All about Retinal Detachment – Symptoms, Causes, Types (Rhegmatogenous, Tractional, Exudative), Diagnosis, Treatment (Pneumatic Retinopexy, Vitrectomy, Scleral Buckle)

What is Retinal Detachment?

Retinal detachment is a disorder of the eye in which the retina – the light-sensing nerve tissue at the back of the eye – lifts away from the underneath layer of the eye. To put it simply, in Retinal detachment, the retinal cells gets separated from the underlying layers of blood vessels which provides oxygen and nourishment to the Retina. Retinal detachment is a medical emergency in which one can permanently lose vision and hence needs to be managed urgently. It is most common in individuals in their 50s or 60s.

What are the symptoms of Retinal Detachment?

Retinal detachment is painless. However, warning signs are almost always present that one must pay attention to. Some of the key symptoms of Retinal detachment are as follows:

Sudden appearance or increase in number of floaters - tiny specks that seem to drift through the field of vision. Floaters occur due to formation of pockets of liquid within the vitreous humour which is the thick fluid or gel that fills the eye)
Flashes of light in one or both eyes (photopsia)
Blurred vision
Gradually reduced side (peripheral) vision
A curtain-like shadow in the field of vision

How is Cataract diagnosed?

Visual Acuity Test – Your vision is tested using an AutoRefractometer and Vision Chart. Poor vision which does not correct with glasses is often an indicator of cataract.

Slit Lamp Exam – Your eye doctor would examine your eyes on a slit lamp (kind of a microscope for eyes which allows ophthalmologists to look into the eye under magnification) to see if your natural lens shows signs of cataract.

Retinal exam – Your eye specialist may choose to dilate your eyes to examine your Retina also to ensure that Retina is healthy. This is important because If the Retina has some problem then even after cataract surgery the vision may not improve to the fullest.

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What causes Retinal Detachment? What are the risk factors for Retinal Detachment?

Risk factor of Retinal detachment include

High myopia (extreme nearsightedness)
Family history of retinal detachment
Retinal tear or detachment in the other eye
Have had cataract, glaucoma or some other eye surgery
Had a serious eye injury
Have weak areas in the retina or thinning of peripheral retina (seen by an eye doctor during an eye examination)
People aged over 50 years are more likely to catch this disorder

What are the types of Retinal Detachment?

There are three types of Retinal detachment

Rhegmatogenous (reg-ma-TODGE-uh-nus) - This is the most common type of Retinal detachment. It is caused by a hole or tear in the retina. The most common cause is aging. As one ages, the gel like material (called vitreous) that fills the interior region of the eye changes its consistency and shrinks to become more liquid and tends to peel off or separate from the retina. This separation from the surface of the retina generally occurs without any complications and is called as posterior vitreous detachment (PVD). However, at times it may tug on the retina with enough force to create a retinal tear. Left untreated, the liquid vitreous can pass through the tear into the space behind the retina, causing the retina to become detached. As the retina is pulled away from the underlying tissues it loses blood supply that provides oxygen and nourishment to the retinal cells leading to loss of vision in the corresponding areas. This is an emergency condition and must be treated urgently to avoid any further deterioration. The longer retinal detachment goes untreated, the greater the risk of permanent vision loss in the affected eye.
Tractional - This type of detachment can occur when scar tissue grows on the retina's surface. The growth of scar tissues causes the retina to pull away from the back of the eye. Tractional detachment is typically seen in people who have poorly controlled diabetes or have any other conditions/ diseases.
Exudative - In this type, fluid accumulates beneath the retina. However, there are no holes or tears in the retina. Exudative detachment can be caused due to number of factors such as ARMD (age-related macular degeneration), injury to the eye, tumors and inflammatory disorders.

Krishna Netralaya's team of specialist Ophthalmologists bring together years of experience of treating Retinal Detachment.

How is Retinal Detachment diagnosed?

After reviewing the medical and family history, the eye doctor will conduct a complete eye exam and may also do some other tests, including:

Examination of the retina or the back of the eye - - The doctor will put dilating eye drop in the patient’s eye, which will widen the pupil and allow the doctor to look inside of patient’s eye using a special lens. He or she will look for retinal holes, tears or detachments.
Optical Coherence Tomography (OCT) - - This test may be required if the Ophthalmologist has difficulty seeing your retina due to bleeding in the eye. OCT is a non-invasive imaging test which displays detailed cross-sectional images of the retina.

How is Retinal Detachment treated?

Retinal detachment can only be treated surgically. There are broadly three types of surgery:

Pneumatic Retinopexy – In this procedure, the retina surgeon will insert a gas bubble inside the patient’s eye. The gas bubble will in turn push the retina into its place. This placing back of retina in its position will help the retina to heal. Post-surgery the patient will be asked to keep the head in a specific position. This is so since keeping the head in the suggested position will help to keep the bubble in the right place. With time and healing the body will produce the fluid/gel that will then fill the eye. It will eventually lead the fluid to replace the gas bubble.

Vitrectomy – In this procedure, the retina surgeon will remove the vitreous that has been pulling the retina. The vitreous will be replaced with an air, gas, or oil bubble. Much like Pneumatic retinopexy, the bubble will push the retina into place and eventually the retina will heal. However, if an oil bubble is used instead of air or gas bubble, then the doctor will remove the oil bubble after a few months. Some word of caution for patient who are treated with air or gas bubble. These patients will have to completely restrict their travel via air or travel to high altitude or travel to deep down the sea (e.g. scuba diving). This is so since at altitude or depths the gas can expand or contract, which can further increase or decrease the pressure on the eye.

Scleral Buckle – In this procedure, a band of rubber or soft plastic is sown to the outside of eyeball. This rubber of sift plastic will press the eye in the inward direction. This helps the detached retina heal as the eye ball is pushed against the retina. The patient will not see the scleral buckle on the eye. The buckle is usually left on the eye permanently.

What are the major risks associated with Retinal Detachment surgery?

Risk factor of Retinal detachment surgery include

Eye infection
Bleeding in the eye
Increased pressure inside the eye, which can lead to glaucoma
Cataract, when the lens in the eye becomes cloudy
Need for a second surgery
Chance that the retina does not reattach properly
Chance that the retina detaches again

What to expect during recovery after Retinal Detachment surgery?

Patient might have some pain or discomfort that can last between few days to weeks after surgery. The patient will be given pain medicine to help feel better.
Patient will be expected to rest and be less active after surgery for a few weeks. The doctor will suggest when the patient can exercise, drive or resume other activities again.
In case a bubble was inserted in the eye, the patient will need to keep his/her head in one position for a certain duration of time (e.g. 1-2 weeks).
The patient might see floaters and flashing lights for a few weeks after surgery. The patient may also notice the bubble in the eye.

When and how much vision improvement can be expected after Retinal Detachment surgery?

Vision in the operated eye should begin to improve in about four to six weeks after surgery. It could also take months after surgery for the vision to improve. The retina may still continue to heal for a year or more after surgery. However, how much the patient’s vision improves will depend on the damage the detachment has caused to the cells of the retina.

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Disclaimer: All information, provided above is for informational purposes only and is not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider. Read our full disclaimer here.