by Mayo Clinic

Definition

Retinal detachment

Retinal detachment describes an emergency situation when a critical layer of tissue (the retina) at the back of the eye pulls away from the layer of blood vessels that provides it with oxygen and nutrients.

Retinal detachment leaves the retinal cells deprived of oxygen. The longer retinal detachment goes untreated, the greater the risk of permanent vision loss in the affected eye.

Fortunately, retinal detachment often has clear warning signs. If you go to an eye specialist (ophthalmologist) as soon as warning signs appear, early diagnosis and treatment of retinal detachment can save your vision.

Causes

Anatomy of the eye

Retinal detachment can occur as a result of:

• Sagging or shrinkage of the jelly-like vitreous that fills the inside of your eye
• Trauma
• Advanced diabetes
• An inflammatory disorder

How retinal detachment occurs
Retinal detachment can occur when vitreous liquid (vitreous humor) leaks through a retinal hole or tear and accumulates underneath the retina. Small retinal holes or tears can develop where the retina has thinned due to aging or with other retinal disorders. Retinal detachment due to a tear in the retina typically develops when there is a sudden separation of the vitreous from the retina. Less commonly, fluid can leak directly underneath the retina, without a tear or break.

As liquid collects underneath it, the retina can peel away from the underlying layer of blood vessels (choroid). The areas where the retina is detached lose their blood supply and stop functioning, so you lose vision.

Aging-related retinal tears that lead to retinal detachment
As you age, your vitreous humor may change in consistency and shrink or become more liquid. Eventually, the vitreous may sag and separate from the surface of the retina — a common condition called posterior vitreous detachment (PVD), or vitreous collapse.

As the vitreous separates or peels off the retina, it may tug on the retina with enough force to create a retinal tear. Left untreated, the tear can progress to a retinal detachment.

PVD can cause visual symptoms. You may see flashes of sparkling lights (photopsia) when your eyes are closed or when you're in a darkened room. New or different floaters may appear in your field of vision.

Risk factors

The following factors increase your risk of retinal detachment:

• Aging — retinal detachment is more common in people older than age 40
• Previous retinal detachment in one eye
• A family history of retinal detachment
• Extreme nearsightedness (myopia)
• Previous eye surgery, such as cataract removal
• Previous severe eye injury or trauma

Symptoms

Retinal detachment is painless, but retinal detachment symptoms almost always appear before it occurs. Retinal detachment symptoms may include:

• The sudden appearance of many floaters — small bits of debris in your field of vision that look like spots, hairs or strings and seem to float before your eyes
• Sudden flashes of light in one or both eyes
• A shadow or curtain over a portion of your visual field

When to see a doctor
Seek immediate medical attention if you suddenly notice retinal detachment symptoms, such as new floaters or flashes of light in your visual field or if it seems as if a dark curtain has fallen across your visual field.

Tests and diagnosis

Tests and procedures used to diagnose retinal detachment include:

• Using a bright light and special lens to see inside your eye. An ophthalmologist may be able to see a retinal hole, tear or detachment by looking at your retina with an ophthalmoscope — an instrument with a bright light and powerful lens that allows your doctor to view the inside of your eyes in great detail and in three dimensions.
• Creating a picture of your eye using sound waves. If blood in your vitreous cavity blocks the view of your retina, ultrasound examination may be useful. Ultrasonography is a painless test that sends sound waves through your eye to bounce off the retina. The returning sound waves create an image of your retina and other eye structures on a video monitor. This test usually provides the information your doctor needs to determine whether your retina is detached.

Treatments and drugs

Surgery is used to repair a retinal tear, hole or detachment. Your ophthalmologist can tell you about the various risks and benefits of your treatment options. Together you can determine what treatment is best for you.

Surgery for retinal tears
When a retinal tear or hole hasn't yet progressed to detachment, your eye surgeon may suggest an outpatient procedure, which can usually prevent retinal detachment and preserve almost all vision. Options include:

• Laser surgery (photocoagulation). During photocoagulation your surgeon directs a laser beam through a contact lens or ophthalmoscope designed for this procedure. The laser makes burns around the retinal tear, and the scarring that results usually "welds" the retina to the underlying tissue.
• Freezing (cryopexy). During cryopexy, your surgeon uses intense cold to freeze the retina around the retinal tear. After a local anesthetic numbs your eye, your surgeon applies a freezing probe to the outer surface of the eye directly over the retinal defect. This freezes the area around the hole, leaving a delicate scar that helps secure the retina to the eye wall.

After your procedure you'll need to remain relatively still for the next two weeks or so, as the bonds created by your procedure strengthen.

Surgery for retinal detachment
Doctors also use surgical procedures to repair retinal detachments. These procedures may be done in conjunction with photocoagulation or cryopexy. The type, size and location of the retinal detachment will determine which surgical approach your eye surgeon recommends. In general, these surgeries can successfully treat most cases of retinal detachment, although a second treatment is sometimes necessary.

Procedures include:

• Injecting air or gas into your eye. A procedure called pneumatic retinopexy involves injecting a bubble of air or gas into the vitreous. Over the next several days, the gas bubble expands, sealing the retinal tear by pushing against it and the detached area that surrounds the tear. With no new fluid passing through the retinal tear, fluid that had previously collected under the retina is absorbed, and the retina is able to reattach itself to the back wall of your eye. Depending on where the retinal detachment is located in your eye, you may need to hold your head in a certain position for several hours in order to keep the bubble in place.
• Indenting the surface of your eye. A procedure called scleral buckling involves suturing a piece of silicone rubber or sponge to the white of your eye (sclera) over the affected area. The silicone material indents the wall of the eye, relieving the tugging of the vitreous on the retina. When you have several tears or holes or an extensive detachment, your surgeon may create an encircling scleral buckle that goes around the entire circumference of your eye like a belt. The buckle usually remains in place for the rest of your life.
• Draining and replacing the fluid in the eye. A vitrectomy is a procedure to remove the gel-like fluid in the center of the eye, along with any tissue that is tugging on the retina. Air, gas or liquids are injected into the vitreous cavity to reattach the retina. A vitrectomy is often combined with a scleral buckling procedure.

Surgery isn't always successful in reattaching the retina. Also, a reattached retina doesn't guarantee normal vision. How well you see after surgery depends in part on whether the central part of the retina (macula) was affected by the detachment before surgery, and if it was, for how long. Your vision may take many months to improve after repair of a retinal detachment. Some people don't recover any lost vision.

Prevention

There's no way to prevent retinal detachment. However, being aware of the warning signs of a detached retina — floaters, bright flashes of light, or a shadow or curtain that seems to fall across your visual field — could help save your vision. If you notice any of the warning signs of retinal detachment, particularly if you're over age 40, you or a family member has had a detached retina, or you're extremely nearsighted, contact your ophthalmologist immediately.