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Detached Retina: Causes, Symptoms and Treatment

Detached Retina A detached retina, which occurs when the retina becomes separated from the tissue which normally supports it, is an extremely serious eye condition which must be treated as a medical emergency. The retina is the very thin sensory membrane which lines the back of the eye and is only about the size of a postage stamp. When light rays enter they eye, they are focused by the cornea and lens onto the retina, which receives the image and transmits it to the brain via the optic nerve. If the retina is detached from its underlying tissue then it cannot function, and if it's not reattached quickly, the result is often permanent blindness.

Symptoms of a detached retina
Symptoms of a retinal detachment may include

  • An increase in the number of spots or floaters
  • Flashes of light
  • A curtain, veil or shadow over the visual field
  • Blurred vision
  • Sharp decrease in vision

Depending on how fast the retina pulls away, these symptoms may occur gradually or suddenly. These signs must not be ignored, even though there is no pain associated with this problem. If you have a detached retina, immediate treatment is the only thing which can save your eyesight.

Generally a retinal detachment only occurs in one eye, but the other eye should be examined for signs of possible weakness and tearing.

Causes of a detached retina
A retina can become detached as the result of an accident or injury to the face, such as blunt trauma from a fist or tennis ball, but there are other causes as well. High levels of nearsightedness are associated with this condition, likely because of the elongated eyeball shape which causes the myopia. Retinal detachment can also be a genetic problem, making those with a family history of this condition more at risk.

Occasionally a detached retina may be caused by LASIK surgery. Once again, very nearsighted patients are most prone to this condition, but this is very rare occurrence indeed affecting less than 0.2% of LASIK patients.

Other causes of a detached retina include be tumors, eye disease or cataract surgery. Diabetes, uveitis and sickle cell disease may also increase the risk. In diabetic retinopathy, new blood vessel growth beneath the retina can cause it to detach from its supporting tissue. Patients using certain eye drops or other medications can also have an increased risk of developing a retinal detachment. An example of such a drug is pilocarpine (brand name: Salagen) which is used to treat dry mouth and sometimes glaucoma.

Treatment for a detached retina
Surgery is the only treatment for a detached retina. Sometimes this can be done as an outpatient procedure, but an overnight stay in the hospital may be necessary.

First, the eye surgeon will seal any holes or tears in the retina using a laser or a freezing procedure (cryopexy). Next, the retina will be reattached, likely using one of the following methods:

  • Pneumatic retinopexy – During this procedure, the surgeon injects a bubble of special gas into the vitreous cavity of the eye. This bubble then expands, putting pressure on the retina and pressing it against the back of the eye, allowing it to reattach. In some cases, the surgeon will first need to remove some fluid from between the cornea and iris in order to soften the eye. The injected gas will disappear on its own, generally over a period of several weeks.

  • Scleral buckling – A scleral buckle is a small piece of silicone which is sewn to the white part of the eye (the sclera) in a way which causes back of the eyeball to indent. This indentation, or “buckling,” reduces the strain on the retina, allowing it to settle against the back wall of the eye. The piece used may be placed only over the affected area, or it may be a semi-circle which wraps around the back part of the eye. The scleral buckle is generally left in place permanently and isn't visible.

In some cases, it is necessary to remove some of the vitreous (the gel-like substance that fills the interior of the eye) before retinal surgery can be performed. This procedure is called a vitrectomy. A vitrectomy may be necessary if the vitreous is cloudy, obscuring the surgeons view of the retina, or if retinal scaring would limit the effectiveness of other procedures. During the vitrectomy, the surgeon will use delicate instruments, inserted through tiny incisions in the sclera, to cut and remove vitreous and scar tissue. A saline solution will simultaneously be infused into the eye to maintain normal eye pressure and shape. After the vitrectomy the surgeon will likely perform a scleral buckling or other procedure to reattach the retina. A gas or silicone bubble may be used to help press the retina against the back wall of the eye.

Prognosis
Even if performed immediately, surgery may not be successful in reattaching the retina, and even a successfully reattached retina does not guarantee that you will regain your normal vision. Many factors will determine how well you will see after surgery. If the central portion of the retina (the macula) was affected, your chances of a good outcome are much lower than if only the perphery was detached. How long the retina was detached before treatment can also greatly affect the outcome of surgery.

In addition, it can take many months for the eye to fully recover and heal after a retinal detachment, so even if your vision is poor immediately following surgery, it may improve over time. At the same time though, it is possible that you will not regain any of your lost vision at all.

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