The retina is a light-sensitive membrane located at the back of the eye. When light passes through the eye, the lens focuses an image on the retina. The retina converts the image to signals that it sends to the brain via the optic nerve. The retina works with the cornea, lens, and other parts of the eye and the brain to produce normal vision.
Retinal detachment occurs when the retina separates from the back of the eye. This causes loss of vision that can be partial or total, depending on how much of the retina is detached. Retinal detachment is a medical emergency. When your retina becomes detached, its cells may be deprived of oxygen. See your doctor immediately if you suspect you have retinal detachment.
If left untreated or if treatment of retinal detachment is delayed, you risk permanent vision loss.
There are three types of retinal detachment:
If you have a rhegmatogenous retinal detachment, you have a tear or hole in your retina. This allows fluid from within the eye to slip through the opening and get behind the retina. The fluid separates the retina from the membrane that provides it with nourishment and oxygen. The pressure from the fluid can push the retina away from the retinal pigment epithelium (RPE), causing the retina to detach. This is the most common type of retinal detachment.
Tractional retinal detachment occurs when scar tissue on the retina’s surface contracts and causes the retina to pull away from the back of the eye. This is a less common type of detachment that typically affects people with diabetes. Diabetes can lead to issues with the retinal vascular system and cause scar tissue in the eye that could cause detachment.
In exudative detachment, there are no tears or breaks in the retina. This type of detachment is caused by retinal diseases such as inflammatory disorder or Coats disease, which causes abnormal development in the blood vessels behind the retina.
Risk factors for retinal detachment include:
- posterior vitreous detachment (PVD)–a common condition in aging individuals, in which the fluid in the retina breaks down, putting strain on the retinal fibers
- extreme nearsightedness because it causes more strain on the eye
- family history of retinal detachment
- trauma to the eye
- being over 40 years old
- prior history of retinal detachment
- complications from cataract surgery
There is no pain associated with retinal detachment, but there are usually symptoms before the retina becomes detached. Primary symptoms include:
- blurred vision
- partial vision loss (as if a curtain has been pulled across your field of vision)
- flashes of light when looking to the side
- areas of darkness in your field of vision
- suddenly seeing many floaters (small bits of debris that appear as black flecks or strings floating before your eye)
To diagnose retinal detachment, your doctor will perform a comprehensive eye examination. He or she will check your vision, pressure, the physical appearance of your eye, and your ability to see colors.
Your doctor might also test the ability of your retina to send impulses to your brain. He or she may check the blood flow throughout your eye and specifically in the retina. Your doctor may order an ultrasound of your eye. This is a painless test that uses sound waves to create an image of your eye.
In general, there is no way to prevent retinal detachment. However, you can take steps to avoid retinal detachment that results from an injury by wearing protective eyewear when playing sports or using tools. If you are diabetic, control your blood sugar and see your doctor regularly. Get yearly eye exams, especially if you have risks for retinal detachment.
It’s important to know the symptoms of retinal detachment. Recognizing when you may have a retinal problem and seeking medical care immediately can save your vision.
In most cases, you will need surgery to repair a detached retina. For minor detachments or tears of the retina, a simple procedure may be done in your doctor’s office.
If you have a hole or tear in your retina but your retina is still attached, your doctor may use photocoagulation (a laser). The laser burns around the tear site, and the resulting scarring affixes the retina to the back of the eye.
Another option is cryopexy (intense cold). For this treatment, your doctor will apply a freezing probe to the tear site and the resulting scarring will help hold the retina in place. Your eye will be numbed for both treatments.
A third option is pneumatic retinopexy, which repairs minor detachments. For this procedure, your doctor will put a gas bubble in your eye to help the retina move back into place. Once the retina is back in place, your doctor will use a laser to seal the holes.
For more severe detachments, you will need to have your eye operated on in a hospital. Scleral buckling, which pushes the wall of the eye into the retina to get it back into place, may be used.
Another option is vitrectomy, which is used for larger tears. The procedure for vitrectomy includes anesthesia and is an out-patient procedure. Your doctor will use small tools to remove scar tissue and fluid from the retina and then put the retina back into its proper place.
The outlook for retinal detachment depends on the severity of the condition and how quickly you receive medical care. Some people will recover completely, especially if the macula was not damaged. The macula is the part of the eye responsible for clear vision and is located near the center of the retina. However, some people may not regain full vision. This would be true if the macula was damaged and treatment was not sought quickly.