Retinal Detachment Causes, Symptoms, Signs, Diagnosis, Complications, Treatment And Prevention

Retinal Detachment Causes, Symptoms, Signs, Diagnosis, Complications, Treatment And Prevention

Retinal Detachment

Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness. It is a medical emergency.Permanent damage may occur, if the detachment is not repaired within 24-72 hours.

Retinal Detachment Causes, Symptoms, Signs, Diagnosis, Complications, Treatment And Prevention

The retina is a thin layer of light sensitive tissue on the back wall of the eye. The optical system of the eye focuses light on the retina much like light is focused on the film or sensor in a camera. The retina translates that focused image into neural impulses and sends them to the brain via the optic nerve. Occasionally, posterior vitreous detachment, injury or trauma to the eye or head may cause a small tear in the retina. The tear allows vitreous fluid to seep through it under the retina, and peel it away like a bubble in wallpaper.

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Causes of retinal detachment 

The most common cause of retinal detachment is when tiny holes develop inside the retina.

The holes allow the fluid found between the retina and the lens of the eye to leak underneath the retina.
If too much fluid builds up underneath the retina it can cause the retina to pull away from the blood vessels that supply it with blood. Without a constant blood supply, the nerve cells inside the retina will begin to die.
The main reason for these holes developing is thought to be because the retina becomes narrower and weakened with age.

People who are very short-sighted have the greatest risk of developing age-related retinal detachment (though in relative terms the risk is still very small) because they are often born with a thinner than normal retina in the first place.

Previous eye surgery, such as cataract removal, may also make the retina more vulnerable to damage.
In some cases, holes can develop if the eye is suddenly injured, such as by a punch to the face or being accidentally hit in the eye with a flying object.

Less common causes of Retinal Detachment

Less common causes of retinal detachment include:

  • Damage to the blood vessels in your eye causes scar tissue to form, which can pull the retina out of position. This is usually the result of a complication of diabetes, called diabetic retinopathy.
  • The retina remains unbroken but fluid from other sources gathers behind the retina. This can sometimes occur in conditions that cause inflammation and swelling inside the eye, such as uveitis and some rare types of cancer that develop inside the eye.

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What are the different types of retinal detachment?

There are three different types of retinal detachment:

  • Rhegmatogenous [reg-ma-TAH-jenous] -- A tear or break in the retina causes it to separate from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina, and fill with fluid. These types of retinal detachments are the most common.
  • Tractional -- In this type of detachment, scar tissue on the retina's surface contracts and causes it to separate from the RPE. This type of detachment is less common.
  • Exudative -- Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina (subretina).

Symptoms of Retinal Detachment:

  • Transient flashes of light (photopsia)
  • Muscae Volitantes
  • Distortion of objects
  • Shadow or cloud is seen in front of the eye
  • Dimness of vision.

Who is at risk for retinal detachment?

Although anyone can experience a retinal detachment, people with certain eye conditions are at increased risk. Some examples of these conditions include posterior vitreous detachment, lattice degeneration, x-linked retinoschisis, degenerative myopia, and uveitis. Injuries to the eye or head can also cause retinal detachment.

Which diseases of the eyes predispose to the development of a retinal detachment?

Lattice degeneration of the retina is a type of thinning of the outside edges of the retina, which occurs in 7% to 10% of the general population. The lattice degeneration, so-called because the thinned retina resembles the crisscross pattern of a lattice, often contains small holes. Lattice degeneration is more common in people with nearsightedness (myopia). This tendency to lattice degeneration occurs because myopic eyes are larger than normal eyes and, therefore, the peripheral retina is stretched more thinly. Fortunately, only about 1% of patients with lattice degeneration go on to develop a retinal detachment.

High myopia (greater than 5 or 6 diopters of nearsightedness) increases the risk of a retinal detachment. In fact, the risk increases to 2.4% as compared to a 0.06% risk for a normal eye at 60 years of age. (Diopters are units of measurement that indicate the power of the lens to focus rays of light.) Cataract surgery or other operations of the eye can further increase this risk in those with high myopia.

People taking certain kinds of eyedrops have an increased risk of developing a retinal detachment. Pilocarpine (Salagen), which for many years was a mainstay of therapy for glaucoma, has long been associated with retinal detachment. Moreover, by constricting the pupil, pilocarpine makes the diagnostic exam of the peripheral retina more difficult, possibly leading to a delay in the diagnosis.

