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Retinal Detachment

Retinal Detachment is a medical emergency which could cause permanent blindness. The longer it goes untreated the greater the risk of permanent vision loss in the affected eye. If you are experiencing any of the below signs and symptoms, please find immediate medical attention. You may call our office 24/7 and we can help you. If you call us after hours, please press 2 and leave an urgent message for the on-call doctor and we will get back to you right away.

What is a Retinal Detachment?

Retinal detachment is an emergency condition where the neuro-sensory tissue in the back of the eye (retina) separates from its blood supply.

There are three different kinds of retinal detachment

  • Rhegmatogenous retinal detachment (most common, accounting for 90% of all retinal detachments)
  • Tractional retinal detachment
  • Exudative retinal detachment (Serous retinal detachment)

 

Retinal Detachment - NYC RetinaWhat is a rhegmatogenous retinal detachment?

Rhegmatogenous detached retinas are the most common detachments and happen because of a hole or tear in the retina, usually in the peripheral retina. Holes or tears, in turn, can happen because of pulling by the liquifying vitreous gel (a normal aging change) or can be traumatic. They usually occur due to the former. Once a tear is formed, fluid can get underneath the retina, and cause it to detach. The portion of the retina that is detached does not have normal vision and is often described by patients as “a veil, curtain or shadow coming over the vision”.

There are several ways in which retinal detachments can be repaired, depending on many factors such as the age of the patient, the location, distribution and number of retinal breaks, among others.

Pneumatic retinopexy is an in-office procedure in which gas is injected into the vitreous cavity to re-attach the retina and cryopexy (freezing), or laser, is used to demarcate or weld around the retinal break. This seals the break to the wall of the eye and is the key step in repairing a retinal detachment.

Surgical correction of a detached retina includes vitrectomy surgery. Vitrectomy is where most of the vitreous gel is removed, and the retina flattened from the inside of the eye. The laser is then used to seal the retinal tears. Finally, an inert gas bubble or silicone oil bubble are used to fill the vitreous cavity in the eye. This bubble serves to push the retina back into the correct position. A gas bubble lasts about a month and goes away on its own. An oil bubble is usually left in the eye for 3-6 months, but sometimes longer or shorter, and needs a separate procedure to remove the oil in the future. The goal is for the retina to stay reattached once the gas bubble goes away or once the oil bubble is removed.

Another procedure for repair of retinal detachment is a scleral buckle. A scleral buckle is a thin silicone band that is placed around the eye, like a belt, and supports the retina from the outside. It is placed behind the eyelids, and under the conjunctiva and tenon capsule (clear/white external “skin” layer of the eye) and, therefore, is not seen.  The retinal tears are supported on the scleral buckle, thus sealing them to the wall of the eye and repairing the retinal detachment. The retinal tears are usually sealed with cryopexy (freezing) that is done from outside the wall of the eye. Scleral buckles can be used to repair retinal detachments with or without drainage of the subretinal fluid.

Some detached retinas necessitate the combination of a scleral buckle and vitrectomy. Your retina specialist will examine you and tailor an individualized surgical plan.

An important factor in the visual prognosis of patients with a rhegmatogenous retinal detachment is the involvement of the macula, the center of the retina. Patients in whom the macula is not involved with the detachment at the time of diagnosis, usually have preserved central vision and have a better prognosis for good vision postoperatively. Once the macula is detached and central vision affected, the prognosis for recovery of central vision is more guarded, though patients often can regain good visual acuity over time.

 

What is a tractional retinal detachment?

Tractional detachments are commonly seen in diabetes but can occur in other retinal diseases that are characterized by loss of the normal blood supply to the retina over time.

In diabetes, the high sugar content of the blood causes structural changes to occur in the retina. Over time, the peripheral retina (which is responsible for one’s peripheral vision) becomes ischemic, or without normal blood supply. In response, various biochemical cascades are activated, causing the formation of abnormal, new blood vessels. These abnormal, new blood vessels are trying to solve the problem of a poor blood supply, but instead, just cause problems. They grow in a disorderly fashion, often into the vitreous cavity and can frequently bleed. If the disease continues to progress without treatment, these new, abnormal vessels regress, leaving behind scar tissue which can pull on the retina and elevate it, causing a tractional retinal detachment.

