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Retinal Detachment

When the sensory retina splits from the retinal pigment epithelium (RPE), retinal detachment occurs, creating a subretinal space. This space then fills with fluid, called subretinal fluid. Retinal detachment usually involves only one eye, but may involve the other eye later.

The good news is that warning signs often appear before retinal detachment occurs, and early diagnosis and treatment by a specialist trained in eye diseases and conditions (ophthalmologist) can save your vision.

Causes

Any retinal tear or hole allows the liquid vitreous to seep between the retinal layers, separating the retina from its choroidal blood supply. In adults, retinal detachment usually results from degenerative changes of aging, which cause a spontaneous retinal hole.

Predisposing factors include myopia, cataract surgery, and trauma. Perhaps the influence of trauma explains why retinal detachment is twice as common in males.

Retinal detachment may also result from seepage of fluid into the subretinal space (because of inflammation, tumors, or systemic diseases) or from traction that's placed on the retina by vitreous bands or membranes (from proliferative diabetic retinopathy, posterior uveitis, or a traumatic intraocular foreign body).

Retinal detachment is rare in children, but occasionally can develop as a result of retinopathy of prematurity, tumors (retinoblastomas), or trauma. It can also be inherited, usually in association with myopia.

Signs and symptoms

The symptoms of retinal detachment include:

• Floaters
• Blurry vision
• Bright lights or sparks, particularly in the periphery of the visual field
• Areas of darkness, shadow or shade in the visual field
• Loss of vision.

Diagnosis

Retinal detachments are usually found because the patient calls the doctor's office with a symptom listed above. It is critical that these problems are reported early, because early treatment can greatly improve the chance of restoring vision.

The doctor makes the diagnosis of a retinal detachment after thoroughly examining the retina with ophthalmoscopy . The retinal surgeon's first concern is to determine whether the macula (the center of the retina) is attached. This is critical because the macula is responsible for the central vision. Whether or not the macula is attached determines the type of corrective surgery required and the patient's chances of having functional vision after the operation.

Ultrasound imaging of the eye is also very useful for the doctor to see additional detail of the condition of the retina from several angles.

Treatment

Depending on the location and severity of the detachment, treatment may include restriction of eye movements and complete bed rest to prevent further detachment.

A hole in the peripheral retina can be treated with cryothermy; in the posterior portion, with laser therapy. Retinal detachment usually requires scleral buckling to reattach the retina and, possibly, replacement of the vitreous with oil, air, gas, or silicone.

Coping skills

Unless you undergo prompt surgery, retinal detachment will cause you to lose vision in the portion of your field of vision that corresponds to the detached part of the retina. Losing part of your vision can greatly change your lifestyle - affecting your ability to drive, read and do many other things you're accustomed to doing. Yet there are ways to cope with impaired vision:

• Check into transportation. Investigate vans and shuttles, volunteer driving networks, or rideshares available in your local area for people with impaired vision.
• Get special glasses. Optimize the vision you have with glasses that are specifically prescribed for the effects of retinal detachment and keep an extra pair in the car.
• Brighten your home. Have proper light in your home for reading and other activities.