What is retinal detachment?
The eye is often compared to a camera. The front of the eye contains a lens that focuses images on the inside of the back of the eye. This area, called the retina, is covered with special nerve cells that react to light.
This layer of cells can sometimes peel away from the back surface of the eye. This is called a retinal detachment, and it can lead to total blindness.
Why do people get retinal detachments?
Some types of injury to the eye or head can cause a retinal detachment. A retinal detachment can also occur in an eye that has had an infection or severe inflammation. Some medical conditions that affect the eyes, such as diabetes, can also cause a retinal detachment.
Retinal detachments happen because there is a hole or a tear in the retina. Fluid that normally fills the inside of the eye can go through these retinal holes or tears and get behind the retina. This separates the retina from the back of the eye, causing a detachment.
Retinal detachment is more common in some types of eyes than others. For example, older people are more likely to have a retinal detachment than younger people. Eyes that are very nearsighted (that is, cannot see objects that are far away) are more likely to get a retinal detachment than eyes that see normally or are farsighted. An eye that has had any type of surgery will be slightly more likely to have a retinal detachment than an eye that has never been operated on.
How does a doctor know whether someone has a retinal detachment?
The doctor may notice some things during the examination, or the patient may mention symptoms, that could be caused by a retinal detachment. These are:
- The appearance of floaters (which look like small specks of dust or wispy threads) or flashes of light in the field of view. (For more information, see the fact sheet on "Floaters and Flashes" from the Cole Eye Institute.)
- A change in vision so that a person feels like he or she is looking through a dense fog or thick, wavy glass.
- The appearance of dark spots, lines or shadows across part or all of the field of view.
When these symptoms are caused by a retinal detachment, they will often occur in one eye only.
If any of these symptoms occur, it is important to schedule an appointment with your doctor immediately. Retinal detachments almost always get worse unless they are treated. The treatments also work best if they are performed soon after the retinal detachment happens.
During your examination, your doctor will use a special instrument to look inside your eye and see whether the retina has become detached and whether there is a hole or tear in it.
How is retinal detachment treated?
Only your doctor can recommend the right treatment for a retinal detachment. The treatment will depend on what caused the detachment, whether or not there is a hole or tear on the retina and how much of the retina is detached.
All of the treatments for retinal detachment are considered surgery. Some treatments just involve shining a laser through the clear front part of the eye and focusing on the retina. In other treatments, the surgeon has to make openings in the eye so special instruments can reach the retina.
What happens in the operations to repair a retinal detachment?
Retinal detachment repair is usually performed under local anesthetic, in which case the patient is awake but does not feel the procedure.
Surgeons have several techniques to repair retinal detachment. These can be used separately, or some methods can be used together. The methods include:
- Laser photocoagulation. This procedure is used to treat the holes or tears in the retina. The surgeon focuses a laser beam into a small spot on the retina. The laser heats up that spot, creating a tiny scar. The scar holds the retina in place so that it will not detach. The surgeon "draws a line" of these small laser spots around the edges of the retinal hole or tear. This holds the edges of the opening in place and prevents fluid from getting behind the retina.
- Cryoretinopexy. This procedure is also used to hold down the edges of a retinal hole or tear. But in this operation, an instrument called a cryoprobe is placed on the outside of the eye. The tip of this instrument gets very cold - so cold that it creates a "frostbite" type of scar inside the eye on the retina. The surgeon places a line of these freeze treatments around the hole or tear to prevent fluid from getting behind the retina.
- Scleral buckling. The laser and cryoprobe only work in areas where the retina is still touching the inside surface of the eye. If the retina is detached from the inside of the eye, the surgeon first has to get them back together. The surgeon can do this using something that looks like a rubber band. This elastic band is placed around the eyeball, and it pushes the inside surface of the eye up against the retina. This is called scleral buckling. After a while, the retina will reattach to the back of the eye. The surgeon will often use the laser or cryoprobe to treat a hole and reattach the retina with scleral buckling.
Sometimes in order to get the retina back into place, the surgeon will use a bubble of air or a special gas inside the eye to push the detached part of the retina back into place. If this is done, the patient might have to lie in a special position after surgery to help the gas bubble get to the right spot.
How successful is surgery to repair a retinal detachment?
Most of the time, surgery succeeds in reattaching the retina. This does not automatically bring back any vision that was lost.
Vision after surgery will depend on which part of the retina was detached and how the eye heals after surgery. The best way to avoid problems and have a good chance of recovering vision is to follow your doctor's advice, use all medications as recommended and keep all appointments with your doctor after surgery.
Click here to make an appointment now. Or call 216/444-2020 or 1/800-223-2273 Ext. 42020 to schedule an appointment with a Cole Eye Institute ophthalmologist.
