Asheesh Tewari, MD the Retina Expert :: Patient Education
Patient Education :: Retinal Detachment

Who is likely to develop a retinal detachment?

Retinal detachments affect about one in 10,000 people in the United States. It typically happens to patients who are nearsighted or have a family history of retinal detachments. Retinal detachments can also happen after cataract surgery.

Sometimes a hard blow to the eye can cause retinal detachment. In some cases, it is a hereditary condition and occurs in children and infants. If the detachment is not diagnosed and treated it can lead to visual impairment and even complete loss of vision.

What are the causes and symptoms of a retinal detachment?

Tears or holes in the retina cause most retinal detachments. In normal aging, there is often shrinkage of the vitreous, which is the gel-like substance that is in the center part of the eye. The jelly is attached to the retina in several places around the back wall of the eye. As the jelly shrinks, it can pull a piece of the retina away with it, causing a hole or tear in the retina. Once this hole or tear occurs, fluid from the vitreous jelly can pass through the hole, in between the retina and the back of the eye. This separates the retina from the back of the eye and causes the retina to detach. When this happens, there will be blurred vision or loss of peripheral vision.

Retinal Detachement Diagram 01

Normal aging is the mechanism that is responsible for most cases of retinal detachment. In some cases, tumors, inflammation, or complications of diabetes cause retinal detachments. Sometimes these detachments do not have holes or tears associated with them. Common symptoms include loss of peripheral vision, along with flashing lights and floaters. Flashing lights and floaters arise from the pulling of the jelly on the retina. Continuing flashing lights or floaters may signal the beginning of a retinal tear. If a sudden shower of flashing lights or floaters are noticed, a comprehensive retinal examination is necessary to check the inside of the eye to determine if retinal tears are present. If retinal tears are treated, a retinal detachment may be avoided in many cases. Some retinal detachments are not associated with floaters or light flashes, and the only symptoms may be the appearance of a dark shadow in part of the patient's side vision. Sometimes, along with retinal detachment, rapid loss of vision can occur if there is bleeding into the gel of the eye when a retinal tear occurs.

How are retinal detachments detected and diagnosed?

A retinal detachment cannot be seen from the outside of the eye. If symptoms of a retinal detachment are noticed, a thorough retinal evaluation is necessary. Various instruments may be used during the examination, including an ophthalmoscope, which is an instrument with a bright light and enough magnification to allow examination of the retina. Pressing around the eye with a cotton tip or depression of the eye is also necessary to detect retinal tears in most cases. At times, ultrasound is used to diagnose a retinal detachment.

What are the treatment options for a retinal tear or detachment?

Typical treatment for a retinal tear includes laser photocoagulation and freezing. A retinal detachment typically requires surgery, which may include a procedure involving pneumatic retinopexy, scleral buckle and/or vitrectomy. The choice depends upon the severity of the retinal detachment and the recommendation of a retina specialist. When new retinal tears are found with no accompanying retinal detachment, the tears are treated with laser therapy. The laser treatment spot welds the retina and prevents the fluid from passing through the retina and causing a retinal detachment. Typically, laser treatment is done on an outpatient basis and requires no surgical incision. Anesthesia for the treatment may include a numbing injection or drops. Cryopexy freezes the back wall of the eye, which will stimulate scar formation and seal down edges of the retinal tear. The reaction is similar to that with laser. The cold freezes the tissue and this prevents a retinal detachment. If a significant amount of fluid has collected underneath the retina, a more complicated operation is necessary.

The following operations may be attempted:
1. Pneumatic retinopexy
2. Scleral buckling
3. Vitrectomy

Retinal Detachement Diagram 02

In pneumatic retinopexy, a gas bubble is injected into the vitreous cavity. As the bubble rises, it presses the retina against the back wall of the eye. The retina specialist will then use laser therapy or cryotherapy to seal the retina in place. The body usually absorbs the bubble within one to three weeks. Until the bubble reabsorbs, you may notice the bubble shifting during eye movement. With this procedure you may need to hold your head in one position in order for the retina to be reattached. In scleral buckling, a silicone band is wrapped around the eye. This causes the sclera, or the back wall of the eye, to indent the retina, bringing it closer to the back wall of the eye. The retina is then sealed using laser or freezing treatment. The band remains around the eye but it does not cause pain and it cannot be seen. Typically, the band does not need to be removed. During this operation, sometimes fluid must be drained from underneath the retina to allow the retina to settle back onto the eye wall. In some complex retinal detachments it is necessary to use a technique called vitrectomy. The retina specialist cuts the vitreous away from the retina and removes the shrunken vitreous. This procedure removes or releases the fibers that are tugging on or growing over the retina. The fibers and vitreous are removed and replaced with either saline, a temporary gas bubble or a silicone bubble. Detachments treated with this technique sometimes represent some of the most complex retinal detachments that retina specialists deal with, and decisions are made on an individual case-by-case basis regarding the technique that will be used in each patient's care.

What is the success rate for repair of a retinal detachment?

About 80 - 85% of all retinal detachments can be reattached by modern surgical techniques. Sometimes more than one operation is required due to the formation of scar tissue after retinal detachment surgery. This occurs in about 10% of patients and typically happens within three to four weeks following surgery. If scar tissue occurs and causes the retina to re-detach, more procedures may be needed in order to reattach the retina.

What are the risks and potential complications with treatment for tears and retinal detachments?

The risks and potential complications include infection, scar tissue, eye pressure problems, damage to nearby structures such as the lens and bleeding.

What sort of vision can I expect after retinal detachment surgery?

After treatment your eye needs time to heal. Although a repaired retina may be in place within a few days, vision can take months to become stable. During the first few days after treatment for a retinal tear, your eye may be red and irritated. If you are treated for a retinal detachment, the eye may be red and swollen and sometimes painful. You are given medications to control your pain and prevent infection. Approximately 40% of patients with successfully treated retinal detachments achieve good vision. The remainder of patients attain varying amounts of reading and/or traveling vision, depending upon the condition of the retina when the surgery is done.

When can I resume my normal activities?

Most patients can expect to return to work and perform many of their normal activities within two to four weeks. If a gas bubble has been placed inside the eye, your doctor will instruct you on restrictions regarding airplane travel. If you have a gas bubble in the eye, you are to let an anesthesiologist know if you are to have any type of general anesthesia. This should be discussed with your doctor.

How many follow-up visits do I typically have after a retinal detachment?

If a retinal tear has been treated, typically patients are seen one to two weeks after treatment and scheduled for follow-up visits over the next two to three months. If you have had an operation for a retinal detachment, you are seen the next day, and again scheduled for follow-up visits over the next two to three months at varying intervals, depending on how you are progressing.

When should I be concerned after a retinal tear or detachment?

1. If you have had surgery and the pain worsens with time.
2. If the swelling or redness increases.
3. If the eye has an increasing amount of discharge.
4. If the vision suddenly worsens, you should call your doctor's office.