Retinal Tears and Detachments
What is a retinal detachment?
The retina is a thin layer of nerve tissue which normally lines the inside wall of your eye, like wallpaper. A retinal detachment occurs when the retina pulls away from the eye wall. When this occurs, the retina cannot function normally, and permanent damage can develop. A retinal detachment is a very serious problem that will almost always lead to blindness if not treated.
What causes a retinal detachment?
The center of the eye is filled with a clear gel called the vitreous. Over time, the vitreous becomes more condensed, which causes it to pull away from the surface of the retina. This process (called a posterior vitreous detachment, or PVD), usually occurs without damaging the retina, but in some cases the vitreous may pull hard enough to tear the retina in one or more places. Fluid can pass through the tear and begin accumulating beneath the retina, causing a retinal detachment. There are some conditions that are associated with a higher likelihood of developing a retinal detachment: myopia (nearsightedness), prior eye surgery, trauma, prior retinal detachment in either eye, or family history of retinal detachment.
Are there warning signs of a retinal detachment?
Early symptoms of a retinal detachment include new floaters, flashes of lights like a flashbulb, or a loss of part of the peripheral vision in one eye. These symptoms do not always indicate a detachment is present, but they should be promptly evaluated by your eye doctor.
How are retinal tears and detachments treated?
If your eye doctor discovers a retinal tear, it can usually be treated in the office with laser or cryotherapy. Both procedures seal the retina around the tear and prevent the development of a retinal detachment. These procedures are usually performed with little or no discomfort in the office and are highly successful. There are sometimes circumstances where a tear or retinal hole may not require treatment, or cases when despite treatment, new tears or a detachment occurs. If the retina has already detached, surgery is typically required to correct the problem. There are several different techniques, and in some cases, a procedure can be done in the office to repair the detachment. Your doctor will discuss which technique is most appropriate for your case.
Pneumatic retinopexy is a procedure that can be performed in the office to repair a retinal detachment. Depending on the characteristics of the detachment, this sometimes can be an ideal treatment that avoids the need for a trip to the operating room. This procedure is accomplished by injecting a gas bubble into the center of the eye, where the vitreous gel is located. The bubble then floats up against the tear in the retina, and pushes the retina back up against the wall of the eye. The tear still needs to be sealed with cryotherapy or laser. The gas bubble will dissipate on its own.
Scleral buckle surgery is performed in the operating room and involves placing a flexible band around the outside of the eye to counteract the pulling force of the vitreous gel and support the retina. This also involves cryotherapy to seal the retinal tear. The band usually remains in place indefinitely.
Vitrectomy surgery is performed in the operating room and involves the removal of the vitreous gel from the inside of the eye. Laser is used to reattach the retina, and a self-dissolving gas bubble is placed inside the eye to hold the retina in place while it heals. The vitreous does not regenerate, but the eye will function normally without it.
Sometimes these procedures are performed simultaneously or sequentially depending on the particular characteristics of the detachment.