Retinal detachment

Overview

Retinal detachment is an emergency situation in which the retina pulls away from its normal position.

Discussion

What are the symptoms of retinal detachment?

Sudden appearance of floaters

Flashes of light (Photopsia)

Blurred vision

Reduced peripheral vision

Curtain like shadow over field of vision

What are the 3 types of retinal detachment?

Rhegmatogenous

Tractional

Exudative

Why does retinal detachment occur?

Rhegmatogenous detachment is caused by a hole or tear in the retina. The retinal hole/tear allows fluid to pass through and collect underneath the retina. As a result fluid builds up and causes the retina to pull away from underlying tissues. The areas where the retina detaches lose their blood supply and stop working leading to loss of vision.

Tractional detachment occurs when scar tissue grows on retinal surface. Because of scar tissue the retina is pulled away from the back of eye.

Exudative detachment occurs due to accumulation of fluid beneath retina in absence of any hole/tear in retina. It can occur due to age related macular degeneration, injury to eye or inflammatory disorders

How do you diagnose retinal detachment?

Retinal examination - Retina is examined to see if there is any hole or tear or detachment. Eyes are dilated before performing retinal examination

Optical coherence tomography (OCT)

Firstly dilating eye drops are given for this imaging. After that the eyes are scanned using OCT machine

Ocular Ultrasound  - It is used if bleeding has occurred in eye making it difficult to examine retina

What are the treatment options available for retinal detachment?

Laser surgery

Cryopexy

Pneumatic (gas bubble) retinopexy

Scleral Buckle

Vitrectomy

Laser surgery

A laser beam is directed into the eye through the By doing this the retinal tear is sealed. The laser beam burns around the retinal tear thus causing a scar that holds the retina in place.

Cryopexy

A freezing probe is applied over the outer surface of eye directly over the retinal tear. This causes a scar that holds the retina in place.

Pneumatic retinopexy

A gas or air bubble is injected into the eye(Vitreous cavity). The bubble presses against the retina closing the tear.

Fluid that had collected under the retina is absorbed by itself, and the retina  then adheres to the wall of the eye. To keep the bubble in the proper position, the head needs to be held in a certain position. The air bubble too reabsorbs on its own.

Scleral buckle

A silicone band or buckle is placed around the eye. The band holds the retina in place.

Vitrectomy

In vitrectomy, the vitreous is surgically removed along with any tissue that is tugging on the retina. Air, gas or silicone oil is then injected into the vitreous space to help flatten the retina.Eventually the air, gas or liquid will be absorbed, and the vvitreous cavity refills with body fluid.