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Retinal detachment

Published by Bupa's health information team, May 2009.

This factsheet is for people who have retinal detachment, or who would like information about it.

Retinal detachment is when the retina separates from the inner wall at the back of your eye (where it's usually attached). This can permanently damage your vision, so emergency surgical treatment is needed to reattach the retina.

Retinal detachment is estimated to affect one in 10,000 people. It tends to occur in people aged 40 to 70, and is most common in people who are very short-sighted.

About retinal detachment

The retina is a thin layer of nerve tissue that lines the inner wall at the back of your eye. When you look at an object, light rays pass into your eye through your cornea (the clear structure at the front of your eye) and lens, to the retina at the back of your eye. Cells in the retina then send this information via the optic nerve to your brain. Your brain interprets this as the 'image' you see.

The retina is thickest around the optic nerve, and then thins out at the top and bottom of your eye towards the front. Just to the side of the optic nerve lies a specialised part of the retina called the macula. The macula is the part of the retina that is used for seeing fine detail, for example reading, writing and recognising faces.

The space inside your eye (the lens to the retina) is filled with a clear jelly-like fluid called vitreous (also referred to as vitreous humour). The jelly is 99 percent water. The rest is made up of strand-like substances that give it its jelly-like consistency. These fine strands are attached at certain points to the retina at the back of the eye. Vitreous is completely transparent so that light can pass through it to the retina.

Retinal detachment is when the retina separates away from the back of your eye. There are three ways this can happen:

Rhegmatogenous retinal detachment

A hole or tear in the retina allows fluid from vitreous in your eye to seep underneath and separate it from the back wall. This is the most common type of retinal detachment and is often associated with posterior vitreous detachment (PVD).

PVD is a normal part of the ageing process. The jelly-like vitreous becomes more liquid in the middle as you get older and tends to shrink away from the retina. As it shrinks away, the attached parts of the vitreous can tug on the retina - this can result in a tear. If a tear in the retina isn't treated, fluid from the vitreous is able to get underneath the retina and separate it from the back wall of your eye.

Tractional retinal detachment

The retina and vitreous can become tightly stuck together as a result of an injury, inflammation or the abnormal growth of blood vessels (sometimes seen in people with diabetes). If the vitreous pulls at the retina it may start to lift away from the back of the eye. Tractional detachment can occur without tears in the retina. This is the second most common type of retinal detachment.

Exudative retinal detachment

An excess of fluid underneath the retina may push the retina off the back of the eye. There are many possible causes for this, such as eye inflammation.

Symptoms of retinal detachment

The most common description given by people who have experienced retinal detachment is that it's like a curtain falling across their field of vision. This usually happens very gradually, only affecting parts of your vision at first. If the macula of the retina is affected in the detachment, you may notice that you can't see faces, read or write using the affected eye.

Most often the retina starts to detach in the upper part of your eye. Because of the way we perceive images, this means that the lower part of your vision will be affected first.

Half of all people with retinal detachment experience early symptoms such as flashes of light or spots before their eyes. This can develop into strands, cobwebs or a cloudy haze in your vision. These symptoms are usually caused by PVD, which often precedes retinal detachment.

Complications of retinal detachment

The most serious complication of retinal detachment is total or partial loss of vision. If the retinal detachment affects the macula, some irreversible damage to your vision is almost certain, although this will vary in severity.

In a small number of people with retinal detachment, the retina can become scarred and stiff. This is usually due to your body trying to heal itself. This condition is known as proliferative vitreoretinopathy (PVR). Since the retina is stiffened and crinkled, it can sometimes be more difficult to get it flat up against the back of the eye and to restore vision.

Causes of retinal detachment

The cause of your retinal detachment will depend on the type you have, either rhegmatogenous, tractional or exudative.

Causes of rhegmatogenous retinal detachment include:

  • ageing - as you get older, the vitreous humour in your eye naturally begins to shrink, making it more likely that you will have PVD
  • short-sightedness (myopia) - people who are very short-sighted have a thinner retina which can tear or break more easily
  • previous eye surgery - for example in a cataract operation where the jelly of the eye has been disturbed
  • injury or trauma to your eye - this may cause retinal detachment immediately, or it can happen months or even years later
  • inherited conditions such as Stickler's syndrome or juvenile X-linked retinoschisis
  • infections or inflammation in your eye such as ocular toxoplasmosis

Tractional retinal detachment may be caused by an eye injury or conditions that affect the retina, including:

  • diabetic retinopathy - abnormal growth of blood vessels from the retina can result in bleeding, scarring and pulling on the retina by the vitreous of the eye
  • retinopathy of prematurity - this happens when a baby is born prematurely before the retina has developed properly
  • sickle cell retinopathy - damage to blood vessels at the back of your eye as a complication of sickle cell anaemia
  • retinal vein occlusion - a blockage in a retinal vein

Exudative retinal detachment may be associated with the following:

  • inflammatory conditions of the eye, such as uveitis (inflammation to the middle layer of the eyeball) or scleritis (inflammation to the white, outside layer of the eyeball)
  • vascular conditions, such as high blood pressure or eclampsia
  • tumours in your eye, which can be cancerous or non-cancerous (benign)
  • conditions affecting the retinal vessels, such as Coat's disease and retinal macroaneurysm
  • conditions affecting the macula, such as macular degeneration

Diagnosis of retinal detachment

With retinal detachment, it's important to get treatment as soon as possible, otherwise your vision may be permanently damaged.

