Retinal Detachment

What is retinal detachment?

Retinal detachment is separation of the retina from the layer of blood vessels (the choroid) underneath it. The retina is the light-sensitive tissue at the back of the eye. A retinal detachment caused by a tear or a hole in the eye is the most common type. This type, if not treated, will cause blindness. It should be repaired as soon as possible.

It is especially important to treat it quickly, if the central vision is good. The chances of saving the vision is better in these cases if the surgery is done within a day. When the central vision is already decreased due to the retinal detachment, having the surgery within a day will not improve the result. In these cases, you should have the surgery within a week.

Sometimes retinal detachment occurs without a hole or a tear in the retina. Although this can be due to a serious condition, it is treated differently than detachment caused by a tear or a hole.

How does it occur?

A detachment that occurs because of a tear or hole is called rhegmatogenous retinal detachment. Changes in the clear gel in the center part of the eye can pull on the retina and cause a tear or a hole. If the fluid inside the eye gets under the retina through a hole or a tear, the retina will lift off from the wall of the eye and detach. This usually requires surgery.

Another type is called exudative retinal detachment. This happens when fluid is leaking into the space between eye wall and the retina. Inflammation, infection, tumor, abnormalities in blood vessels, and other rare conditions can cause leakage of fluid under the retina. This kind is treated by treating the underlying disease and does not require surgery.

Traction retinal detachment occurs because scar tissue inside the eye pulls the retina off the wall of the eye. This can happen in diabetes, with long-lasting inflammation, eye injury, or from a previous surgery. Your eye doctor may talk to you about doing a surgery to repair the eye.

What are the symptoms?

In rhegmatogenous retinal detachment, the first symptoms are those of a retinal tear including flashing lights and seeing floaters in your field of vision. Many people just have gradual loss of peripheral (side) vision without pain. If not treated, vision becomes dark all over. This may take hours or days.

In the other types of retinal detachment, you may have gradual vision loss over a long period of time.

How is it diagnosed?

A detached retina cannot be seen without special instruments. Therefore, you should see an ophthalmologist (a medical doctor who specializes in eyes) as soon as you think you may have a problem with your vision.

In some cases, an ultrasound of the eye is needed.

How is it treated?

Rhegmatogenous retinal detachment can be treated with surgery. No laser or medicine is effective. There are 3 main ways to treat the problem.

Pneumatic retinopexy. The eye surgeon injects a gas bubble into the eye to push the retina back in place. The tears in the retina are sealed later with cryopexy (freezing) or a laser. Although this is the least invasive procedure with the quickest recovery, the success rate is low and it is not used very often.
Scleral buckling. A silicone band or sponge can be placed under the muscles. This makes the eye wall push against the retina. This is a more painful procedure and has some risks. However, it is successful 90% of the time.
Vitrectomy. The vitreous (clear gel inside the eye) may be pulling the retina away from the eye. The eye surgeon will cut the vitreous away from the retina to stop the pulling. The surgeon then fills the eyeball with air, gas, or silicone oil to push the retina back against the wall of your eye. Over time, the air or gas is replaced with the eye's own fluids. If silicone oil is used, it needs to be removed during a second operation several weeks or months later. This has success rate similar to scleral buckling. Some surgeons combine vitrectomy with scleral buckling to increase the chance of success in some cases.

Your eye is numbed for these procedures. For most of them you can go home the same day. While you recover, you will usually need to keep your head in a specific position (such as face down or to one side) for several days or weeks to help your eye heal. Your doctor will tell you what position to rest your head in, how long you need to do this each day, and for how many days.

You may need other minor procedures as well. Your eye doctor will check your eyes often.

How long will the effects last?

Unlike other types of eye surgery, your vision is often very blurry after retinal detachment surgery. It may take several weeks for the blurriness to go away.

Surgery to repair a detached retina is successful in most cases. However, because the retina is very delicate and complex, there is almost always some degree of permanent damage.

Around 10% of people who have surgery will need more surgery. Sometimes scar tissue forms or there is trouble with recovery. If your vision gets worse or you start having new peripheral (side) vision problems after surgery, let your doctor know.

How can I take care of myself?

Follow your doctor's instructions after surgery to help your eye heal. You will need to:

Use the eyedrops or ointment prescribed by your doctor.
Limit your activities for a few days.
Keep your head in the position recommended by your doctor for a few days to a few weeks.

Several weeks after surgery, after your eye has completely healed, have your eyeglasses prescription checked to see if you need to change it.

If you have had retinal detachment in one eye, your risk of retinal detachment in the other eye is greater. See your eye doctor regularly so that any minor problems in your other eye can be corrected before they become serious.

What can I do to help prevent this from occurring?

If you are very nearsighted or have a family history of retinal detachments, see your eye doctor regularly. While you cannot prevent some changes in your eyes, you can help prevent them from seriously damaging your vision. Treating holes and tears promptly helps prevent retinal detachment.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File EYE4219F.HTM Release 9.0/2006