A retinal detachment can cause permanent vision loss; prompt evaluation and treatment by a retina specialist is important.
Causes of Retinal Detachments
Most retinal detachments occur because of a retinal tear. A retinal tear usually occurs because of a posterior vitreous detachment (PVD). While most posterior vitreous detachments occur without causing any problems, some will occur with enough force on the retina to create a tear.
If a tear is not detected and treated by a retina specialist in a timely manner, it can lead to a retinal detachment. Other retinal detachments can occur from scar tissue, and are termed tractional retinal detachments, and most frequently occur in patients with diabetes; it is important that patients with diabetes be closely monitored by a retina specialist to help detect and treat any sight-threatening problems. Other, less frequent causes of retinal detachments include trauma, or sometimes congenital malformations, as well.
Symptoms of a Retinal Detachment
The signs and symptoms of a retinal detachment are variable, but frequently involve a dimming, or shadow-like curtain that creeps across the filed of vision; sometimes, flashes of light (photopsias) can occur at the beginning. Depending on the location of the retinal detachment, vision can deteriorate very slowly, or rapidly. In either case, prompt evaluation by a retinal specialist is a good choice.
Most retinal detachments are diagnosed by a retina specialist in the office just by looking into the eye; usually, gentle pressure on the outside of the eye is used to help see the entire retina, as retinal tears can frequently occur in more than location. If necessary, a retina specialist may use an ultrasound in the office to help see through any blood. A careful drawing of the retinal detachment is made, and the retina specialist will discuss with the patient the various treatment options.
Treatment of Retinal Detachments
Many retinal detachments can be treated the same day in the office by a procedure called a pneumatic retinopexy; this office-based procedure involves injecting some gas in the eye, and applying either laser (warm energy) or cryo (super cold energy) to the eye, on either the same, or the following day or two.
With a pneumatic retinopexy, patients leave the office the same day, usually without any patch over the eye, and are instructed by their retina specialist to maintain their head in such a position as to displace the gas bubble against the retinal tear, thus insuring the highest level of success. Eye drops are usually prescribed for a few days, as well.
If the retina specialist deems that a pneumatic retinopxy is not the best choice, then two other options exist, called a scleral buckle and vitrectomy (pars plana vitrectomy); these procedures can be performed by themselves, or in combination– but either way, the patient is usually treated as an outpatient in the operating room.
With a scleral buckle, a very thin silicone band is sutured on the outside of the eye, and some gas is usually injected into the eye, as well. The scleral buckle indents the wall of the eye just enough so that the traction on the retinal tear is sufficiently reduced; in most cases, the scleral buckle remains on the eye for life.
With a pars plana vitrectomy, tiny instruments are passed into the eye, and the clear, jelly-like fluid in the eye (called the vitreous) is removed, all retinal tears are treated (usually with laser), and a bubble of gas is placed in the eye.
With either a scleral buckle or pars plana vitrectomy, only iv sedation and some anesthetic around the eye is all that is required, and patients go home the same day with a patch over the eye–and are again instructed by their retina specialist to keep their head in a certain position. Eye drops are started the next day, and patients are usually seen back in about one to two weeks.
In most cases of retinal detachment surgery, a retina specialist will review with the patient certain limitations and restrictions after surgery, which usually involves avoiding air travel for a number of weeks; aircraft are pressurized to a certain altitude, which can cause the gas bubble in the eye to get too big, causing eye pain and serious elevation in the eye pressure.