Your GP or optometrist will recognise the symptoms of a retinal detachment. An optometrist is a healthcare professional who examines eyes, tests sight and dispenses glasses and contact lenses.

If your GP or optometrist isn't available, you should go to the Accident and Emergency department of your local hospital.

Your doctor or optometrist will ask about your symptoms and carry out simple tests to check your eyesight. This may involve flashing a torch in your eyes and examining your eye with an ophthalmoscope. An ophthalmoscope is an instrument that is used to take a closer look at the inside and back of your eye.

If you have retinal detachment or your doctor or optometrist suspects you have one, you will get an urgent referral to an ophthalmologist. An ophthalmologist is a surgeon who specialises in diagnosing and treating eye conditions.

Treatment for retinal detachment

Retinal detachment is a medical emergency. The sooner you get treatment, the less chance there is of permanent damage to your vision.

Retinal tears or holes

Holes or tears in the retina, without a retinal detachment, are treated using laser therapy or cryotherapy (freezing treatment). Laser or cryotherapy is used to create a tiny scar in the retina surrounding the tear. The scar acts as a kind of 'glue' and seals the break. This takes about ten days to heal. During this time, it's possible for the retina to detach again - your doctor will advise you of the signs to look out for.

Both laser therapy and cryotherapy are done as an outpatient procedure under local anaesthetic. This completely blocks feeling from your eye and you will stay awake during the procedure.

Retinal detachment

If your retina has become detached, you will usually need to have surgery to reattach it and deal with any breaks or scar tissue. Often only one operation is needed to do this but in more complicated cases it may be necessary to perform two or more procedures.

If your central vision has been affected, it may take several months after your operation for your vision to recover. In some cases, your vision may never completely recover - this is often dependent on how long the macula has been detached for. Occasionally, it may not be possible to restore the retina to its correct position and your vision may be lost completely. Surgery is most successful when the macula has not become detached. This highlights the importance of seeking medical attention as soon as possible after noticing changes in your vision.

There are currently two types of surgery used to treat a detached retina: scleral buckle surgery and vitrectomy. You may need to stay in hospital for your operation and may require a general anaesthetic. This means you will be asleep during the operation. Your surgeon will discuss these options with you.

Scleral buckle surgery

This is a procedure that involves putting pressure on the outside of your eye using a thin band of synthetic material.

First, any tears or holes in the retina may be treated using laser or cryotherapy. A fine strip or band of silicone (a buckle) is then stitched to the tough white outer coat of the eye (the sclera). The translucent outer coat of the eye (the conjunctiva) is then stitched over the top of the buckle to conceal it. The buckle indents the wall of the eye at the site of the tear allowing the eye to effectively 'heal' itself.

Fluid still underneath the retina can be drained out or if left will disappear as it is absorbed by the underlying layers. The buckle can be left in place quite safely - it is not usually necessary to remove it but if removed the risk of the detachment recurring is very small. The buckle may distort the shape of the eye slightly, resulting a change to your glasses prescription.

Vitrectomy

This involves removing the vitreous from the back of your eye. Tiny incisions are made in the white of your eye. An instrument is passed through the cuts to suck up the vitreous and cut the fine strands that run through it. After the jelly has been removed, the fluid under the retina is drained and any tears or holes are treated with freezing or laser so that the surrounding retina is stuck down. A special lighter-than-air gas (or sometimes silicone oil) may be used to fill up the empty space left once the jelly has been removed. This holds the retina in place while treatment to a tear or hole takes effect.

Over the following weeks and months, the small amount of gas slowly leaves the eye and is replaced with the watery fluid which normally circulates in the jelly. You may notice the gas disappearing as a line slowly moving downwards in your field of vision.The gas may cause your vision to be blurry after the surgery because it affects the way light passes to your retina.

After your operation

After your surgery, you will be given antibiotics and corticosteroid drops. These will help prevent infection and reduce any inflammation. The procedures aren't usually painful. If you do experience pain, you can take regular painkillers that you would normally take for a headache, such as paracetamol, or your doctor may prescribe painkillers. If you are still in pain despite taking painkillers, you should contact your surgeon. Sometimes surgery results in a temporary rise in the pressure inside the eye, and your surgeon may prescribe drops or tablets to treat this for a short period. Always read the patient information leaflet that comes with your medicine.

If you have had gas put into your eye, you may be asked to keep your head in a certain position for about a week after the operation. You will also be advised not to travel on an airplane while any gas remains in your eye.

Related topics

Further information

Sources

  • Kang HK, Luff AJ. Management of retinal detachment: a guide for non-ophthalmologists. BMJ 2008; 336:1235-1240
  • Tractional retinal detachment. eMedicine. www.emedicine.com, accessed 21 October 2008
  • Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:945
  • Retinal detachment. GP Notebook. www.gpnotebook.co.uk, accessed 21 October 2008
  • Khaw PT, Elkington AR. ABC of Eyes. London: BMJ Publishing Group, 2002:23
  • McLatchie GR, Leaper DJ. Oxford Handbook of Clinical Surgery. 2nd ed. Oxford: Oxford University Press, 2003:194-195
  • Rhegmatogenous retinal detachment. eMedicine. www.emedicine.com, accessed 21 October 2008
  • Personal communication. Dr Scott Robbie, MBBS BSc MRCOphth, Institute of Ophthalmology, UCL 9 December 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2009

 

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