Retinal detachment (patient information)

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 * Assistant Editor(s)-In-Chief: Erin E. Lord

Overview
Retinal detachment is an eye disorder in which the retina, the light-sensitive membrane in the back of the eye, separates from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness.

There are three different types of retinal detachment:

Rhegmatogenous -- A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina. These types of retinal detachments are the most common.

Tractional -- In this type of detachment, scar tissue on the retina's surface contracts and causes the retina to separate from the RPE. This type of detachment is less common.

Exudative -- Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.

What are the symptoms of retinal detachment?

 * Bright flashes of light, especially in peripheral vision
 * Blurred vision
 * A sudden or gradual increase in the number of floaters in the eye
 * Shadow or blindness in a part of the visual field of one eye
 * Appearance of a curtain over the field of vision

What are the causes of retinal detachment?
Retinal detachments are often associated with a tear or hole in the retina through which eye fluids may leak. This causes separation of the retina from the underlying tissues.

Retinal detachment often occurs on its own without an underlying cause. However, it may also be caused by trauma, diabetes, or an inflammatory disorder. It is most often caused by a related condition called posterior vitreous detachment.

The risk factors are previous eye surgery, nearsightedness, a family history of retinal detachment, uncontrolled diabetes, and trauma.

Who is at highest risk?
A retinal detachment can occur at any age, but it is more common in people over age 40. It affects men more than women, and Whites more than African Americans.

A retinal detachment is also more likely to occur in people who:


 * Are extremely nearsighted
 * Have had a retinal detachment in the other eye
 * Have a family history of retinal detachment
 * Have had cataract surgery
 * Have other eye diseases or disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degeneration
 * Have had an eye injury

How to know you have retinal detachment?
Tests can be done by your eye doctor to check the retina and pupil response, as well as your ability to see colors properly. These may include:


 * Electroretinogram (a record of the electrical currents in the retina produced by visual stimuli)
 * Fluorescein angiography
 * Intraocular pressure determination
 * Ophthalmoscopy
 * Refraction test
 * Retinal photography
 * Test to determine your ability to see colors properly (color defectiveness)
 * Visual acuity
 * Slit lamp examination
 * Ultrasound of the eye

When to seek urgent medical care
A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately, as retinal detachments require medical attention within 24 hours of the first symptoms. If not promptly treated, retinal detachment can cause permanent vision loss.

Treatment options
Most patients with a retinal detachment will need surgery, either immediately or after a short period of time. However, surgery may not be needed if you do not have symptoms or have had the detachment for a while.

Types of surgery include:


 * Cryopexy: Intense cold is applied to the area with an ice probe. This helps a scar form, which holds the retina to the underlying layer.
 * Laser surgery: Tiny burns are made around the hole to "weld" the retina back into place.
 * Pneumatic retinopexy: A gas bubble is placed in the eye and helps the retina float back into place. Laser surgery is performed after pneumatic retinopexy to permanently fix it in place.

More extensive detachments may require surgery in an operating room. Such procedures include:


 * Scleral buckle: A tiny synthetic band is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina
 * Vitrectomy: A small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the center of the eye and helps the eye maintain a round shape. Gas is often injected to into the eye to replace the vitreous and reattach the retina. The gas pushes the retina back against the wall of the eye. During the healing process, the eye makes fluid that gradually replaces the gas and fills the eye.

With all of these procedures, either laser or cryopexy is used to "weld" the retina back in place.

Where to find medical care for retinal detachment?
Directions to Hospitals Treating retinal detachment

Prevention of retinal detachment

 * 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.

What to expect (Outlook/Prognosis)?
What happens will depend on the location and extent of the detachment and whether you receive early treatment. With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. However, the final visual outcome is not always predictable and may not be known for up to several months following surgery. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and vision may eventually be lost.

Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches. That is why it is important to contact an eye care professional immediately if you see a sudden or gradual increase in the number of floaters and/or light flashes, or a dark curtain over the field of vision.