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Detachment of the Retina di-ˈtach-mənt-

by Sunir J. Garg, MD, FACS

Retinal detachment is separation of the retina (the transparent, light-sensitive structure at the back of the eye) from the underlying layer to which it is attached.

  • People notice a sudden increase in floaters, a sudden onset of flashing lights, a curtain or veil across vision, or sudden loss of vision.

  • Doctors make the diagnosis by looking in the eye with an ophthalmoscope.

  • Most retinal detachments can be repaired, resulting in improved vision if done soon after the detachment occurs.

A retinal detachment may begin in a small area, usually as the result of a retinal tear. If the small area is not soon reattached, the entire retina can detach. Retinal tears that can lead to retinal detachment are more likely to occur in people who have or have had the following:

  • Severe nearsightedness (myopia)

  • Cataract surgery

  • An eye injury

  • Lattice retinal degeneration (a common disorder characterized by thinning and scar formation usually along the outside, or periphery, of the retina)

  • A family history of retinal detachment

When the retina detaches, it separates from part of its blood supply. Unless the retina is reattached, it may be permanently damaged by lack of blood.

Sometimes a retinal detachment is not caused by a tear. Some detachments are caused by complications of diseases that damage the retina (such as diabetes). Fluid or blood from a damaged blood vessel may also collect between the retina and the underlying tissue, causing a detachment.

Symptoms and Diagnosis

A retinal detachment is painless. People usually see an increase in floating objects (floaters—objects that appear to move through a person's field of vision) or many flashes of bright light that last less than a second (photopsias) and have blurred vision. Peripheral vision is typically lost first, and vision loss spreads as the detachment progresses. The loss of vision causes grayness in the field of vision or resembles a curtain or veil falling across the line of sight. People may have blood in the jellylike vitreous humor near the back of the eye (vitreous hemorrhage). If the macula becomes detached, vision rapidly deteriorates, and everything becomes blurred. Some retinal detachments do not cause symptoms at first.

After applying eye drops to dilate the pupil, doctors examine the retina using an ophthalmoscope and can usually see a detachment. If the detachment is not visible, an ultrasound of the eye may help identify it.

Prognosis

Surgery usually helps prevent additional vision loss. Vision often improves, except in the following circumstances:

  • The retina has been detached for several days or weeks.

  • Bleeding or scarring has occurred.

  • The macula has been detached or is damaged.

Treatment

Most retinal detachments can be repaired. The surgeon seals the tears with laser surgery or freezing therapy (cryotherapy). The surgeon may bring the retina and the wall of the eye together either by placing a band around the eye (a scleral buckle) or by removing the vitreous jelly behind the lens and in front of the retina with surgery called a vitrectomy. A gas bubble is often used to hold the retina in place. Occasionally, the retina can be reattached using laser surgery or cryotherapy plus a gas bubble (called pneumatic retinopexy).

Detachments that are caused by a disease that affects the retina (such as diabetes) can be treated with a vitrectomy. Detachments that are caused by fluid leakage may be treated with corticosteroids or drugs that suppress the immune system (immunosuppressants such as methotrexate and azathioprine) taken by mouth or given via a surgical implant in the eye that slowly releases constant levels of a corticosteroid.

Drugs Mentioned In This Article

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  • OTREXUP
  • IMURAN