Retinal Detachment

What is retinal detachment?

Retinal detachment is separation of the retina from the tissues under it. (The retina is the lining at the back of the eye that senses light coming into the eye.) A retinal detachment is very serious and needs to be treated promptly to save your vision.

What is the cause?

• Eye problems that may increase the risk of retinal holes and tears include nearsightedness, eye injuries, and some types of eye surgery, such as cataract surgery.
• Swelling, infection, tumor, abnormal blood vessels, and other rare conditions can cause fluid to leak into the space between the wall of the eye and the retina.
• Scar tissue inside the eye can pull the retina off the wall of the eye. Diabetes, long-term swelling, eye injuries, or surgeries can cause this to happen.
• The gel in the center of the eyeball, called the vitreous, develops pockets of fluid as we age. When the pocket of fluid is in the very back of the eye, the vitreous can pull away from the retina. If the vitreous pulls on a thin or weak area, the fluid can get under the retina and lift the it off the wall of the eye. If this type of detachment is not treated, it will cause blindness.

What are the symptoms?

If you have a retinal detachment caused by holes or tears, the most common first symptom is seeing a lot of new flashes and floaters. Many people have a gradual loss of peripheral (side) vision without pain. Often the loss of vision appears like a curtain that is slowly being pulled across the front of the eye. If not treated, your vision becomes dark all over. This may take hours or months.

In the other types of retinal detachment, you may have a gradual vision loss over a long period of time.

How is it diagnosed?

Your eye care provider will ask about your symptoms. He or she will dilate your pupils using drops and use a special lens and lighted instrument to examine the inside of your eyes. A detached retina cannot be seen without these special instruments. Therefore, you should see an ophthalmologist (a medical doctor who specializes in eyes) as soon as you think you have a problem with your vision.

In some cases, an ultrasound of the eye is needed.

How is it treated?

If retinal detachment is caused by swelling or infection, treating those problems may be all that is needed. Other types of retinal detachment are usually treated with surgery. There are 3 main ways to treat the problem.

• The eye surgeon may inject a gas bubble into the eye to push the retina back in place. The tears in the retina are sealed with cryopexy (freezing) or a laser (often done the following day). Although this is the least invasive procedure with the quickest recovery, the success rate is lower than other forms of treatment.
• The eye surgeon may place a silicone band under the eye muscles around the eye. This makes the eye wall push against the retina. This is often a less comfortable procedure. It is done in an operating room, and it has some risks. However, it is successful most of the time.
• The eye surgeon may cut the vitreous away from the retina to stop the pulling. The surgeon then fills the eyeball with air, gas, or silicone oil to push the retina back against the wall of your eye. Over time, the air or gas is replaced with the eye's own fluids. If silicone oil is used, it needs to be removed during a second operation several months later.

When you have surgery, your eye is numbed and you may be given a sedative or be put in a deep sleep with a general anesthetic. For most of the procedures, you can go home the same day.

While you recover, you will usually need to keep your head in a certain position (such as face down or to one side) for several days or weeks so your retina attaches properly. Your provider will tell you what position to rest your head in, how long you need to do this each day, and for how many days or weeks. There are companies that sell special furniture that can help you keep your head positioned comfortably. Ask your provider for more information.

You may need other minor procedures as well. Your eye care provider will check your eyes often.

How long will the effects last?

Your vision will probably be very blurry after surgery. It may take several weeks or months for the blurriness to go away.

Surgery to repair a detached retina is successful in most cases. However, because the retina is very delicate and complex, there is almost always some degree of permanent damage.

Around 10 to 15% of people who have surgery will need more surgery. Sometimes scar tissue forms or there is trouble with recovery. If your vision gets worse or you start having new vision problems after surgery, let your provider know. Rarely, a retinal detachment cannot be repaired successfully due to severe scarring.

How can I take care of myself?

Follow your provider's instructions after surgery to help your eye heal. You will need to:

• Keep your head in the position recommended by your provider for as long as instructed (usually a few weeks).
• Use the eyedrops or ointment prescribed by your provider.
• Limit your activities for a few days to a couple of weeks.

Several weeks after surgery, after your eye has completely healed, you can have your eyeglasses prescription checked to see if you need to change it.

If you have had retinal detachment in one eye, your risk of retinal detachment in the other eye is greater. See your eye care provider regularly so that any problems in your other eye can be corrected before they become more serious.

How can I help prevent retinal detachment?

If you are very nearsighted or have a family history of retinal detachments, see your eye care provider regularly. While you cannot prevent some changes in your eyes, finding and treating holes and tears promptly helps prevent retinal detachment.