retinal detachment?

There are three main types of retinal detachment:

1. Rhegmatogenous retinal detachment: This occurs when a tear or hole in the retina allows fluid to seep underneath, causing the retina to lift away from its supportive tissue. It is the most common type and is often linked to ageing or conditions like myopia.
2. Tractional retinal detachment: This type develops when scar tissue on the retina’s surface contracts, pulling the retina away from the back of the eye. It is commonly associated with conditions such as diabetic retinopathy.
3. Exudative retinal detachment: This happens when fluid builds up beneath the retina without any tears or holes. Causes include inflammation, injury or certain underlying diseases such as tumours or central serous chorioretinopathy.

What are the symptoms of retinal detachment?

Floaters and flashes in the eye are usually the initial symptoms. .  Floaters are dots or lines that you may see moving or floating in your field of vision. New-onset floaters or an increase in floaters are of concern. Flashes are the sensation of flashing lights or lightning streaks in your field of vision.

The appearance of a "curtain" or dark shadow blocking part of or your entire field of vision is another concerning symptom.

When should you see a doctor?

A retinal detachment is a medical emergency. If you experience these symptoms suggestive of a retinal detachment, you should see an ophthalmologist immediately. If too much time lapses, the chances of successfully repairing the retina through surgery will be lower, and you may develop permanent vision loss.

How is retinal detachment prevented?

Avoidance of eye trauma or excessive eye rubbing can help to reduce the risk of retinal tears and detachment. Frequent eye examinations can pick up problems early. With prompt treatment, a torn retina can be fixed before full retinal detachment occurs.

What causes retinal detachment? 

Retinal detachment occurs after a tear in the retina develops, allowing fluid to seep under the retina and detaching it from the wall of the eye. Over time, the detachment may cause part of the retina to lose contact with its blood supply and stop functioning. This is when you lose your vision.

What are the risk factors for retinal detachment?

Your risk of retinal detachment increases if you:

1. Are over 40 years old
2. Have had retinal detachment in one eye previously
   
3. Have myopia (short-sightedness)
4. Have a family history of retinal detachment
5. Have had any recent eye surgery (e.g. cataract surgery)
6. Have sustained eye injuries or trauma 
   
   
   

How is retinal detachment diagnosed?

Retinal exam

Diagnosis of retinal detachment is made by clinical examination. Your ophthalmologist will administer eye drops to enlarge (dilate) the pupils temporarily so that they can examine the retina. This is usually done with an ophthalmoscope, an instrument with a bright light and a special lens to examine the inside of your eye. The ophthalmoscope provides a highly detailed 3D view of the retina, allowing the ophthalmologist to see any retina holes, tears or detachments.

Retinal Detachment 

Ultrasound imaging

An ultrasound scan may occasionally be used to make the diagnosis. Ultrasound uses sound waves to create an image of the structure of the eye on a video monitor. The sound waves travel through your eye and bounce off the retina and other structures within the eye, to construct the image. Ultrasound scans are painless, and does not involve the use of any radiation.

How are retinal tears and retinal detachment treated?

There are a few different options to treat retinal tears or detachments, such as laser treatment or surgery, depending on the situation and severity. Your ophthalmologist will discuss the benefits and limitations of these options with you and recommend a suitable treatment plan.

Retinal tears

When a retinal tear or hole has not progressed to a retinal detachment, your ophthalmologist may suggest an outpatient laser procedure to prevent the tear from developing into a retinal detachment.

Laser treatment does not close the tear but works by forming a scar around the retinal tear, to prevent the retina from detaching.

Retinal detachment

If your retina has detached, usually surgical procedures will be required to repair it. There are a few different surgical procedures used to repair retinal detachments, and your ophthalmologist will recommend the most suitable approach for you, which depends on factors such as the type of detachment and severity. Some of the potential options include: 

• Scleral buckling
  Your ophthalmologist may choose to place a scleral buckle, which is a silicone band that encircles the eye like a belt. The scleral acts externally to reattach the retina.
   
• Vitrectomy
  A vitrectomy is a form of "keyhole" surgery that uses small instruments to enter the eye to remove the vitreous gel in the eye. This allows the surgeon to reattach the retina internally, and to apply laser treatment around the retinal tear. In most cases, the eye will be filled with a gas bubble (or sometimes silicone oil) at the end of surgery, to help with holding the retina in place, and keeping it attached. Following surgery, if a gas bubble was injected, your doctor may instruct you to maintain a specific head position (usually face-down) for up to two weeks after surgery, and you would also need to avoid air travel until the gas bubble dissolves. The eye will refill naturally with fluid over time.
  
  
• Pneumatic retinopexy
  Some select cases of retinal detachment may be treated with a gas injection into the eye, which can be done as an outpatient procedure in the clinic. The gas bubble helps to temporarily seal the retinal tear and helps the reattachment of the retina. Usually a laser treatment will be needed to seal the area around the retinal tear in the next few days. 
• Similarly, after gas bubble injection, your doctor may instruct you to maintain a specific head position (usually on one side) for a few weeks, and you would also need to avoid air travel until the gas bubble dissolves. The eye will refill naturally with fluid over time.
  

Face-down posture after retinal detachment surgery

References

619673. (2024, October 11). Detached retina. American Academy of Ophthalmology. https://www.aao.org/eye-health/diseases/detached-torn-retina

U.S. Department of Health and Human Services. (n.d.). Retinal detachment. National Eye Institute. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinal-detachment

Yale Medicine. (2022, October 29). Retinal detachment. Yale Medicine. https://www.yalemedicine.org/conditions/retinal-detachment