Retinal Detachment - Symptoms, Causes, and Treatment of Retinal Detachment

When the retina detaches from its underlying layer inside the eye, doctors refer to this as a retinal detachment. Fluid accumulates between the layers at the back of the eye. As a result, the retina bulges into the eyeball like a bubble. At this point, the retina is no longer supplied with oxygen and nutrients from the choroid.

This leads to visual impairment—ranging from loss of peripheral vision to complete blindness. However, if the condition is treated early, vision in the affected eye can usually be preserved.

Retinal detachment affects one in 10,000 people, which corresponds to 0.01%. In addition to nearsightedness, previous cataract surgeries, diabetes mellitus, and inflammatory processes or tumors in the eye are also considered risk factors.

Generally, physicians distinguish between three different forms of the condition based on the cause: rhegmatogenous, exudative, and tractional retinal detachment.

If retinal detachment occurs due to a tear in the retina, doctors refer to it as rhegmatogenous or tear-induced retinal detachment. It is most often caused by the shrinkage of the vitreous body that occurs with age. The vitreous body is a gel-like mass inside the eyeball.

As the vitreous shrinks, it “pulls” on the retina, causing it to tear. Holes form, allowing fluid from the vitreous to escape. This fluid seeps between the retina and the underlying pigment epithelium, leading to retinal detachment.

The primary risk factor for rhegmatogenous retinal detachment is the patient’s age. Also,

• severe myopia,
• previous cataract surgery, or
• blows to the eye

can also contribute to retinal detachment.

Tractive retinal detachment occurs when tissue in the vitreous body and/or layers of the retina scar. This causes the area around the scar to shorten, creating tension on the retina. In many cases, diabetic retinopathy—that is, damage to the retina caused by long-term diabetes—is the trigger for tractional detachment. Sometimes, however, it is also a late complication of what is known as retinopathy of prematurity.

Tractive retinal detachment is more commonly observed among relatives. The risk of this condition is therefore higher if it has already occurred in family members.

Exudative retinal detachment is caused by fluid accumulation and is diagnosed only very rarely. In this condition, fluid leaks from the choroidal vessels and accumulates between the retina and the pigment epithelium.

The causes are often inflammation or tumors in the eye. Inflammation occurs in association with severe systemic diseases—such as AIDS. In the case of tumors, such as choroidal melanoma, the newly formed blood vessels “leak,” leading to fluid accumulation under the retina.

Typical symptoms of retinal detachment include flashes of light, as well as spots, lines, and patches of fog. In addition, some patients report seeing specks of soot—or even a “rain of soot”—that is, what appears to be a swarm of tiny black dots.

Others perceive a dark curtain or shadow in their visual field as a disturbance: In the areas of the eye affected by retinal detachment, light perception is not possible. 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 see an ophthalmologist immediately!

Floaters

In contrast, so-called “mouches volantes,” or flying gnats, are usually harmless—they are caused by vitreous opacities. Characteristic features include nearly transparent streaks, specks, or “floaters.” They are particularly noticeable against a bright background or while reading.

Nevertheless, caution is advised: If you notice “mouches volantes” for the first time or observe that they are changing, you should definitely consult an ophthalmologist as a precaution—if only because similar symptoms can also occur with a hole-related retinal detachment.

An ophthalmologist makes the diagnosis by examining the back of the eye. If the ophthalmologist observes only tears in the retina, these can be treated with a laser. However, if the retina has already detached, surgery is usually the only effective treatment. Just like retinal detachment, retinal holes cannot be treated with medication.

The doctor usually examines both eyes, even if the patient only notices symptoms in one eye. In many cases, changes are also present in the retina of the seemingly healthy eye. These often turn out to be a precursor to retinal detachment. The doctor can treat them preventively with a laser.

Ophthalmoscopy & More

The actual examination is usually performed using an ophthalmoscope with the pupil dilated using medication. This procedure is necessary because the retina, located at the back of the eye, cannot be seen with the naked eye.

If there are multiple holes, a cerclage is indicated: The surgeon wraps a band around the entire eyeball and tightens it until a circular constriction is created. A puncture in the fluid-filled space between the retina and the choroid is used to remove fluid. The surgeon then seals the holes or tears using a plug or band.

However, the two surgical methods described above do not always provide a solution: If the retinal detachment has been present for an extended period and adhesions are already visible, a so-called pars plana vitrectomy is unavoidable.

The vitreous humor is removed from the eye to detach the adhesions and eliminate the strands of connective tissue.

The surgeon replaces the vitreous humor: this can be done using either gas or silicone oil. Both allow the retina to be pressed against the choroid from the inside. The silicone oil usually needs to be removed in a subsequent surgery.

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, vision is usually reduced compared to before the detachment, or there may be a loss of visual field.

How a retinal detachment ultimately progresses depends on various factors: On the one hand, the extent of the detachment—that is, how far it has already progressed—is crucial. On the other hand, time is a very significant factor—specifically, how long the detachment had been present before surgery.

This means that the course and prognosis of a retinal detachment—both for the eye and for vision—are all the better and more favorable

• the less retinal tissue is affected and
• the shorter the duration of the retinal detachment, and
• the less complicated the initial findings are.

Anyone who has undergone retinal surgery should avoid physical exertion, at least for the next few weeks. This includes sports and lifting heavy objects. In the first few days, you should avoid anything that requires your eyes to move rapidly back and forth. This includes, above all, reading. Watching television, on the other hand (where you are looking steadily in one direction), is permitted.

Follow-up eye exams should be scheduled at intervals of several weeks, then several months.

If the symptoms mentioned—such as flashes of light, dark spots, or blurred vision—recur, you should immediately consult an ophthalmologist or visit an eye clinic.

If you notice the first signs of retinal detachment, see an ophthalmologist immediately. If you notice flashes of light or sudden black spots, an immediate visit to the ophthalmologist is essential. If you’re experiencing visual field defects, you can assume that the retina is already beginning to detach.

In general, regular examinations of the back of your eye are recommended if you are at increased risk for retinal detachment. This is the case, for example, if

• you have severe nearsightedness,
• you recently underwent surgery for cataracts, or
• you have had a retinal detachment in the past.

An examination of the back of the eye can also reveal potential degenerative changes that could lead to more serious conditions.

Laser treatment of such retinal changes serves as a preventive measure. The scars that form later at the treated site fuse the retina to the choroid.

It should be expressly noted: This preventive measure is only possible as long as a retinal detachment has not yet occurred.