A retinal detachment is an emergent eye condition in which the neurologic tissue responsible for vision (the retina) is displaced from its normal position. Most commonly, retinal detachment occurs in middle-aged and older adults when the vitreous (gel-like substance in the center of the eye) separates from the retina. Vitreous separation (posterior vitreous detachment) can result in a retinal tear, which can subsequently allow fluid to pass through the tear and beneath the retina resulting in a retinal detachment.
Risk factors for a retinal detachment include:
- Advancing age
- Nearsightedness (myopia)
- Prior ocular injury
- Family history of a retinal detachment
- Prior retinal detachment in the fellow eye
- Prior ocular surgery.
Symptoms that typically occur prior to a retinal detachment include:
- Sudden appearance of numerous floaters
- Flashes of light
- Decreased peripheral vision
- The sensation of a shadow progressing towards the center of vision
At the onset of any warning symptoms, a prompt (within 24-48 hrs) dilated eye exam should be performed. If no retinal tear or detachment is identified, the eye is typically re-examined in the next several weeks. If a retinal tear is present without a retinal detachment, this can be treated in the office with either laser photocoagulation or cryopexy to create an adhesion around the edges of the tear and prevent progression to a retinal detachment.
If a retinal detachment is present, there are multiple options for repairing the detachment:
- One option, a pneumatic retinopexy, is performed in the office and involves injecting a gas bubble into the eye. If the eye is positioned such that the gas bubble is located over the retinal tear, this can allow for resolution of the detachment. This procedure is typically combined with either cryopexy or laser photocoagulation.
- A scleral buckle is typically performed in an operating room on an outpatient basis. This procedure involves suturing a silicone band (bucke) to the white of the eye (sclera) in order to indent the eye wall inwards in the area of the retinal tear. This is often combined with cryopexy and making a small incision in the eye to drain the fluid causing the detachment.
- Alternately, a surgery to remove the gel inside the eye (vitrectomy) can be performed. This is combined with removing fluid from under the retina internally, performing laser photocoagulation, and filling the eye with a gas bubble. This procedure can be combined with placement of a scleral buckle.
Each procedure has advantages and disadvantages and a vitreoretinal surgeon will determine which procedure is likely to have the highest chance of successfully reattaching the retina. Following surgery, it may take several months for complete visual recovery and the vision may never return to normal if an extensive retinal detachment is present. Thus, it is very important to be examined soon after the onset of any concerning visual symptoms as this can prevent permanent visual impairment.