If the retina inside the eye separates from the choroid, doctors speak of a retinal detachment. Fluid collects between the layers at the back of the eye. This causes the retina to bulge into the eyeball like a bubble . At this point, the retina is not supplied with oxygen and nutrients from the choroid.
Functional disorders are the result - ranging from visual field loss to complete blindness. However, if the disease is treated early, the vision of the affected eye can usually be preserved.
A retinal detachment in the light of a slit lamp
Retinal detachment affects one in 10,000 people, which corresponds to 0.01%. In addition to short-sightedness, previous cataract operations and diabetes mellitus as well as inflammatory processes or tumors in the eye are also considered risk factors.
Depending on the cause, doctors generally differentiate between three different forms of the disease: rhegmatogenous, exudative and tractional retinal detachment.
Rhegmatogenous retinal detachment
If the retinal detachment is caused by tearing of the retina, doctors refer to it as rhegmatogenous or tear-related retinal detachment. It is usually due to the shrinking of the vitreous body with age . The vitreous body, which consists of a gelatinous mass, is located inside the eyeball.
As it shrinks, the vitreous body "pulls" on the retina, causing it to tear. Holes are created, allowing fluid to leak out of the vitreous. This seeps between the retina and the underlying pigment epithelium, leading to detachment of the retina.
The mainrisk factor for rhegmatogenous retinal detachment is the age of the patient. Also
also increase the risk.
Older people in particular have an increased risk of retinal detachment due to tears © Wira SHK / AdobeStock
Tractive retinal detachment
Traction-related retinal detachment occurs when tissue of the vitreous body and/or layers of the retina scar. This causes the area around the scar to shorten, resulting in a traction effect. In many cases, diabetic retinopathy caused by long-term diabetes - i.e. a damaged retina - is the trigger for tractional detachment. Sometimes, however, it is also a late consequence of so-called retinopathy of prematurity.
Tractional retinal detachment is more common in related people. The risk of this disease is therefore higher if it has already occurred in family members.
Exudative retinal detachment
Exudative retinal detachment - which is very rarely diagnosed - is caused by fluid retention. Fluid leaks from the vessels of the choroid and accumulates between the retina and the pigment epithelium.
This is often caused by inflammation or tumors in the eye. Inflammations occur in conjunction with serious general illnesses - for example AIDS. In the case of tumors, such as choroidal melanoma, the newly formed vessels are "leaky" and fluid accumulates under the retina.
The structure of the human eye
Flashes of light, soot flakes, visual field loss
In addition to flashes of light, typical symptoms of retinal detachment are mainly dots and lines as well as clouds of fog. In addition, some patients also report soot flakes, even soot rain, i.e. an apparent swarm of black dots.
Others perceive a dark curtain or shadow disturbingly in the field of vision: light perception is not possible in the areas of retinal detachment in the eye. This results in a loss of visual field, which the affected person perceives as a curtain or veil.
If you notice the symptoms described, you should consult an ophthalmologist immediately!
Flying mosquitoes
The so-called "mouches volantes", or flying gnats, are normally harmless in comparison - they are caused by vitreous opacities. They are characterized by almost transparent streaks, dots or "gnats". They are particularly noticeable against a light background or when reading.
Caution is nevertheless advised: If you notice "mouches volantes" for the first time or notice that they are changing, you should always consult an ophthalmologist prophylactically - if only to rule out a retinal tear and thus the risk of retinal detachment.
"Mosquito vision" of the eyes
An ophthalmologist makes the diagnosis by examining the back of the eye. If he only observes tears in the retina, these can be treated with a laser beam. However, if the retina has already detached, surgery is usually the only option. Just like retinal detachment, retinal holes cannot be treated with medication.
The doctor usually examines both eyes, even if the patient only notices the symptoms in one eye. In many cases, there are also changes in the retina of the apparently healthy eye. These often prove to be a precursor to retinal detachment. The doctor can treat them preventively using a laser.
Ophthalmoscopy & Co.
The actual examination is usually carried out by means of an ophthalmoscopy with the pupil dilated with medication. This procedure is necessary as the retina at the back of the eye cannot be seen with the naked eye.
Examination of the eyes using ophthalmoscopy © Henrik Dolle / AdobeStock
For this purpose, the patient is given eye drops in advance with a preparation that promotes dilation of the pupil. In this case, the patient should not visit the ophthalmologist by car on the day of the examination: The rigidly dilated pupils lead to impaired driving immediately after the examination.
With the aid of a light source, the ophthalmologist then illuminates the back of the eye in order to visualize a potential retinal detachment.
It is not uncommon for a so-called contact lens to be used to diagnose a retinal detachment. This is a magnifying glass-like device that the ophthalmologist places on the eyeball. This enables the doctor to diagnose a retinal detachment and possibly also its cause - for example, a tear in the retina. If a retinal detachment is already present, this often manifests itself in gray, raised folds.
