Retinal detachment is a serious eye disorder in which the retina, a thin tissue of cells located in the back of the eye, separates from the underlying tissue layers.
Description
There are three layers of the eyeball. The outer, tough, white layer is called the sclera. Lining the sclera is the choroid, a thin membrane that supplies nutrients to part of the retina. The retina is located at the back of the eye and consists of three cellular layers.
The retina contains the light-sensitive receptors for sight and processes visual images. A retinal detachment occurs between the two outermost layers of the retina, the photoreceptor layer that receives light and the outermost pigmented epithelium. When a tear in the retina occurs, the fluids in the eye may leak and pull the retina out of place, or detach it from the layers. Because the choroid supplies the photoreceptors within the retina with nutrients, a detachment can basically starve the photoreceptors. If a detachment is not repaired within 24–72 hours, permanent damage may occur.
Causes & symptoms
Several conditions may cause retinal detachment:
Scarring or shrinkage of the vitreous (substance comprising the insides of the eye) can pull the retina inward.
Small tears in the retina allow liquid to seep behind the retina and push it forward.
Injury to the eye can loosen the retina. Trauma is the most common cause of retinal detachment in children, although it is comparatively unusual in the adult population.
Bleeding behind the retina, most often due to diabetic retinopathy or injury, can push it forward.
Retinal detachment may be spontaneous. This occurs more often in the elderly or in very nearsighted (myopic) eyes.
Retinal detachment will cause a sudden defect in vision. It may look as if a curtain or shadow has just descended before the eye. If most of the retina is detached, there may be only a small hole of vision remaining. If only a portion of the retina is involved, there will be a blind spot that may not even be noticed. Retinal detachment is often associated with floaters, which are little dark spots that float across the eye and can be mistaken for flies in the room. There may also be flashes of light. Anyone experiencing sudden flashes of light or floaters should contact his/her eye doctor immediately since these may be symptoms of detachment.
Diagnosis
Diagnosis of retinal detachment should be done by an ophthalmologist. A person who has flashes, floaters, or has a curtain-like blockage of their visual field should see an ophthalmologist immediately because early treatment is required to prevent loss of sight. An optometrist may also diagnose retinal detachment during a routine eye examination.
Treatment
No alternative treatment is recommended for acute retinal detachment. Vision may be lost if the problem is
not diagnosed and attended to promptly. However, some alternative therapies such as behavioral optometry prescribe eye relaxation exercises and use techniques that attempt to prevent and naturally heal myopia (near-sightedness). Nearsighted (myopic) people are at greatest risk for retinal detachment. Some alternative therapies that reduce stress to the eyes may promote general eye health. Also, alternative treatments to control high blood pressure such as diet, Chinese herbs, massage for stress relief, relaxation exercises, and yoga, may also indirectly prevent retinal damage by reducing high blood pressure and relieving stress. Antioxidants such as bilberry may also be used to decrease inflammation.
Allopathic treatment
Traditional treatment of retinal detachment involves immediate surgery to repair the retina. Small holes or tears may be sealed with a laser or with cryotherapy (freezing) under local anesthesia in a doctor's office. More extensive repairs are done in the hospital under general anesthesia. These may involve injection of silicone oil to help the retina reattach.
Expected results
Retinal detachment is a serious condition that can result in blindness. If retinal detachment is diagnosed in its early stages and repair is made quickly, the patient's sight usually returns to normal. If the retina is fully detached, and extensive surgery is needed, the patient's sight may be partially or fully restored. The amount of restoration depends on the severity of the damage and how soon it is treated.
Prevention
To prevent retinal detachment, people should be keenly aware of eye function and diseases that may affect it. Regular eye examinations can detect changes that the patient may not notice. In such diseases as diabetes, with a high incidence of retinal disordes, routine eye examinations can detect early changes. Good control of diabetes can help prevent diabetic eye disease. High blood pressure and stress should be controlled daily. Blood pressure control can prevent hypertension from damaging the retinal blood vessels, and stress management techniques can also reduce blood pressure. Wearing eye protection can also prevent direct injury to the eyes.
Early treatment can prevent both progressing to detachment, and blindness from other events like hemorrhage. Other diseases can cause the tiny holes and tears in the retina through which fluid can leak. Preventive treatment uses a laser to cauterize the blood vessels so that they do not bleed and seals the holes so they do not leak.
PERIODICALS
Butler, T. K. H., A. W. Kiel, and G. M. Orr. "Anatomical and Visual Outcome of Retinal Detachment Surgery in Children." British Journal of Ophthalmology 85 (December 2001): 1437-1439.
"Eye Disorders: Retinal Detachment." Harvard Health Letter (December 1, 1998).
Jonas, Jost B., et al. "Retinal Redetachment After Removal of Intraocular Silicon Oil Tamponade." British Journal of Ophthalmology 85 (October 2001): 1203.
ORGANIZATIONS
American Academy of Ophthalmology. P.O. Box 7424, San Francisco, CA 94120-7424. (415) 561-8500.
American Optometric Association. 243 North Lindbergh Blvd., St. Louis, MO 63141. (314) 991-4100.
