What is retinal detachment?
Within the eye, the space between the lens and the back of the eye’s inner lining (retina) is filled with a kind of jelly, known as vitreous.
Vitreous fluid plays an important role in the processes leading to posterior vitreous detachment, retinal tear and retinal detachment.
The process of retinal detachment usually follows the same series of events:
- Posterior vitreous detachment
The vitreous usually sticks closely to the retina; however, the aging process involves a change in its composition. The jelly-like fluid shrinks slightly, gradually withdrawing from the retina. At some point is may release its hold on the retina (posterior vitreous detachment). This is a normal process that occurs suddenly. At the same time, bleeding within the vitreous or a retinal tear may sometimes take place
- Retinal tear
Vitreous detachment is a relatively normal phenomenon, but sometimes the posterior vitreous membrane is stronger at certain points and can pull the retina with it when shrinking, causing a retinal tear. Sometimes multiple tears can occur. This situation can lead to complete retinal detachment
- Retinal detachment
When there is a retinal tear, fluid from the vitreous cavity may pass through the tear and work its way under the retina so that the retina (or part of it) is pushed off the inner surface of the eye (retinal detachment). The released part of the retina can no longer function properly because it is no longer connected. Someone experiencing retinal detachment will see a dark, blurred spot which usually begins at the edges of the visual field before spreading
Retinal detachment: symptoms
The following symptoms may be experienced:
- ‘Floaters’: clouding of the vitreous can be experienced as dark dots, spots, hovering insects and cobwebs
- Flashes of light, as if a fluorescent lamp is turned on and off
- Failure of the visual field: a dark spot is seen through the corner of the eye, this dark area then expands
- Reduced vision: retinal detachment can cause vision to disappear, either gradually or very quickly. The dark spot at the corner of the eye grows; when it reaches the macular, meaning that the macular has also detached, all detailed vision is lost
Retinal detachment: causes
Retinal detachment can occur at any age, but some people are at an increased risk. The main causes are:
- High degree myopia (short-sightedness)
- Former retinal detachment in the other eye
- Former cataract surgery
- Hereditary factors
- Accident or head trauma
Retinal detachment: treatment
To check whether symptoms are associated with an actual detachment, an eye fundus examination will be performed.
- Posterior vitreous detachment treatment
In principle, this does not need treatment. However, if the patient finds the blurred vision or floaters highly irritating, a vitrectomy procedure might be discussed. During this surgical procedure the vitreous is removed along with the tensile forces that it exercises on other elements inside the eye. The newly emptied vitreous space must therefore be filled with gas or oil to supply the necessary pressure, as vitreous does not replace itself.
- Retina tear treatment
Retinal tears must be treated with laser beams (argon laser) when symptoms occur in order to prevent retinal detachment. This laser treatment involves securing the retina to the back of the eye all around the tear so that no moisture can get through and push the retina inwards, causing it to come loose.
- Retinal detachment treatment
In cases of retinal detachment, a comprehensive surgical procedure is necessary. Different methods are available:
- Conventional ablatio retinae surgery: (external procedure) this type of surgery is relatively common, especially when the patient still has his or her original lens. It does not involve cutting into the eyeball itself. The purpose of this procedure is to lower the pressure caused by vitreous seeping under the retina by placing a synthetic band (scleral buckle) around the outside of the eye, under the eye socket
- Vitreous and retinal surgery (vitrectomy) (internal procedure): this is the most common surgical procedure in cases of retinal detachment when the external procedure is insufficient (e.g. cloudy vitreous, multiple or large tears). For more information, look at the description under the posterior vitreous detachment section. The chances of success are high (approximately 90%). The field of vision usually makes a full recovery after successful surgery