Detached retina: Symptoms, causes and treatment

A detached retina is a serious and sight-threatening event, occurring when the retina becomes separated from its underlying supportive tissue.

The retina cannot function when not in contact with these layers and unless the retina is reattached quickly, permanent vision loss may result.

Detached retina: Symptoms and signs

If you suddenly notice eye spots, floaters and flashes of light, you may be experiencing the warning signs of a detached retina. Your vision might become blurry, or you might have poor vision.

Seeing a curtain-like shadow coming down across your field of vision can be a sign of retinal detachment.

Another sign is seeing a shadow or a curtain descending from the top of the eye or across from the side.

These signs can occur gradually as the retina pulls away from the supportive tissue, or they may occur suddenly if the retina detaches immediately.

Approximately one in seven people who experience a sudden onset of flashes and floaters will have a retinal tear or detachment. And 50 percent of people who have a retinal tear will experience a subsequent retinal detachment.

A detached retina is painless. If you experience any of the visual signs of retinal detachment, consult your optometrist immediately. Urgent treatment increases your odds of maintaining your vision.

What causes a retinal detachment?

An injury to the eye or face can cause a detached retina.

High levels of short-sightedness (myopia) can also cause a retinal detachment. This is because highly myopic people typically have longer-than-normal eyeballs with thinner retinas that are more prone to detaching.

On rare occasions, a detached retina may occur after LASIK surgery in people with high myopia. Cataract surgery, tumours, eye disease and systemic diseases such as diabetes and sickle cell disease may also cause retinal detachments.

New blood vessels growing under the retina — which can happen in diseases such as diabetic retinopathy — may push the retina away from its support network and cause a retinal detachment as well.

Treatment for a detached retina

Surgery is required to repair a detached retina. The procedure usually is performed by a retinal specialist — an ophthalmologist who has undergone advanced training in the medical and surgical treatment of retinal disorders.

Generally, the sooner the retina is reattached, the better the chances that vision can be maintained or restored.

Surgical procedures used to treat a retinal detachment include:

Scleral buckling surgery

This is the most common retinal detachment surgery, and consists of attaching a small band of silicone or plastic to the outside of the eye (sclera). This band compresses (buckles) the eye inward, reducing traction on the retina and thereby allowing the retina to reattach to the interior wall of the eye.  

The scleral buckle is attached to the posterior portion of the eye and is invisible after surgery.  

Scleral buckling surgery often is combined with one of the following procedures to fuse the retina to its underlying supporting tissue (called the retinal pigment epithelium, or RPE).

Vitrectomy

In this procedure, the clear jelly-like fluid is removed from the posterior chamber of the eye (vitreous body) and replaced with clear silicone oil to push the detached portion of the retina back onto the RPE.

Pneumatic retinopexy

In this procedure, the surgeon injects a small bubble of gas into the vitreous body to push the detached portion of the retina onto the RPE.

If the detachment is caused by a tear in the retina, the surgeon usually uses a laser or a freezing probe to "spot weld" the retina firmly onto the RPE and underlying tissues and thereby seal the tear. If a laser is used, this is called laser photocoagulation; use of a freezing probe is called cryopexy.

Surgical reattachment of the retina isn't always successful. The odds for success depend on the location, cause, and extent of the retinal detachment, along with other factors.

Also, successful reattachment of the retina doesn't guarantee normal vision. Generally, visual outcomes are better after surgery if the detachment is limited to the peripheral retina and the macula is not affected.

Page published on Monday, 16 March 2020