Retinal Tear & Retinal Detachment

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Retinal Tear & Retinal Detachment

The retina lines the back wall of the eye, and is responsible for absorbing the light that enters the eye and converting it into an electrical signal that allows you to see. Many conditions can lead to a retinal detachment, in which the retina separates from the back wall of the eye. The typical symptoms of a retinal detachment include floaters, flashing lights, and a shadow in the peripheral vision that can move toward the center of vision. A variety of treatments are used to reattach the retina to the back wall of the eye including scleral buckling, vitrectomy, laser, or pneumatic retinopexy.

Types & Causes

In general, retinal detachments are classified based on the cause of the detachment: rhegmatogenous, tractional, or exudative.

Rhegmatogenous retinal detachments are the most common type. They are caused by holes or tears in the retina that allows fluid to pass through and collect underneath the retina, detaching it from its underlying blood supply. Retinal tears can develop when the vitreous gel separates from the retina as part of aging or in patients with abnormal thinning in the peripheral retina (lattice degeneration) or occasionally from trauma. Retinal tears often present with acute onset of flashes and floaters. Untreated retinal tears may progress to a retinal detachment.

Tractional retinal detachments are caused by scar tissue that grows over the retina and pulls the retina off the back wall of the eye. This type of retinal detachment may occur from diabetes or other conditions.

Exudative retinal detachments form when fluid leaks out of blood vessels and accumulates under the retina. This type of retinal detachment is uncommon and can occur in eyes with abnormal inflammation, tumors, or excessive leakage from abnormal blood vessels.

Risk Factors & Symptoms

Risk factors for developing a rhegmatogenous retinal detachment include:

• lattice degeneration (thinning in the peripheral retina)
• Severe near-sightedness
• Family history of retinal tears or retinal detachment
• Previous retinal detachment
• Previous eye surgery
• Tauma

The typical symptoms of a retinal detachment include floaters, flashing lights, and a shadow or curtain in the peripheral vision that can be stationary or progress to involve the center of vision. Less commonly, patients may not be aware of any changes in their vision. The severity of the symptoms is often related to the extent of the detachment.

Treatments

The goal of treatment is to reattach the retina to the back wall of the eye and seal the tears or holes that caused the retinal detachment. Several methods can be used to repair a retinal detachment:

Scleral buckle: In this surgery, a silicone band is placed outside the eye wall of the eye near the retinal tear in order to close the tear. The tear is treated with a freezing probe to induce controlled scarring around the tear and permanently seal it. A small gas bubble may be placed in the eye to help seal the retinal break.

Vitrectomy: In this surgery, three small incisions are made in the white part of the eye and fine instruments are used to remove the vitreous gel that fills the eye and drain the fluid from under the retina. The surgeon may then use a laser or a freezing probe to seal the retinal breaks. The eye is then filled with a gas bubble or silicone oil to hold the retina in place while it heals.

Pneumatic retinopexy: In this office-based procedure, a gas bubble is injected into the eye and the patient maintains a specific head position to place the gas bubble over the retinal tear. The tear itself is sealed either with a freezing treatment at the time of the procedure, or with laser after the retina is reattached.

Laser: When a retinal detachment is small or is not associated with significant symptoms of vision loss, laser may be used to wall off the detachment to prevent it from spreading. Based on the characteristics of the detachment, a retina specialist can determine which approach is most appropriate. In general, retinal detachment repairs succeed in about 90% of the time, though sometimes more than one procedure is required to successfully put the retina back into place. The visual results depend on each patient’s preoperative vision and other factors that differ between individual patients. In general, when the center of the retina has not detached before surgery, the post-operative vision tends to be similar to the pre-operative vision. If the central retina is detached prior to surgery, successful re-attachment often leads to vision improvement, though some degree of permanent vision loss may occur.

After treatment for a retinal tear or detachment, patients are typically advised to refrain from strenuous activities for several days. If a gas bubble is used for your surgery, head positioning and altitude restrictions are usually required. Your Colorado Retina surgeon will discuss your individualized instructions in detail prior to surgery.

Testing & Diagnosis

A Colorado Retina specialist will perform a detailed eye exam including a careful examination of the peripheral retina. This may require pushing on the outside of the eye to view the far peripheral retina where tears are likely to occur. Photographing the retina is sometimes performed to document the extent of the detached retina, and an optical coherence tomography scan of the retina can be useful to determine whether fluid has reached the center of the retina. When a clear view of the retina is not possible, an ultrasound of the eye can be helpful.

Post Treatment

After treatment for a retinal tear or detachment, patients are typically advised to refrain from strenuous activities for several days. If a gas bubble is used for your surgery, head positioning and altitude restrictions are usually required. Your Colorado Retina surgeon will discuss your individualized instructions in detail prior to surgery.

Conclusion

In summary, a variety of conditions predispose individuals to retinal tears and detachments. It is important to recognize symptoms of flashes, floaters, and shadows in your vision and see your Colorado Retina physician promptly for a thorough, dilated eye exam. Early treatment can usually prevent permanent vision loss and blindness.