If bleeding in the vitreous body makes it impossible to see the retina, the ophthalmologist will carry out an ultrasound examination instead. This allows changes in the retina to be identified.
Surgery is practically always necessary to treat a retinal detachment. There are several surgical procedures. The two most important are
A laser is also used in the treatment of retinal detachment.
Laser treatment
Retinal detachment and retinal tears cannot be treated with medication. In the case of a retinal tear - i.e. before the onset of a retinal detachment - lasering the affected eye helps.
The laser beam can be used to provoke an inflammatory reaction at the injured area. As a result, the tissue scars and the hole in the retina sticks together. In this way, retinal detachment can be prevented in many cases.
Eye surgery
If a retinal detachment is diagnosed, however, laser treatment proves to be ineffective: in such cases, only eye surgery can help. The surgical method depends largely on the form and stage of the retinal detachment.
The focus here is on fixing the detached retina and eliminating the triggering factors - for example changes to the vitreous body.
Other forms of treatment
If inflammation is the cause of retinal detachment, treatment of the underlying disease is essential.
Eye inflammation can cause retinal detachment © Birgit Reitz-Hofmann / Fotolia
However, if tumors are responsible, a special tumor center is responsible for treatment. There are various treatment options here: on the one hand, the tumors can be surgically removed or irradiated. The latter can take the form of irradiation of the entire eyeball. Or it can take the form of local irradiation using radiation carriers directly on the eye.
The following surgical procedures are available for the treatment of retinal detachment:
Hump surgery with foam seal
If there is a single hole or tear, so-called hump surgery is used.
The surgeon sutures a foam seal, usually made of silicone rubber, onto the sclera from the outside. This causes the sclera to indent and the retina is brought back into place on this "hump". The application of cold through a cryoprobe supports this cohesion. The fluid that has accumulated under the detached retina is drained by the surgeon from the outside through a puncture.
A special form of this indenting operation is the application of a band that compresses the sclera, a cerclage.
A retinal detachment practically always has to be treated as part of an operation © DragonImages / AdobeStock
Girdle operation
If there are several holes, girdle surgery is indicated: In this procedure, the surgeon pulls a band around the entire eyeball and shortens it until a circular constriction is created. A puncture in the fluid area between the retina and choroid is used to remove fluid. The surgeon then seals the holes or tears using a seal or tape.
Surgery inside the eye
However, the two surgical methods mentioned above do not always provide the solution: if the retinal detachment has been present in the eye for a long period of time and adhesions are already visible, there is no way around a so-called pars plana vitrectomy.
The vitreous body is removed from the eye to detach the adhesions or eliminate the connective tissue strands.
The surgeon replaces the vitreous body: this can be done using a gas or silicone oil. Both allow the retina to be pressed against the choroid from the inside.
In nine out of ten patients, eye surgery is successful the first time. This means that the retinal detachment can be cured with the help of surgery. In some cases, however, a new retinal detachment occurs later. Further surgery is then unavoidable.
The treatment of retinal detachment places high demands on the surgeon. Patients should be aware of this. Accordingly, you should choose an eye center that specializes in this type of surgery.
Even after successful retinal surgery, the patient's visual acuity or visual field loss is usually reduced compared to the time before the retinal detachment.
How a retinal detachment ultimately develops depends on various factors: On the one hand, the extent is decisive, i.e. how far the retinal detachment has already progressed. Secondly, time is a very important factor, i.e. how long the detachment has been present before the operation.
This means that the progression and prognosis of a retinal detachment - both for the eye and for vision - are all the better and more meaningful,
- the less retinal tissue is affected and
- the shorter the period of retinal detachment, and
- the less complicated the initial findings are.
Anyone who has undergone retinal surgery should avoid physical exertion for at least the next few weeks. This includes sport and lifting heavy objects. In the first few days, you should avoid anything that causes your eyes to move back and forth quickly. This includes reading in particular. However, watching television (where you look fixedly in one direction) is permitted.
Eye checks should be carried out at intervals of several weeks, then several months.
If the above-mentioned symptoms such as glare, darkening or deterioration of vision recur, you should consult an ophthalmologist or eye clinic immediately.
Regular ophthalmological check-ups are necessary after the operation © M.Dörr & M.Frommherz / AdobeStock
Symptom-related examination
See an ophthalmologist immediately at the first sign of retinal detachment. If you notice flashes of light or black dots that suddenly appear, you should see an ophthalmologist immediately. If there are even visual field restrictions, you can assume that the retina is already in the process of detaching.
Regular examination
It is generally advisable to have a regular examination of the back of your eye if you are at an increased risk of retinal detachment. This is the case, for example, if
- you suffer from severe short-sightedness,
- you have recently undergone cataract surgery or
- you have already had a retinal detachment.
An examination of the back of the eye also provides information about possible degenerations that could lead to worse consequences.
Laser treatment of such retinal changes serves as a preventive measure. The scars that later form on the lasered area weld the retina to the choroid.
This should be expressly pointed out: This preventive measure is only possible as long as there is no retinal detachment.
