Ocular Disease: Retinal Detachement

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Retinal detachment occurs when the retina separates from the back wall of the eye. It generally affects people of middle-age and older. Individuals who are nearsighted (myopic) or those with a family history of retinal detachment are more likely to develop this condition. Detachment may also occur due to injury or complications resulting from eye surgery.

Most cases of detachment are due to small tears or holes in the retinal tissue. These tears or holes are most often caused by shrinkage of the vitreous. Because the vitreous is attached to the retina in many areas, the shrinkage in vitreous may tear areas of retinal tissue away. Tears or holes may also appear due to the natural thinning of the retinal tissue with age, or with trauma. People who are highly nearsighted may also experience tears because their eyeballs are longer with thinner retinal layers, which are more prone to detachment.

When a retinal tear occurs, fluid from within the vitreous space may work its way through the hole or tear and begin to accumulate behind the retina. As more fluid begins to flow behind the retina, the force of the fluid causes the retina to separate and detach from the supporting tissues beneath. The detached retinal tissue will not function, resulting in blurriness or blind spots within the field of vision. Retinal tissue does not regenerate and if treatment is not sought promptly, continued vision loss or blindness might result.

The appearance of flashes of light, floaters, or spots may indicate shrinkage of the vitreous and tears within the retina. Floaters that appear to travel across the visual field are possible indicators of partial retinal detachment or coagulation of collagen fibers within the vitreous. As detachment progresses, a dark shadow may appear over the field of vision that continues to grow as the detached area becomes larger. Blurred central vision and serious vision loss will occur unless the retina is reattached.

As the retina is in the process of detaching, it is common for no pain to be experienced by the patient. DO NOT wait for the onset of pain before contacting an eyecare practitioner. Consult your eye doctor at the first signs of detachment. 

• Age - individuals of middle-age and older have an increased risk of developing a detachment

• High myopia

• Family history

• Eye surgery

• Diseases such as diabetes, diabetic retinopathy, sickle cell, Marfan's syndrome, etc.

• Eye injury

Small tears, holes, and limited detachments may be repaired via laser photocoagulation. This is an outpatient procedure that seals the openings in the retina to the supporting tissue by creating scar tissue around the openings, which will prevent fluid from flowing through the tears and accumulating behind the tissue. A similar procedure, called cryopexy, involves freezing the tissue to stimulate scar formation.

Retinal detachments must be repaired by an ophthalmologist. Depending upon the degree of detachment and other complications, more than one surgery may be required to repair the retina. It is widely claimed that over 90% of retinal detachment cases are repairable and result in the return of useful vision.

The best way to avoid retinal detachment is to seek treatment promptly upon the first signs of the condition, especially for those individuals who fit one or more of the risk factor categories. Early detection greatly increases the chances for successful treatment.