Individuals with chronic inflammation of the eye (uveitis) are at increased risk of developing retinal detachment.

Signs and Diagnosis of Retinal Detachment:

Retinal Detachment Causes, Symptoms, Signs, Diagnosis, Complications, Treatment And Prevention
1. Plan mirror examination: There is defective or no red glow seen

2. Fundus examination: The detached retina looks greyish white and raised above the surface, the retinal vessels are dark with no central light reflex, the detached retina oscillates with the movement of the eye, one or more holes are commonly seen in the upper temporal region, in total retinal detachment the retina is funnel shaped being attached to the disc and ora serrata, it is grey in colour.

3. Visual fields: Scotomas (dark spots) appear corresponding to the area of detached retina

4. Electroretinography (ERG) It is subnormal or absent

5. Ultrasonography (B scan): it confirms the diagnosis of retinal detachment in cases when retina can't be visualised for example, mature cataract, corneal opacity or vitreous opacities.

How does cataract surgery lead to a retinal detachment?

Cataract surgery, especially, if the operation has complications involving the vitreous, increases the risk of a retinal detachment. Cataracts create a cloudiness (opacity) within the lens. In cataract surgery today, the goal is to leave much of the capsule of the natural lens in place. Phacoemulsification, the most common procedure, utilizes a very high speed ultrasonic instrument to break up and suck out the clouded lens material inside the capsule. The new intraocular lens (IOL) is then placed within the capsule. The IOL and intact capsule help to support the vitreous gel which fills the back of the eye. Movement of the vitreous gel is a key factor in retinal detachments because the vitreous movement can place traction on the retina and lead to a hole or tear which can be the start of a detachment. Although cataract surgery does increase the chance of retinal detachment, the risk is low, that is less than 2 % over 20 years; and the benefits of cataract surgery ordinarily far outweigh the risk of retinal detachment.

Complications Of Detached Retina

1. Total Retinal Detachment may occur
2. Proliferative vitreo-retinopathy
3. Complicated Cataract
4. Chronic Uveitis
5. Phthisis bulbi may occur.

Treatment of Detached Retina

The mainstay of treatment is to approximate and adhere the torn part of the retina to the area of choroid by exciting aseptic inflammation of choroid.

following methods are used.

1. Photocoagulation:

2. Cryosurgery: It is done to seal the retinal breaks by causing tissue necrosis.

3. Scleral Buckling

4. Drainage of sub retinal fluid

5. Pars Plana Vitrectomy: It breaks the tractional fibrous band in the vitreous, thus releasing the pull on the retina in cases of tractional retinal detachment.

6. Pneumoretinopexy: Air or other suitable gas such as SF6 or silicon oil is used as a vitreous substitute to produce internal temponade which pushes the retina back to its position.

Why is it mandatory to treat a retinal detachment?

A tear or hole of the retina that leads to a peripheral retinal detachment causes the loss of side (peripheral) vision. Almost all of those affected will progress to a full retinal detachment and loss of all vision if the problem is not repaired. The dark shadow or curtain obscuring a portion of the vision, either from the side, above, or below, almost invariably will advance to the loss of all useful vision. Spontaneous reattachment of the retina is rare.

Early diagnosis and repair are urgent since visual improvement is much greater when the retina is repaired before the macula or central area is detached. The surgical repair of a retinal detachment is usually successful in reattaching the retina, although more than one procedure may be necessary. Once the retina is reattached, vision usually improves and then stabilizes. Successful reattachment does not always result in normal vision. The ability to read after successful surgery will depend on whether or not the macula (central part of the retina) was detached and the extent of time that it was detached.

Can a Detached Retina Be Prevented?

Yes, in some cases.

Getting an eye exam can flag early changes in your eyes that you may not have noticed. Treating those changes can help.

You should get your eyes checked once a year, or more often if you have conditions such as diabetes that make you more likely to have eye disease. Regular eye exams are also important if you are very nearsighted, as nearsightedness makes retinal detachment more likely.

If you have diabetes or high blood pressure, keeping those conditions under control will help the blood vessels in your retina, which is good for your eyes.

Not sure how often you should get your eyes checked? Ask your eye doctor.

You should also use the appropriate eye protection for certain activities. For instance, you should wear sports goggles with polycarbonate lenses while playing racquetball or certain other sports. You may also need eye protection if you work with machines, chemicals, or tools at work or home.