Retinal Detachment

In retinal detachment, separation of the retinal layers creates a subretinal space that fills with fluid. Twice as common in men as in women, retinal detachment may be primary or secondary. The disorder usually involves only one eye but may occur in the other eye later. A detached retina rarely heals spontaneously; it can usually be reattached successfully with surgery. The prognosis depends on the area of the retina affected.

Causes

A retinal detachment may be primary or secondary. A primary detachment occurs spontaneously because of a change in the retina or the vitreous; a secondary detachment results from another problem, such as intraocular inflammation or trauma. The most common cause of retinal detachment is a hole or tear in the retina. This hole allows the liquid vitreous to seep between the retinal layers and separate the sensory retinal layer from its choroidal blood supply. In adults, retinal detachment usually results from degenerative changes related to aging (which cause a spontaneous tear). Predisposing factors include myopia, cataract surgery, and trauma.

Additionally, retinal detachment may result from fluid seeping into the subretinal space as an effect of inflammation, tumors, or systemic disease. Or detachment may result from traction placed on the retina by vitreous bands or membranes (resulting from proliferative diabetic retinopathy, posterior uveitis, or a traumatic intraocular foreign body, for example).

The disorder may occasionally develop in a child from retinopathy of prematurity, tumors (retinoblas­tomas), or trauma. Retinal detachment can also be inherited, usually in association with myopia.

Retinal Detachment Signs and Symptoms

The typical signs and symptoms for a retinal detachment are as follows:

• Light flashes
• "Wavy," or "watery" vision
• Veil or curtain obstructing vision
• Shower of floaters that resemble spots, bugs, or spider webs
• Sudden decrease of vision

Diagnostic tests

Direct ophthalmoscopy, after full pupil dilation, shows folds or discoloration in the usually transparent retina; indirect ophthalmoscopy can be used to detect retinal tears.

Ocular ultrasonography may be performed to examine the retina if the patient has an opaque lens.

Treatment

Depending on the location and severity of the detachment, treatment may include restricting eye movements to prevent further separation until surgical repair can be made. The patient's head is positioned to allow gravity to pull the detached retina into closer contact with the choroid.

A patient with a hole in the peripheral retina may be treated with cryothermy. A hole in the posterior retina may respond to laser therapy.

To reattach the retina, scleral buckling may be performed. In this procedure, the surgeon places a silicone plate or sponge over the reattachment site and secures it in place with an encircling band. The pressure exerted gently pushes the choroid and retina together. Scleral buckling may be followed by replacement of the vitreous with silicone, oil, air, or gas.

Prevention

Preventing retinal detachment is possible by having regular eye exams and seeing an eye care practitioner immediately when early symptoms (floaters and flashes) are experienced. In most cases, small tears can be repaired easily and vision can be preserved. People at high risk should discuss the frequency of eye exams with their practitioner.

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