Retinal detachment is separation of the retina from the
layer of blood vessels (the choroid) underneath it. The
retina is the light-sensitive tissue at the back of the eye.
A retinal detachment caused by a tear or a hole in the
eye is the most common type. This type, if not treated, will
cause blindness. It should be repaired as soon as possible.
It is especially important to treat it quickly, if the
central vision is good. The chances of saving the vision is
better in these cases if the surgery is done within a day.
When the central vision is already decreased due to the
retinal detachment, having the surgery within a day will not
improve the result. In these cases, you should have the
surgery within a week.
Sometimes retinal detachment occurs without a hole or a tear
in the retina. Although this can be due to a serious
condition, it is treated differently than detachment
caused by a tear or a hole.
How does it occur?
A detachment that occurs because of a tear or hole is called
rhegmatogenous retinal detachment. Changes in the clear gel
in the center part of the eye can pull on the retina and
cause a tear or a hole. If the fluid inside the eye gets
under the retina through a hole or a tear, the retina will
lift off from the wall of the eye and detach. This usually
requires surgery.
Another type is called exudative retinal detachment. This
happens when fluid is leaking into the space between eye wall
and the retina. Inflammation, infection, tumor,
abnormalities in blood vessels, and other rare conditions can
cause leakage of fluid under the retina. This kind is
treated by treating the underlying disease and does not
require surgery.
Traction retinal detachment occurs because scar tissue inside
the eye pulls the retina off the wall of the eye. This can
happen in diabetes, with long-lasting inflammation, eye
injury, or from a previous surgery. Your eye doctor may talk
to you about doing a surgery to repair the eye.
What are the symptoms?
In rhegmatogenous retinal detachment, the first symptoms
are those of a retinal tear including flashing lights and
seeing floaters in your field of vision. Many people
just have gradual loss of peripheral (side) vision without
pain. If not treated, vision becomes dark all over. This
may take hours or days.
In the other types of retinal detachment, you may have
gradual vision loss over a long period of time.
How is it diagnosed?
A detached retina cannot be seen without special
instruments. Therefore, you should see an ophthalmologist
(a medical doctor who specializes in eyes) as soon as you
think you may have a problem with your vision.
In some cases, an ultrasound of the eye is needed.
How is it treated?
Rhegmatogenous retinal detachment can be treated with
surgery. No laser or medicine is effective. There are
3 main ways to treat the problem.
- Pneumatic retinopexy. The eye surgeon injects a gas
bubble into the eye to push the retina back in place.
The tears in the retina are sealed later with cryopexy
(freezing) or a laser. Although this is the least invasive
procedure with the quickest recovery, the success rate
is low and it is not used very often.
- Scleral buckling. A silicone band or sponge can be placed
under the muscles. This makes the eye wall push against
the retina. This is a more painful procedure and has
some risks. However, it is successful 90% of the time.
- Vitrectomy. The vitreous (clear gel inside the eye) may
be pulling the retina away from the eye. The eye surgeon
will cut the vitreous away from the retina to stop the
pulling. The surgeon then fills the eyeball with air,
gas, or silicone oil to push the retina back against the
wall of your eye. Over time, the air or gas is replaced
with the eye's own fluids. If silicone oil is used, it
needs to be removed during a second operation several
weeks or months later. This has success rate similar to
scleral buckling. Some surgeons combine vitrectomy with
scleral buckling to increase the chance of success in some
cases.
Your eye is numbed for these procedures. For most of
them you can go home the same day. While you recover, you
will usually need to keep your head in a specific position
(such as face down or to one side) for several days or weeks
to help your eye heal. Your doctor will tell you what
position to rest your head in, how long you need to do
this each day, and for how many days.
You may need other minor procedures as well. Your eye
doctor will check your eyes often.
How long will the effects last?
Unlike other types of eye surgery, your vision is often very
blurry after retinal detachment surgery. It may take several
weeks for the blurriness to go away.
Surgery to repair a detached retina is successful in most
cases. However, because the retina is very delicate and
complex, there is almost always some degree of permanent
damage.
Around 10% of people who have surgery will need more surgery.
Sometimes scar tissue forms or there is trouble with
recovery. If your vision gets worse or you start having new
peripheral (side) vision problems after surgery, let your
doctor know.
How can I take care of myself?
Follow your doctor's instructions after surgery to help your
eye heal. You will need to:
- Use the eyedrops or ointment prescribed by your doctor.
- Limit your activities for a few days.
- Keep your head in the position recommended by your doctor
for a few days to a few weeks.
Several weeks after surgery, after your eye has completely
healed, have your eyeglasses prescription checked to see if
you need to change it.
If you have had retinal detachment in one eye, your risk of
retinal detachment in the other eye is greater. See your
eye doctor regularly so that any minor problems in your
other eye can be corrected before they become serious.
What can I do to help prevent this from occurring?
If you are very nearsighted or have a family history of
retinal detachments, see your eye doctor regularly. While
you cannot prevent some changes in your eyes, you can help
prevent them from seriously damaging your vision. Treating
holes and tears promptly helps prevent retinal detachment.


Disclaimer: This content is reviewed periodically and is subject to
change as new health information becomes available. The
information provided is intended to be informative and educational and is not a
replacement for professional medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
HIA File eye4219.HTM Release 9.0/2006. Copyright © 2006 McKesson Corporation and/or one of its subdiaries. All Rights Reserved.
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