Retinal detachment

What is it?

A retinal detachment is a medical emergency requiring immediate treatment. In this separation of the light sensitive membrane in the back of the eye (retina) becomes separated from its supporting layers (the outermost pigment layer).

What are the causes?

The following conditions may cause retinal detachment: Scarring or shrinkage of the vitreous (the jelly like substance in the eye) can pull the retina inward. Small tears in the retina allow liquid to seep behind the retina and push it forward. Injury to the eye can knock the retina loose. Bleeding behind the retina, most often due to diabetic retinopathy or injury, can push it forward. Retinal detachment may be spontaneous, which occurs most often in the elderly or in very near sighted (myopic) eyes. Tumours.

What are the symptoms?

Retinal detachment causes a sudden defect in vision; it appears as though a shadow has fallen across the eye. There may be bright flashes of light, in the peripheral areas of vision. Sometimes, translucent specks of various shapes (floaters) are seen in the eye. The vision may become blurred.

What are the risk factors?

Those at risk for developing retinal detachment include: Nearsighted (myopic) adults People over 50 years of age Those who have had an eye injury After cataract surgery People with a family history of retinal detachment

How is the diagnosis made?

If the eye is clear, a detachment can be seen by looking into the eye with a hand-held instrument called an ophthalmoscope. Other special lenses also may be used to examine the back of the eyes. The commonest instrument used for examination is a binocular indirect ophthalmoscope.

What is the treatment?

The treatment of retinal detachment is by surgery. Several procedures are available. Laser can be used to seal the tears or holes in the retina that generally precede retinal detachment. The application of intense cold with an ice probe (known as cryopexy) leads to the formation of a scar that holds the retina to the underlying layer. Surgical reattachment involves indentation of the sclera to relieve pressure on the retina, allowing it to re-attach. This procedure is called scleral buckling.Sometimes, the eye may have to be entered to pump in air or gas to force the retina outward against the sclera. This is called pneumatic retinopexy, can generally be done under local anaesthesia and causes minimum discomfort. Sixty to 90% patients with retinal detachment can be treated by this method. If these methods are unsuccessful, or if there is disease in the vitreous, the vitreous may have to be removed and replaced with saline through a procedure called vitrectomy.

What is the prognosis?

The outcome depends upon the location and extent of the detachment and its early treatment. If the macula (the central, most sensitive part of the retina) has not detached, the results of treatment can be excellent. 5 to 10% of people will not get back their vision.

What are the prevention?

Regular eye examinations are important for patients with high myopia who are more prone to detachment. In diseases with a high incidence of retinal problem, such as diabetes, routine eye examinations can detect early changes in the eye that a patient himself may not sense.

DoctorNDTV Team

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