Retinal Detachment: Types, Symptoms, Causes, Risk Factors, Diagnosis and Treatment

We speak of a light-sensitive membrane located at the back of the eye.

When light passes through your eye, the lens focuses an image on your retina. The retina converts the image into signals that it sends to your brain through the optic nerve .

The retina works in conjunction with the cornea , lens, and other parts of the eye and brain to produce normal vision.

What you need to know about a detached retina

A detached retina occurs when the retina detaches or is shed from its underlying layer of supportive tissue at the back of the eye. The retina is a thin layer of light-sensitive nerve cells at the back of the eye. We need a healthy retina to be able to see clearly.

At first, the detachment may affect only a small part of the retina, but without treatment, the entire retina may detach, and vision in that eye will be lost.

A detached retina usually only occurs in one eye and is treated as a medical emergency.

People with severe myopia, those with diabetes, patients who have undergone complicated cataract surgery, and anyone who has received a blow to the eye are all more susceptible to the condition.

There is a risk of permanent vision loss if the retinal detachment is not treated or if treatment is delayed.

Types of retinal detachment

Rhegmatogenous retinal detachment is a tear, tear, or hole in the retina. This hole allows fluid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium.

This epithelium is the pigmented cell layer just outside the sensorineural retina.

There is another type, which is known as secondary retinal detachment, exudative retinal detachment, or serous retinal detachment.

It occurs when inflammation, vascular abnormalities, or injuries cause fluid to accumulate under the retina. There is no hole, tear or tear.

Tractional retinal detachment occurs when injury, inflammation, or neovascularization causes fibrovascular tissue to remove the sensory retina from the retinal pigment epithelium.

Symptoms

A person with retinal detachment can experience a number of symptoms.

These include:

  • Photopsia, or sudden, brief flashes of light out of the central part of your vision or peripheral vision. Flashes are more likely to occur when the eye moves.
  • A significant increase in the number of floaters, which are debris in the eye that make us see things floating in front of us, usually as small chains of transparent bubbles or rods that follow our field of vision when our eyes turn.
  • An unpleasant sensation in the eye.
  • A shadow that begins to appear in peripheral vision and gradually extends towards the center of the field of vision.
  • A sensation of a transparent curtain descending on the field of vision.
  • Straight lines begin to appear curved.
  • It is usually not painful.
  • Blurry vision.
  • Partial loss of vision, making it appear that a curtain has been passed through your field of vision, with a dark shadow effect.

Causes

The retina is the layer of tissue that lines the inside of the eye. It is sensitive to light and its function is to send visual signals to the brain through the optic nerve.

When we see, light passes through the eye’s optical system and hits the retina, just like in a non-digital camera. When light hits the retina, it produces an image that is translated into neuronal impulses and sent to the brain through the optic nerve.

In other words, an image is focused on the retina, nerve cells process the information and send it through electrical impulses through the optic nerve to the brain.

If the retina is damaged, this can affect a person’s ability to see.

Retinal detachment occurs when this layer is pulled from its normal position. Sometimes there are tiny tears on the retina. These can also cause the retina to detach.

Risk factor’s

Factors that can increase your risk of developing retinal detachment include:

  • Genetics, for example, if a close relative has had a retinal detachment.
  • Middle and advanced ages.
  • Extreme myopia
  • Previous cataract surgery, especially if it was complicated.
  • Anterior retinal detachment.
  • Eye conditions, such as uveitis, degenerative myopia, lattice degeneration, and retinoschisis.
  • Trauma, for example, a blow to the eye.
  • Diabetes, especially if diabetes is poorly controlled

Anyone with these risk factors should be aware of the possibility of a detached retina.

Diagnosis

If a doctor suspects retinal detachment, they will usually refer the patient to an eye doctor or ophthalmologist, for an accurate diagnosis.

The ophthalmologist will examine your eyes after dilating or widening the pupils with eye drops. An ultrasound can give more details.

The specialists will verify:

  • Your vision.
  • Your eye pressure.
  • The physical appearance of your eye.
  • Your ability to see colors.

Your doctor may also test your retina’s ability to send impulses to your brain. They can control blood flow through your eye and specifically to your retina.

Your doctor may also order an ultrasound of your eye. This is a painless test that uses sound waves to create an image of your eye.

Treatment

Treatment options for a detached retina are all types of surgery, as will be described.

Surgery

Surgery will be needed to find and seal all retinal tears and to relieve present or future vitreoretinal traction, or pulling. Without surgery, there is a high risk of total vision loss.

Options for surgery include:

  • Laser surgery or photocoagulation: A laser beam is directed through a contact lens or ophthalmoscope. The laser burns around the retinal tear, producing scar tissue that then fuses the tissue back together.
  • Cryotherapy: Cryosurgery, cryoprotection, or freezing involves applying extreme cold to destroy abnormal or diseased tissue. The procedure produces a delicate scar that helps connect the retina to the wall of the eye.
  • Scleral buckling: In the area where the retina has detached, very thin bands of silicone rubber or sponge are sewn onto the sclera, the white outer part of the eye. The tissue around the area can be frozen or lasers can be used to mark the tissue.
  • Vitrectomy: Vitreous gel is removed from the eye and a gas bubble or silicone oil bubble is used to hold the retina in place. The wound is stitched up. Silicon oil should be removed 2 to 8 months after the procedure.
  • Pneumatic retinopexy: can be used if detachment is not complicated. The surgeon freezes the tear area, using cryoprotection, before injecting a bubble into the vitreous cavity of the eye.

A person who has a gas bubble in his eye may be advised to hold his head in a particular way for a time, and will not be allowed to turn.

Researchers have been studying the use of silicone oil to treat proliferative vitreoretinopathy (PVR), a complication of retinal detachment surgery that can lead to increased retinal detachment.

The National Eye Institute estimates that about 90 percent of treatments for retinal detachment are successful, although some people will need more treatment.

Sometimes the retina cannot be reattached, and the person’s vision will continue to deteriorate.

The patient’s vision should return a few weeks after treatment. If the macula is involved in detachment, the person’s vision may not be as clear as before. The macula is the part of the eye that allows us to see what is straight in front of us.

The cost of retinal detachment surgery depends on the type of procedure.

Research published in 2014 suggests that “DR treatment and prevention are extremely cost-effective compared to other treatments for other retinal diseases, regardless of treatment modality.”

The study, published in the journal Ophthalomology, balanced the cost of treatment against the benefits of good eyesight and quality of life.

There is a small risk of complications after surgery. These include drug allergies, eye bleeding, double vision, cataracts, glaucoma, and eye infection.

Attending regular eye exams can help reduce the risk of retinal detachment, as eye conditions can sometimes be detected in the early stages.