Retinal Detachment: Causes, Symptoms, Diagnosis and Treatment

Posted on 12 Dec 2010 01:42




By Ground Up Strength

The retina is the transparent light sensitive membrane which lines the back of the eye. When light strikes this membrane messages are sent to the brain through the optic nerve. When the retina becomes separated from it's underlying supportive tissue this is termed "retinal detachment" or a detached retina. This condition, which causes visual disturbances, was known as early as the 1700's when a pathological examination of an eye was reported by de Saint-Yves. Almost a century later the the first clinical description appeared and after that, with the invention of the opthalmoscope in 1851 retinal detachments were increasingly observed.

When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss. here are numerous ways that a retinal detachment can occur, including direct trauma, disease, and inflammation. but three main categories are recognized, rhegmatogenous, exudative, and tractions. Rhegmatogenous detachments are sometimes called primary detachments. Exudative and tractional detachments are sometimes called secondary or nonrhegmatogenous detachments. 1,2

Rhegmatogenous Retinal Detachment

The word rhegmatogenous comes from the Greek word rhegma meaning rent, rupture, or fissure. A rhegmatogenous (reg-ma-TAH-jenous) retinal detachment is the most common type of detached retina and is caused by a break in the retina which allows fluid from the vitreous cavity to get under the retina and separate it from the retinal pigment epithelium (RPE) which is pigmented cell layer that nourishes the retina. Most of the time these breaks in the retina can be identified with noninvasive techniques but occasionally the breaks are too small to detect and must be assumed.


labeled diagram of detached retina in eye

Detached Retina
image by RexxS via wikimedia


Tractional

Tractional retinal detachments are less common and are caused by adhesions on the surface of the retina. These adhesions are scar tissue and their contraction pulls at the retina and causes it to separate from the RPE. The most common causes of tractional detachments are proliferative diabetic retinopathy, cictricial retinopathy of prematurity, proliferative sickle retinopathy and penetrating trauma. Breaks in the retina may occur as a result so that a combination of tractional and rhegmatogenous detachment results.

Exudative

Exudative retinal detachments, also called serous detachments, are caused by any condition that produces subretinal fluid without a retinal break. This could be diseases of the retina and injury or trauma to the eye. These types of detachments do not involve tears or breaks in the retina itself but instead fluid leaks underneath the retina and causes it to detach. This frequently involves a choroidal tumor or an inflammatory disorder. 1,2

Athletes and Retinal Detachment

Retinal detachments can be caused by a jarring blow to the head or direct trauma to the eye. Of course, athletes with any of the predisposing factors discussed here are more likely to suffer a detached retina. It is important to note that the retinal detachment may, and probably will not, occur directly after the injury but may take weeks or months to develop. 3

Symptoms of a Detached Retina

Patients often describe a retinal detachment as a "curtain being pulled in front of the eye" as the retinal detachments is spreading from the side or below. The actual detachment is then experienced as a shadow in that portion of the visual field. Sometimes when detachments spread from below they are described as a "rising wall." Sometimes there is minor bleeding into the vitreous space and this is experienced as a "swarm of bees," "black rain," a "cloud," or a "shadow."

General symptoms are a sudden or gradual increase in either the number of floaters, which are little "cobwebs" or specks that float about in the field of vision, and/or light flashes in the eye.,2

Vision may become severely affected if bleeding from small retinal blood vessels cloud the vitreous space which is normally filled with fluid. If the center of the retina, called the macula, becomes detached then central vision will be severely affected as this as this is the part of the retina needed for fine, detailed vision such as reading, recognizing faces, etc. The rest of the retina, called the periphearl retina is need for side vision and is not capable of detailed vision.5 4

If you have these symptoms consider them a medical emergency. Make an appointment with an ophthalmologist immedietely. If the retina remains detached it will degenerate and vision could be permanently impaired. When retinal detachments go untreated blindness usually results.

Who is at Risk?

A retinal detachment can occur at any age, but it is more common in people over age 40. It affects men more than women, and Whites more than African Americans. A retinal detachment is also more likely to occur in people who:

  • Are extremely nearsighted
  • Have had a retinal detachment in the other eye
  • Have a family history of retinal detachment
  • Have had cataract surgery
  • Have other eye diseases or disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degeneration
  • Have had an eye injury 2


colored and labeled diagram of eye showing lens, pupil, retina, vitreous space, iris, macula, cornea and optic nerve

Labeled Diagram of Eye



+++How is a Detached Retina Diagnosed?

You ophthalmologist will probably be able to see the detached retina through an opthalmoscope. Various changes to the way the eye looks through the scope will alert him or her to the detachment. These include the gray appearance of the detached retina itself, absence of normal light reflex from the choroid, changes in vascular appearance, etc. Occasional it can even be seen with the unaided eye. 4

How are Retinal Detachments Treated?

Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor's office. During laser surgery tiny burns are made around the hole to "weld" the retina back into place. Cryopexy freezes the area around the hole and helps reattach the retina.

Retinal detachments are treated with surgery that may require the patient to stay in the hospital. In some cases a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the center of the eye and helps the eye maintain a round shape. Gas is often injected to into the eye to replace the vitreous and reattach the retina; the gas pushes the retina back against the wall of the eye. During the healing process, the eye makes fluid that gradually replaces the gas and fills the eye. With all of these procedures, either laser or cryopexy is used to "weld" the retina back in place.

With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. However, the visual outcome is not always predictable. The final visual result may not be known for up to several months following surgery. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and vision may eventually be lost. Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches. That is why it is important to contact an eye care professional immediately if you see a sudden or gradual increase in the number of floaters and/or light flashes, or a dark curtain over the field of vision. 2

References
1. Brinton, Daniel A., C. P. Wilkinson, and George F. Hilton. Retinal Detachment Principles and Practice. Oxford [etc.: Oxford UP, 2009. Print.
2. "Facts About Retinal Detachment [NEI Health Information]." National Eye Institute [NEI], of the U.S. National Institutes of Health. Web. 11 Dec. 2010. <http://www.nei.nih.gov/health/retinaldetach/retinaldetach.asp>.
3. McKeag, Douglas, and James L. Moeller. ACSM's Primary Care Sports Medicine. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2007. Print.
4. Wolf, Sebastian, Bernd Kirchhof, and Martin Reim. The Ocular Fundus: from Findings to Diagnosis. Stuttgart: Thieme, 2006. Print.
5. Retinal Detachments." Angeles Vision Clinic. Web. 11 Dec. 2010. <http://www.avclinic.com/RetinalDetachment.htm>.


This page is provided by Ground Up Strength for information purposes only and should not take the place of professional medical advice. Although we have done our utmost to provide accurate and safe information, we are not medical professionals and the information on this page should not be taken as professional medical advice, or any other kind of medical advice.

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