Tractional retinal detachments are repaired by releasing the scar tissue and traction on the retina with surgery, allowing the retina to settle back into its anatomic position. Because there must be advanced retinopathy to develop a tractional retinal detachment, even when such detachments are repaired successfully, vision may be limited because of long-standing impaired circulation in the retina.

 

What is an exudative retinal detachment or serous retinal detachment?

Exudative retinal detachments are the accumulation of fluid under the retina, without a full-thickness break in the retinal tissue itself.
Seriously detached retinas can be associated with diseases such as Central Serous Chorioretinopathy, inflammatory (uveitis) or infectious diseases of the retina.

Tumors in the retina or choroid can also present with an accompanying serous retinal detachment. Often, exudative detached retinas are treated by addressing the underlying cause of the subretinal fluid, though there are cases when serous detachments of the retina need to be surgically drained.

 

How is a Detached Retina Diagnosed?

You cannot see a detached retina from outside the eye, nor do they cause pain. Only a dilated eye exam can diagnose retinal tears and retinal detachment. Diagnosis is made by looking in your eye using a lighted magnifying instrument and a lens to examine the retina, which is the inside back of the eye. Other diagnostic instruments that aid in diagnosis includes OCT, fundus photography and ultrasound.

 

What are the Causes of a Retinal Detachment?

While retinal detachments can happen at any age, especially in people who are nearsighted, it tends to be more common for people who are over 40 years old. Men are more affected by retinal detachment than women, and Caucasians more than African Americans.

Rhegmatogenous Retinal Detachment Causes

Although holes or tears can occur after trauma to the eye, the large majority of rhegmatogenous retinal detachment occur spontaneously, not in the setting of any trauma to the eye. They usually occur due to pulling of the liquifying vitreous gel on the retina (a normal aging change) which in turn causes a retinal tear.  Once a retinal tear is formed, fluid can get underneath the retina, and cause it to detach. This process is painless, but almost always cause changes in vision.

Tractional Retinal Detachment Causes

A growth or build up of scar tissue growing on the retina can pull on the retina and cause it to detach. This type of retinal detachment is most commonly associated with patients who have uncontrolled diabetes. When this happens in the setting of diabetic retinopathy it often requires surgery to repair.

This can also happen as an abnormal healing response, called proliferative vitreoretinopathy, in the setting of a rhegmatogenous retinal detachment, before or after surgery. Ten percent of patients with rhegmatogenous detached retinas develop this abnormal healing response for unknown reasons and usually need surgery to remove the scar tissue and repair the retina.

Exudative Retinal Detachment Causes

Serous or Exudative retinal detachments can be associated with diseases such as Central Serous Chorioretinopathy, inflammatory (uveitis) or infectious diseases of the retina. Tumors in the retina or choroid can also present with an accompanying exudative retinal detachment.

 

What are the Signs and Symptoms of a Detached Retina?

Symptoms and signs of retinal detachment include:

  • New Floaters, often many or one big one
  • New Flashes
  • Seeing Spots
  • Loss of central and/or peripheral vision
  • Weak vision
  • A curtain or shadow in the side of your  vision

 

What are the Risk Factors?

Risk factors for retinal detachment include:

  • Aging
  • Previous retinal detachment
  • Severe nearsightedness (myopia)
  • Retinal detachment in family history
  • Lattice degeneration
  • Previous eye surgery, e.g. cataract surgery
  • >Diabetes

 

What are the Possible Treatments for Retinal Detachment?

There are several possible treatments for retinal detachment. Treatment depends on the type of detachment and severity:

Pneumatic Retinopexy: Pneumatic retinopexy is an in-office procedure in which gas is injected into the vitreous cavity to re-attach the retina and cryopexy (freezing) or laser is used to demarcate or weld around the retinal tear that leads to the detachment.

