Retinal Detachment

The retina is a thin layer of nerve cells that lines the inside of the eye.  It is sensitive to light (like the film

Retinal detachment is when the retina, the light sensitive layer at the back of your eyes, comes away or separates from the back of the eye. The retina is the sensory layer that helps us detect light and see. A retinal detachment can occur for different reasons and needs to be treated quickly to preserve your eyesight.

- Onset of new or different floaters

- Flashing lights

- Dark shadow or dark curtain in any area of your vision

- Loss of vision or blurry vision

If you suspect you have a retinal detachment, it is IMPORTANT, that you seek medical advice immediately. See an optician for an emergency appointment on the same day and do not wait! Or visit your local eye hospital on the same day to be reviewed. It is essential that retinal detachments be treated, as soon as possible, to prevent it from becoming worse and preserving your sight.

Retinal detachment can occur as a natural part of aging. Other causes for a retinal detachment to occur are, retinal holes & tears, a direct blow to the eye, scar tissue or fluid.

Retinal holes and tears on the retina that have not been treated or sealed off, allow fluid to seep in underneath the retina and separate the retina from the underlying tissue. The separation of the retina from the underlying tissue causes a retinal detachment. The vitreous jelly pulling hard on the retina causes most retinal tears; this is called acute posterior vitreous detachment, as it tries to come away during the natural aging process. It is important to note that most patients will not get a tear from the vitreous coming away through the natural process of posterior vitreous detachment (PVD).

Retinal detachments can occur with hemorrhaging if a blood vessel tears.

A direct blow to the eye may cause a retinal detachment due to force of the trauma.

Scar tissue formation on the surface of retina or vitreous caused by certain eye conditions can contract and pull on the retina. This is called a tractional retinal detachment, caused by the traction of the scar tissue that pulls the retina off.

Fluid that has accumulated from blood vessels underneath the retina can push the retina off, causing a retinal detachment. This is a rare type of detachment that occurs when there are no holes or tears present. The usual cause is tumours or inflammation.

Risk factors for retinal detachment

- Over 60 and 70 years of age

- Untreated retinal tears or holes

- Short-sighted (increased risk if over -6.00DS)

- Trauma, a direct injury or blow to your eye

- You have already previously had a detachment in one eye

- Family history of retinal detachment

- Previous cataract, glaucoma or eye surgery

- Retinal thinning or weak areas in the retina

It is important to attend regular eye tests especially if you fall into one of the risk categories. Small tears and holes and eye conditions can be detected on your annual eye examination. Early detection and treatment of tears, holes & eye conditions can prevent a retinal detachment from occurring. Retinal tears and holes can be simply treated with laser or cryotherapy (freezing) to seal the retinal tear or hole.

Always wear DIY protective goggles or sports goggles to prevent blunt trauma to the eyes.

If you do have a retinal detachment the types of treatments available are:

Retinal detachment surgery is used to reattach the retina back onto the back of the eye. As mentioned before it is important that surgical treatment for retinal detachments is done as soon as possible, to preserve your eyesight. When the retina first detaches it is still ‘sticky’, therefore early treatment can allow the ‘sticky’ retina to be put back to its original place and allow it to reattach.

There are different types of retinal detachment surgeries and the type of treatment required is dependent on the type of retinal detachment, location and if there are any other complicating eye conditions present. Retinal detachment treatments vary from person to person.

Most retinal detachment surgery is done under local anaesthetic.

Cryotherapy and scleral buckles (made of silicone or sponge) can be used to treat the retinal detachment. The scleral buckles are used as splints to hold the retinal in place. Scleral buckles are permanent and attached to the outer sclera (white of your eye); this causes the inside of your eye to move inwards and pushes it against the detached retina. The detached retina can then reattach itself. Cryotherapy is then used around the detached or torn retina to seal it, by freezing it. Laser can also be used with a similar effect.

Vitrectomy, cryotherapy or laser, and injection of gas bubble or silicone oil. Vitrectomy is used to remove the vitreous jelly from the eye.

The gas or silicone oil is then injected into the back of the eye to replace the vitreous. The gas or silicone oil acts like a ‘splint’, by holding the detached retina back in place until the retina reattaches itself by natural scar healing. Cryotherapy is then used to freeze the retina surrounding the detached area; this seals the retina against the back of the eye by adhesion and scarring. Laser can be used instead of cryotherapy.

The two types of gas used are SF6, which is short acting and lasts in the eye for 2-3 weeks. C3F8 is long acting and stays in the eye for up to 3 months. The gas bubble dissipates with time and is replaced by naturally occurring fluid in the eye. If silicone oil is used, you will require a further minor operation to have this removed. When using gas or silicone oil you will need to remain in a head or face down position to keep the silicone oil or gas bubble in place, your ophthalmologist will tell you how long you will need to do this for.

It is important that you do not fly until advised by your ophthalmologist, and you must tell your other doctors or consultants if you are having any other health treatments.

Pneumatic retinopexy (gas bubble surgery) is used if the retinal detachment is small. A gas bubble is injected into the vitreous (vitreous is not removed) and the gas bubble helps push the detached retina back into place. Laser and cryotherapy are then used to seal the retina around the detached retina site. However, this surgery is not often done, as the success rates are not very high.

Possible complications from surgery are:

- Bruising of the eye or eyelids

- High eye pressure

- Cataracts, you may need cataract surgery in the future

- Double vision

- Allergy to eye drops or medication given

- Inflammation inside the eye, requires urgent treatment

- Endophthalmitis, infection inside the eye, requires urgent treatment

- Further surgery, for new scar formation or retinal holes post surgery, this occurs in 5-10% of patients

It is vital you attend all post op appointments, inform your ophthalmologist if you have any concerns and attend regular eye examinations after you have been discharged.