Retinal Detachment – Causes, Symptoms and Treatment
Retinal detachment is a serious eye condition in which the retina separates from the back of the eye and can lead to permanent vision loss if left untreated.
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Retinal detachment is a serious eye condition in which the retina separates from the back of the eye and can lead to permanent vision loss if left untreated.
What is Retinal Detachment?
Retinal detachment (Latin: Ablatio retinae or Amotio retinae) is a sight-threatening eye condition in which the retina – the thin, light-sensitive tissue lining the back of the eye – separates from the underlying choroid (the layer of blood vessels that supplies it with oxygen and nutrients). Without prompt treatment, the lack of nourishment causes retinal cells to die, resulting in permanent vision loss or blindness. Retinal detachment is considered an ophthalmic emergency.
Causes
There are three main types of retinal detachment, each with different underlying causes:
Rhegmatogenous Retinal Detachment
This is the most common form. A tear or hole in the retina allows fluid from the vitreous humor (the gel-like substance filling the eye) to seep behind the retina and lift it away. Risk factors include:
- High degree of short-sightedness (myopia)
- Previous eye surgery (e.g., cataract surgery)
- Eye injury or trauma
- Posterior vitreous detachment, especially in older adults
- Family history of retinal detachment
Tractional Retinal Detachment
Scar tissue on the surface of the retina pulls it away from the back of the eye. This type is commonly associated with diabetic retinopathy or previous eye inflammation.
Exudative (Serous) Retinal Detachment
Fluid accumulates beneath the retina without a tear or break, often due to inflammation, tumors, or vascular diseases of the eye.
Symptoms
Retinal detachment produces characteristic warning signs that should never be ignored:
- Flashes of light (photopsia): Sudden flickering or flashing lights, especially in the peripheral vision
- Floaters: A sudden increase in dark spots, dots, or cobweb-like shapes drifting across the visual field
- Shadow or curtain effect: A dark veil or curtain descending over part of the visual field, indicating an existing detachment
- Blurred or distorted vision
- Partial or complete loss of vision in one eye
Retinal detachment is generally painless. Anyone experiencing these symptoms should seek immediate medical attention.
Diagnosis
Diagnosis is made by an ophthalmologist using several examination methods:
- Ophthalmoscopy (fundoscopy): Direct visualization of the retina after pupil dilation
- Slit-lamp examination with special contact lenses to assess peripheral retinal areas
- Ultrasound (B-scan sonography): Used when the view of the retina is obscured, for example by a vitreous hemorrhage
- Optical coherence tomography (OCT): High-resolution cross-sectional imaging of retinal layers, especially useful for macular assessment
Treatment
Retinal detachment always requires surgical treatment, which should be carried out as soon as possible. The choice of procedure depends on the type, size, and location of the detachment:
Laser Photocoagulation and Cryotherapy
For small retinal tears or holes without significant detachment, laser or freezing treatment can seal the break and prevent progression to full detachment.
Pneumatic Retinopexy
A gas bubble is injected into the vitreous cavity. By maintaining a specific head position, the bubble presses the detached retina back into place, while laser or cryotherapy seals the break.
Scleral Buckling
A silicone band or sponge is sutured to the outside of the eyeball to indent the sclera (white of the eye), reducing the pull on the retina and helping it reattach. This method is particularly suitable for peripheral breaks.
Vitrectomy
The vitreous gel is surgically removed and replaced with a gas bubble or silicone oil to press the retina back into position. This technique is preferred for complex cases, macular involvement, or tractional detachment.
The visual outcome depends greatly on whether the macula (the central area responsible for sharp vision) is involved. When treated before macular detachment occurs, the prognosis for preserving good central vision is favorable.
References
- American Academy of Ophthalmology (AAO): Preferred Practice Pattern – Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration. AAO, 2019.
- Heimann H, Bartz-Schmidt KU, Bornfeld N et al.: Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment. Ophthalmology 2007; 114(12): 2142–2154.
- Ryan SJ et al.: Retina. 5th edition. Elsevier Saunders, 2012.
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