Scleral Buckling: A scleral buckle is a surgical correction of a retinal detachment in which a thin silicone band is placed around the eye like a belt, supporting the retinal tears from the outside of the eye. The scleral buckle, in addition to cryopexy (freezing) or laser to the retinal tears, with or without drainage of the subretinal fluid, repairs the retinal detachment. Scleral buckles are often the treatment of choice in young, nearsighted patients. Also, they are used in the setting of trauma, recurrent retinal detachments or proliferative vitreoretinopathy. Scleral buckles have been around for many decades and, in the proper setting, work very well.

Vitrectomy: Surgical correction of detached retinas includes vitrectomy surgery (removal of the vitreous gel), flattening the retina from the inside of the eye. A laser is used to treat the retinal tears and a gas or oil bubble is used to fill the vitreous cavity (the inside of the eye) to push the retina back into place. If a gas bubble is used, it usually goes away by itself between 4-8 weeks. If a silicone oil bubble is used it needs a second surgery to remove the silicone oil, often in 3-6 months. The goal is for the retina to remain attached, in its proper position, once the gas or oil is no longer there to support the retina.

 

Are there Preventative Steps or Measures to Avoid a Detached Retina?

Unfortunately, most retinal detachments cannot be prevented, only treated early. Avoiding trauma to the eye prevents traumatic rhegmatogenous detached retinas. However, as discussed above, retinal detachments due to trauma represent only a small percentage of all detachments. Most occur spontaneously and not in the setting of trauma.

Therefore, the following steps may help:

  • If you are very nearsighted, have regular, dilated eye exams.
  • If you have a family history of retinal problems, have regular, dilated eye exams.
  • If you experience:
    • A big, new floater
    • Many new floaters
    • New flashes or flashing lights
    • Curtain or shadow in part of your vision

Then you must come in immediately to a retina exam to make sure you do not have a retinal tear or retinal detachment that needs urgent treatment.

  • If you have a serious eye injury, have your eye doctor examine your retina.
  • Always wear safety eyewear during sports and other hazardous activities to prevent eye injury.

 

What are the Risks if a Retinal Detachment is Left Untreated?

If retinal detachment is left untreated there is a high risk that the entire retina may detachment which will likely lead to total, permanent vision loss in that eye. The longer it goes untreated in the affected eye, the greater the risk of permanent vision loss. This is an emergency medical condition and if you think you have any of the signs or symptoms please seek medical help immediately.

 

Are There Other Related Conditions to a Retinal Detachment?

  • Retinal Tears
  • Posterior Vitreous Detachment (PVD)
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NYC Retina is home to New York’s leading retina specialist team. Our highly-trained subspecialized ophthalmologists focus on diagnosis and treatment of a variety of retina and vitreous conditions. Treated conditions include posterior vitreous detachment, macular degeneration, macular hole, macular pucker, cancers of the eye, diabetic retinopathy, retinoblastoma, retinal detachment, and other eye traumas. Learn More »

Select Relevant Publications

Ana Suelves, Julia Shulman, Majida Gaffar, Ajey Jain and M. Elizabeth Hartnett. Practice Patterns in Ophthalmic Examinations for Retinopathy of Prematurity in the United States. Ophthalmology Research Article. 42279. Link to Article.

Patel NN, Shulman Julia, Chin KJ, Finger PT. Optical Coherence Tomography/Scanning Laser Ophthalmoscopy (OCT/SLO) Imaging of Optic Nerve Head Drusen. Investigative Ophthalmology & Visual Science. May 2007, Vol.48, 2476. Link to Article.

Shulman Julia, Kropinak M, Ritterband DC, Perry HD, Seedor JA, McCormick SA, Milman T. Failed Descemet-Stripping Automated Endothelial Keratoplasty Grafts: A Clinicopathologic Analysis. American Journal of Ophthalmology. 2009 Nov; Volume 148, Issue 5, Pages 752–759.e2. Link to Article.

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