Home / Procedures / Retinal Detachment
What causes retinal detachment ?
How is a person to know of the presence of retinal weakness, holes or tears ?
What can be done about floaters ?
How can retinal detachment be prevented ?
Symptoms of retinal detachment
Retinal detachment is the separation of the retina from the underlying choroid.This results in a profound loss of vision and requires major surgery to re-attach it.To know and understand more , please scroll down.
Most retinal detachments are caused by the presence of one or more tears or holes in the retina. Normal aging can sometimes cause the retina to thin and develop holes, but more often these are caused by shrinkage of the vitreous body (posterior vitreous detachment).
The vitreous is firmly attached to the retina in several places around the back wall of the eye. As the vitreous shrinks with aging, it may pull a piece of retina with it, leaving a tear or hole in the retina. Fluid from the vitreous body then passes through the retinal tear detaching the retina from its normal position
Posterior vitreous detachment (vitreous separation from the retina) is a natural process of aging and usually does not lead to any damage of the retina. It is however more common and occurs earlier in people who: -
- Are abnormally nearsighted (high myopia);
- Have undergone cataract operations (aphakics);
- Have had YAG laser surgery of the eye;
- Have had inflammation inside the eye.
Note: It should be noted that there are some retinal detachments that are caused by other diseases of the eye such as tumors, severe inflammations, or complications of diabetes. These so-called secondary detachments do not have tears or holes in the retina and treatment of the disease that caused the retinal detachment is the only treatment that may allow the retina to return to its normal position.
In some patients the formation of a retinal tear is preceded by flashes of light, which are indicative of pull (traction) on the retina. In others, the tear may break a small blood vessel in its path causing a small hemorrhage (bleeding), with blurring of vision and 'floaters'.
However in the majority, retinal holes are completely asymptomatic, as they usually occur in the periphery of the retina and not in the visually important central part. They therefore do not cause any visual problem at all, unless they have led on to a retinal detachment. At this stage, profound loss of vision or field occurs.
It should also be noted that 'floaters' are very commonly seen by people who have no eye disease. They are seen as small specks, circles, lines, clouds or cobwebs moving in one's field of vision. They are actually tiny clumps of gel or cells inside the vitreous and cause no harm.
Floaters can get in the way of clear vision, which may be annoying when you are trying to read. You can try moving your eyes; looking up and then looking down to move the floaters out of the way. While some floaters may remain in your vision, many of them will fade over time and become less bothersome. However you should visit your ophthalmologist if you suddenly notice new floaters because you need to know if your retina is torn.
When the vitreous gel rubs or pulls on the retina, you may see flashing lights or "lightning streaks". If you notice the sudden appearance of light flashes, you should visit your ophthalmologist immediately to see if your retina has been torn. Who runs a greater risk of developing such a problem?
People more prone to developing retinal degeneration, holes and tears, and subsequently retinal detachment are myopes (near sighted persons), aphakics (people who have undergone cataract surgery), those with a family history of retinal detachment and people with symptoms like light flashes and onset of a large number of floaters.
These groups of patients must undergo regular and thorough retinal examination by indirect ophthalmoscopy.
A careful examination of your retina by binocular indirect ophthalmoscopy as mentioned above will be done. For this procedure, your pupils will be dilated with eye drops. During this painless examination, your ophthalmologist will carefully observe your retina and vitreous and look for holes and weak areas. At this stage (i.e. retinal detachment has not yet occurred), they can easily be closed or sealed by producing minute scars in the retina around them, which "weld" the retina to the choroid and prevent fluid from seeping through the hole. These scars can be produced by the heat of a strong light source (laser photocoagulation), or by controlled freezing (cryotherapy). Which of these two modalities is chosen, depends on the location of the hole and the presence or absence of cataract and vitreous hemorrhage, and the retinal surgeon decides individually for each case after a thorough examination. Both cryotherapy and photocoagulation are usually carried out as an outpatient procedure. As the treatment is from the surface of the eye, no invasive surgery is involved.
Some retinal detachments may begin without noticeable floaters or light flashes. In those instances, patients may notice a wavy or watery quality in their overall vision or the appearance of a dark shadow in some part of their side vision. Further development of the retinal detachment will blur central vision and create significant loss of sight in the eye unless the detachment is repaired.
A few detachments may occur suddenly and the patient will experience a total loss of vision in one eye. Similar rapid loss of vision may also be caused by bleeding into the vitreous when the retina is torn.
A detached retina cannot be viewed from the outside of the eye. Therefore, if the above symptoms are noticed, an ophthalmologist should be visited as soon as possible. Again, binocular indirect ophthalmoscopy through dilated pupils is essential to thoroughly examine the retina. Other special instruments including contact lenses, slit lamp and ultrasound may also be used.
Next page : Treatment/ Surgery Of Retinal Detachment
