Retinal Tear and Detachment

What is Retinal Tear and Detachment?

The retina is a sensory tissue lining the inner surface of the eye. Retinal detachment is a serious condition that occurs when the inner layer of the retina separates from the eye wall.

Incoming light from the outside world triggers nerve impulses in the retina, which send visual information to the brain. When the retina detaches, the nerve cells have reduced functionality, potentially causing blurriness and vision loss.

Retinal detachment requires immediate medical care. If treated early on, vision can be restored.

Diagnosis

To diagnose retinal detachment, your doctor will examine your eyes and ask you questions regarding any symptoms you may be experiencing.

If you have experienced symptoms of retinal detachment, your doctor will use a lighted magnifying tool called an ophthalmoscope to examine your retina. With this tool, your doctor can detect holes, tears, or a complete retinal detachment. Alternatively, an ultrasound may be used if the patient has a dense cataract, the eye is filled with blood, or if the patient is uncooperative. The underlying cause of one particular brand of detachment called, rhegmatogenous retinal detachment, is a retinal break. To detect a break, an examination of the retinal periphery might be recommended, using an indirect ophthalmoscope and sclera depression.

Who is at risk?

Retinal detachment often begins when the thick fluid that fills the center of the eye, called the vitreous gel, shrinks and separates from the retina. This sometimes-harmless phenomenon is referred to as a posterior vitreous detachment (PVD) and often occurs with age. In cases where the vitreous gel is strongly attached to the retina, PVD’s can occasionally cause more severe damage. When the vitreous gel shrinks, it will create so much tension that the retina might tear. This tear allows fluid to collect under the retina, sometimes causing the retina to detach completely. The 3 forms of retinal detachment include: rhegmatogenous, tractional and exudative.

Other causes of retinal detachment include eye or head injury, nearsightedness (myopia), eye disease, and conditions such as diabetes.

Unfortunately, most cases of retinal detachment cannot be prevented. But you can reduce your risk of retinal detachment with regular visits to your eye doctor and by wearing protective helmets and eyeglasses. Also, if you suspect that you might have diabetes or have been diagnosed previously, proper treatment is crucial in risk reduction.

Signs and Symptoms

Many people experience symptoms of a posterior vitreous detachment before they have symptoms of retinal detachment. When the vitreous gel shrinks and separates from the retina, it causes floaters and flashes. Floaters are spots, specks, and lines that float across your field of vision. Flashes are brief sparkles or lightning streaks that are most easily seen when your eyes are closed. Floaters and flashes do not always mean that you will have a retinal detachment but they may be warning signs. It is best to be seen by a doctor if you experience an increase in these symptoms. Sometimes a retinal detachment occurs without warning. The first sign of detachment may be a permanent shadow across a portion of your vision field. Alternatively, you may experience a new and sudden loss of peripheral vision, which worsens over time.

Treatment

Retinal detachment requires immediate care. Without treatment, vision loss can progress, often resulting in blindness within hours or days. Surgery is the only way to reattach the retina. In most cases, surgery can restore a good amount of vision. There are several surgical methods, including the use of lasers or a freezing probe to seal the tear in the retina. In complex cases, a vitrectomy, characterized by the removal of the vitreous gel, may be required. Another method uses the injection of a gas or oil bubble to hold the retina in place during healing. A silicone band or scleral buckle may also be required. Patients must pay careful attention to post-operative instructions in order to increase their chances of success.

The goal of treatment is to reduce the risk of further vision loss while reversing current visual impairment. In complex or advanced cases, vision restoration may not be possible but the eye, itself, might be saved with surgery. Newer restorative treatments are now available for patients with complex retinal detachments. We specialize in these therapies here at the Retina Macula Institute.