EYE SPECIALISTS - VISION
Sidebar

Retinal Detachment

The Cause

  1. Many detachments occur for no apparent reason, sometimes there is a familial weakness of the retina.
  2. Other people have had a serious head or eye injury in the past.
  3. If you have very short sight then this predisposes you to detachment.
  4. It can occur with age and with diabetes.

The Other Eye

One in ten patients with retinal detachment also have a weakness in their apparently good eye so this will be examined as well to see whether you require treatment to the normal eye also.

How does the retinal detachment develop?

  1. First a degenerative hole appears in the retina, or a firm gel attachment to the retina pulls a tear in the retina.
  2. Degenerate vitreous gel, eye fluid, passes through these breaks in the retina causing the retina to detach, like wallpaper peeling from the wall.
  3. As the fluid accumulates the area of detached retina increases, so the area of visual disturbance increases. This is most noticeable when the reading vision is lost. That is when the macula part of the retina has detached. This may occur within days of the first symptoms. Once this has occurred reading vision may not be recoverable even if surgery successfully reattaches the retina. This is because the receptors are damaged and misdirected by the detachment.
  4. Sometimes (10%), a scarring process occurs, (p.v.r.), this can lead to microscopic bands which pull and distort the retina. This is more likely to occur: the larger the hole or tear in the retina, and the larger the area of detachment. Once it begins it can make surgery more difficult and less successful.

The Aim of Surgery

The aim of surgery is to re-attach the retina and put a seal round the retinal hole (by laser, or a freezing probe, or diathermy).

Common Causes of Failure

  1. Unfortunately, in some patients there is more than one hole in the retina. Unless 'all the punctures' in the retina are detected and sealed then the retina will not re-attach permanently. It is often very difficult to identify a microscope second break in the retina.
  2. Even if the retina is successfully re-attached and breaks sealed, the body can undo the good work during the healing process. Essentially scar tissue formed can act like miniature ropes and pull the retina off, some days and weeks after the operation. This problem occurs in up to one in ten patients operated on for detachment. If the retina fails to re-attach or detaches after it has been successfully re-attached then further surgery can be offered but at each operation the chances of success reduces.

Different Forms of Treatment for Retinal Detachment

Laser Treatment
If there is only a retinal hole then the hole can be sealed by shining laser light into the eye through a lens. This is not always successful, that is it may still progress on to develop into a retinal detachment.
Gas Injection
If the retinal detachment is very localised and the retinal break is very localised in the top half of the eye then an injection of gas can be used as an iron inside the eye to express the fluid out through the retinal break, then the gas seals the retinal break to prevent further fluid collection under the retina. The gas acts like an internal splint. This allows the body to clear any remaining fluid beneath the retina. Then the retina can be sealed to the eye wall with laser treatment. However, this procedure depends very much on patient co-operation after surgery. That is the patient must maintain their head and eye position as directed by the doctor, to keep the gas bubble floating up against the retinal break area.
Larger Operations and Plastic Wall Implants
These implants are stitched to the outside of the eye wall to cause an indentation into the eye to help seal the retinal break. Sometimes fluid is drained from beneath the retina and sometimes gas is injected into the centre of the eye to act as a splint, laser or cryo-probe causes a retinal reaction which sticks the retina down around the retinal break.
Vitrectomy
Your doctor will advise you whether he thinks a vitrectomy is required. This involves removing the vitreous gel from within the eye and replacing it with fluid or gas or silicone oil. It may involve the use of heavy liquid which can also be used as an internal iron to express fluid or to hold the retina flat. (There is another information sheet on these subjects).

Gas warning

If you have a gas bubble in the eye you will notice that there is a large dark ball at the bottom of your vision with a silver crescent. This will gradually reduce in size until it completely disappears. The time it takes to disappear depends on the gas used. It can take 2-3 months. During this time you must not fly, as change in cabin pressure would cause changes in eye pressure and volume with pain. Your doctor will advise you how to posture your head and on what side to sleep. Posturing is most critical in the early period after surgery and becomes less critical by 2 weeks.

Warning Signs, after surgery.

  1. Pain.
  2. Deterioration of vision.
  3. Recurrent curtain-like field defect from one corner of the eye.

LINKS

Vitrectomy

Argon Laser Retina

Silicone Oil: Insertions/Removal

Back to Eye Parts

This information site has been provided by varied UK and US eye doctors for patients with eye problems.

Once your eye doctor has made a diagnosis or recommended an investigation or treatment, then you will be able to find further explanation on this site.

It is not a self diagnosis centre. It should not be relied upon without taking professional advice.