Retinal detachment occurs when theretina, a light-sensitive membrane, separates from the back of the eye.
When light passes through your eye, the lens focuses an image on your retina. The retina, which is located at the back of the eye, converts the image to signals that it sends to your brain through theoptic nerve. The retina works with the cornea, lens, and other parts of your eye and brain to produce normal vision.
所以,当从后面的视网膜分离eye, this causes loss of vision that can be partial or total, depending on how much of the retina is detached. When your retina becomes detached, its cells may be seriously deprived of oxygen.
Retinal detachment is a medical emergency. Call your doctor right away if you suffer any sudden vision changes.
There are three types of retinal detachment:
- rhegmatogenous
- tractional
- exudative
There’s a risk of permanent vision loss if retinal detachment is left untreated or if treatment is delayed.
There’s no pain associated with retinal detachment, but there are usually symptoms before your retina becomes detached. Primary symptoms include:
- blurred vision
- partial vision loss, which makes it seem as if a curtain has been pulled across your field of vision, with a dark shadowing effect
- sudden flashes of light that appear in one or both eyes
- suddenly seeing manyfloaters, which are small bits of debris that appear as black flecks or strings floating before your eye
Symptoms of retinal detachment typically occur quickly. If the issue isn’t addressed immediately then you may be at risk of more of the retina detaching, which may increase your risk of vision loss.
Types of retinal detachment differ based on the state of your retina, and whether it’s caused by a tear, scar tissue, or disease.
Rhegmatogenous retinal detachment
If you have a rhegmatogenous retinal detachment, you have a tear or hole in your retina. This allows fluid from within your eye to slip through the opening and get behind your retina.
The fluid separates the retina from the retinal pigment epithelium, which is the membrane that provides your retina with nourishment and oxygen, causing the retina to detach.
This is the most common type of retinal detachment.
Tractional retinal detachment
Tractional retinal detachment occurs when scar tissue on the retina’s surface contracts and causes your retina to pull away from the back of your eye. This is a less common type of detachment that typically affects people withdiabetes mellitus.
Poorly controlled diabetes mellitus can lead to issues with theretinal vascular system. This vascular damage can later lead to scar tissue accumulation in your eye that could cause retinal detachment.
Exudative detachment
In exudative detachment, there are no tears or breaks in your retina. Retinal diseases, such as the following, cause this type of detachment:
- an inflammatory disorder causing fluid accumulation behind your retina
- cancer behind your retina
- Coats disease, which causes abnormal development in the blood vessels. The blood vessels leak proteins that build up behind your retina.
Risk factors of retinal detachment
Anyone can usually experience retinal detachment, but there are a number of factors that may put you more at risk. These can include:
- family history of retinal detachment
- you’ve had a serious eye injury in the past
- have gone through eye surgery in the past (to treat cataracts, for instance)
- you’ve received a diagnosis of certain eye diseases
- you’re extremely nearsighted
- aging
Eye disease and general problems with your eyes may put you at higher risk of retinal detachment. These eye issues can include:
- diabetic retinopathy (diabetesaffects blood vessels in the retina)
- posterior vitreous detachment (gel-like fluid in the center of the eye pulls away from the retina)
- retinoschisis (retina separates into two layers)
- lattice degeneration (thinning of the retina)
To diagnose retinal detachment, your doctor will perform a thorough eye exam. They’ll check:
- your vision
- your eye pressure
- the physical appearance of your eye
- your ability to see colors
Your doctor may also test the ability of your retina to send impulses to your brain. They may check the blood flow throughout your eye and specifically in your retina.
Your doctor may also order anultrasound of your eye. This is a painless test that uses sound waves to create an image of your eye.
In most cases, surgery is necessary to repair a detached retina. In other cases of minor detachments or tears of the retina, a simple procedure may be done in your doctor’s office.
For tears of the retina, laser surgery (photocoagulation) and freezing (cryopexy) are the most common treatment options.
Photocoagulation
If you have a hole or tear in your retina but your retina is still attached, your doctor may perform a procedure called photocoagulation with a laser. The laser burns around the tear site, and the resulting scarring affixes your retina to the back of your eye.
Cryopexy
Another option is cryopexy, which is freezing with intense cold. For this treatment, your doctor will apply a freezing probe outside of your eye in the area over the retinal tear site, and the resulting scarring will help hold your retina in place.
If a larger part of your retina is detached, surgery will typically be recommended in order to move the retina back in place. The three most common surgeries are pneumatic retinopexy, scleral buckling, and vitrectomy.
Pneumatic retinopexy
Pneumatic retinopexy is done to repair minor detachments and can sometimes be done in your doctor’s office. First your doctor will typically put a numbing medicine in your eye so you feel no discomfort. The next steps include:
- Insert a tiny needle in the eye to extract a small amount of fluid.
- Inject a small amount of air into the eye so that a small bubble forms in the eye.
- Wait for the retina to move back into place and then repair any holes or tears with laser surgery or freezing.
The air bubble in the eye will disappear over time, but there are certain precautions to take after the procedure to make sure the eye heals completely.
While recovering, avoid intense exercise, flying in an airplane, or heavy lifting in order to not strain your body. You’ll also have a follow-up with your doctor so they can make sure your eye is healing correctly.
Scleral buckling
Scleral bucklingmay be done in more severe cases of retinal detachment. For this surgery, your doctor will typically give you anesthesia so you can sleep during the entire procedure. From there:
- A small and flexible band will be placed around thesclera(white part of the eye).
- The band will gently push the sides of the eye and towards your retina so it will reattach.
- The band will be attached permanently after the surgery.
- Laser surgery or freezing may be provided to repair any holes or tears.
The procedure is relatively simple, so you may be able to go home the same day. However, due to the anesthesia, you’ll need someone to drive you home.
In order to make sure your eye heals completely after surgery, you’ll need to:
- Wear an eye patch for at least one day after the surgery.
- Avoid any intense exercise.
- Have a follow-up visit with your doctor.
Vitrectomy
Vitrectomyis a surgery similar to pneumatic retinopexy, but is used for larger tears and usually needs to be performed in an outpatient surgery center. You’ll be given anesthesia so you can sleep through the procedure. The next steps can include:
- A small incision will be made in the sclera of the eye.
- A microscope will be inserted to see inside the eye.
- Any abnormalities such as scar tissue, vitreous (gel-like fluid), or cataracts will be removed.
- The retina will be put back in its place with a gas bubble.
- Laser surgery or freezing will be done to repair any holes or tears.
Severe pain is extremely rare after the procedure, but you may experience some discomfort. In some cases, you’ll be able to go home that same day as long as someone else can drive you home. In other cases, you may have to stay overnight.
You’ll need to wear an eye patch for a few days after the procedure to make sure the eye heals completely. Avoid anystrenuous activities.
In general, there’s usually no way to prevent retinal detachment. However, you can take steps to try to avoid retinal detachment that results from injury or disease. These can include:
- wearing protective eyewear when playing sports, doing any heavy lifting, or using tools
- controlling your blood sugar if you have diabetes
- getting dilated eye exams regularly
It’s also important to know the symptoms of retinal detachment and visit your doctor immediately if signs present themselves.
The outlook depends on the severity of the condition and how quickly you get expert medical care.
Some people will recover completely, especially if their macula isn’t damaged. The macula is the part of the eye responsible for the clearest vision and is located near the center of the retina. Some people may not regain full vision if their macula is damaged and treatment isn’t sought quickly enough.
However, if the condition is addressed in a timely manner, retinal detachment surgery has generally high success rates. Depending on the severity of the tear, your doctor will consult with you and recommend which treatment option may be best for you.