Generality/Definition
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Retinal detachment is a separation of the light-sensitive membrane in the back of the eye (the retina) from its supporting layers. Retinal detachment may be caused by trauma, the aging process, severe diabetes, or an inflammatory disorder, but it frequently occurs spontaneously. In pre-term babies, retinal detachment can be caused by retinopathy of prematurity (abnormalities of the retina associated with being born prematurely).
Source: Retinal detachment (nlm.nih.gov)
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People who are short-sighted are at a slightly higher risk of retinal detachment due to thinner retinal layers. This is when there is a separation between the two main layers of the retina. It occurs when there is tension pulling on the retina which tears and then allows fluid to seep in and collect between the layers.
Source: Retinal detachment (cataract-doctor.com)
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Epidemiology
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However, certain eyes are at significantly increased risk for retinal detachment. These include fellow eyes in persons previously suffering from retinal detachment, eyes with pathologic or high myopia, and eyes undergoing vitreous surgery for any reason but particularly for macular hole closure. Fellow eyes in retinal detachment patients have been shown to have a five year risk of retinal detachment of between 10-26%.
Source: Retinal Detachment (retinaldetachmentprevention.com)
Prevention
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Use protective eye wear to prevent eye trauma. Control your blood sugar carefully if you have diabetes. See your eye care specialist at least yearly, especially if you have risk factors for retinal detachment.
Source: Retinal detachment (nlm.nih.gov)
Symptoms
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Bright flashes of light, especially in peripheral vision Translucent specks of various shapes (floaters) in the eye Blurred vision Shadow or blindness in a part of the visual field of one eye
Source: Retinal detachment (nlm.nih.gov)
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Flashes of light, floaters, shadows or a curtain across the vision. Any loss in vision may be at the edge of the visual field and may not be immediately noticed. If the centre of the retina that allows detailed vision becomes detached there will be a sudden loss of vision. Pain is not usually associated with retinal detachment as the retina has no pain nerve fibres.
Source: Retinal detachment (cataract-doctor.com)
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Treatment
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Laser surgery may be used to seal the tears or holes in the retina, which generally precede detachment. Another technique, 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. This technique is used in combination with the injection of a gas bubble and the maintenance of specific head positions to prevent the re-accumulation fluid behind the retina. If the retina is already detached, surgery is required. Some detachments can be repaired by placing a gas bubble in the eye to float the retina back into place (pneumatic retinopexy), followed by laser surgery to permanently fix it in place. This is often done in the office. More extensive detachments may require surgery in the operating room. The goal of such surgery may be to indent the wall of the eye (scleral buckle) or remove vitreous gel or scar tissue pulling on the retina using microsurgery (vitrectomy).
Source: Retinal detachment (nlm.nih.gov)
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An operation under general anaesthetic is usually necessary to re-attach the retinal layers. This is done by attaching a small sponge to the outside of the eye and sometimes a bubble of gas on the inside, bringing the layers of the retina together. If the jelly in the centre of the eye (the vitreous) is removed (vitrectomy) gas or fluid may also be injected to maintain the correct pressure. Any fluid that has collected between the layers will be drawn off.
Source: Retinal detachment (cataract-doctor.com)
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Illustrations
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Source: Retinal detachment (nlm.nih.gov)
A slit-lamp, which is a specialized magnifying microscope, is used to examine the structures of the eye (including the cornea, iris, vitreous, and retina). The slit-lamp is used to examine, treat (with a laser), and photograph (with a camera) the eye.
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Information for specialists
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IDO Laser Cerclage, is a highly effective treatment for prophylaxis against retinal detachment, that may be employed in certain eyes known to be at high risk. IDO Laser Cerclage Prophylaxis, from the French word meaning surround or encircle, Laser Cerclage is the treatment of the peripheral retina in a 360 degree band, from the equator or vortex veins, to the ora serrata. A pattern type treatment is applied using the indirect ophthalmoscope laser. Typical laser settings would be 300-400 mW,0.1 sec. The laser spots should be of moderate intensity, and are placed about two spot widths apart, with more confluent focal treatment of obvious pathology within the band. An average cerclage treatment would have between 900 and 1200 applications.
Source: Retinal Detachment (retinaldetachmentprevention.com)
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