Retinal detachment is a condition where the retina detaches from the back of the eye. This condition is classified as an emergency and must be treated immediately. Otherwise, retinal detachment can cause permanent blindness.
The retina is a thin layer at the back of the eye. This layer functions to process light captured by the eye. The captured light will be converted into electrical signals and forwarded to the brain which will translate the signals as images.
A detached retina can cause impaired vision. This impairment can be partial or complete, depending on how much of the retina has detached. Retinal detachment can happen to anyone, but is more common in people over 50 years of age.
Types and Causes of Retinal Detachment
Retinal detachment occurs when the retina of the eye is detached from the blood vessels that carry oxygen and nutrients. Based on the mechanism that causes the detachment of the retina, retinal detachment is divided into three types, namely:
Rhegmatogenous retinal detachment
Rhegmatogenous retinal detachment is the most common type of retinal detachment. This type of retinal detachment occurs when a tear in the retina allows the fluid in the center of the eyeball (vitreous fluid) to leak in and accumulate behind the retina. This condition causes the retinal layer to detach from its base.
Generally, tears in rhegmatogenous retinal detachment occur due to changes in the texture of the vitreous fluid as we age. Tears can also occur due to several conditions, namely nearsightedness , eye injuries, and eye surgery.
Exudative retinal detachment
Exudative retinal detachment occurs when fluid or blood builds up behind the retina, causing the retina to detach. However, in this type, the fluid buildup does not cause a tear in the retina.
Fluid buildup is usually caused by leaking blood vessels or swelling in the back of the eye. Causes can include:
- Injury or trauma to the eye
- Macular degeneration
- Eye tumor
- Inflammation of the eye
- Coats’ disease, a rare disease that causes abnormalities in the development of the retina of the eye
- Injury or trauma to the eye
- Macular degeneration
- Eye tumor
- Inflammation of the eye
- Coats’ disease, a rare disease that causes abnormalities in the development of the retina of the eye
Tractional retinal detachment
This type occurs when there is scar tissue that causes the retina to pull and detach. This scar tissue is usually formed due to diabetic retinopathy , an eye disorder that occurs in people with diabetes. Diabetic retinopathy can cause damage to the blood vessels of the eye.
In other words, tractional retinal detachment is more common in diabetics whose blood sugar levels are uncontrolled.
Risk factors for retinal detachment
There are a number of factors that can increase a person’s risk of developing retinal detachment, namely:
- Over 50 years old
- Have had a previous retinal ablation
- Having a history of retinal detachment in the family
- Suffering from serious eye injury
Suffering from severe nearsightedness (myopia) - Have had eye surgery, such as cataract surgery
- Suffering from eye disease, for example inflammation of the middle layer of the eye (uveitis)
Symptoms of Retinal Detachment
Retinal detachment or retinal detachment is painless. Vision loss can occur suddenly, or be preceded by a number of symptoms below:
- Many black spots appear floating in the vision (floaters)
- Vision is blurred or covered by shadows
- Narrowed field of vision
- Flashes of light in vision (photopsia)
When to see a doctor
As mentioned earlier, retinal detachment is an emergency. Therefore, see a doctor immediately if you experience the symptoms mentioned above, so that treatment can be carried out immediately. This can prevent permanent blindness.
Retinal Detachment Diagnosis
To diagnose retinal detachment, the doctor will ask about the patient’s symptoms. After that, the doctor will give eye drops to dilate the patient’s pupils. Please note that these eye drops may cause temporary discomfort in the eyes.
Next, the eye doctor will perform an ophthalmoscopy examination with a special tool, to see the inside of the eye. If the ophthalmoscope cannot observe the condition of the retina clearly, for example due to bleeding in the eye, the doctor will perform an eye ultrasound.
Treatment for retinal detachment varies depending on the patient’s condition. If the retina is torn or perforated but has not yet detached, an eye doctor may perform the following actions to improve vision and prevent retinal detachment:
Retinal Ablation Treatment
Treatment for retinal detachment varies depending on the patient’s condition. If the retina is torn or perforated but has not yet detached, an eye doctor may perform the following actions to improve vision and prevent retinal detachment:
- Cryopexy, to freeze the retinal tear so that the retina remains attached to the wall of the eye.
- Laser therapy (photocoagulation), to burn the tissue around the retinal tear and help the retina stay attached.
If the retina has detached, the doctor will treat it with a surgical procedure. The type of surgery performed depends on the severity of the patient’s condition, namely:
- Pneumatic retinopexy
This procedure involves injecting a gas bubble into the eye that will push the retina back into its normal position. This procedure is chosen if only a small portion of the retina has detached. - Vitrectomy
In a vitrectomy , the doctor will remove the vitreous and tissue that is pulling on the retina. After that, a bubble of gas or silicone will be injected into the eye to hold the retina in place. Over time, the gas bubble will be replaced naturally by body fluids. - Scleral buckling
The doctor will place silicone from the outside of the white part of the eye (sclera). This silicone will bring the wall of the eyeball closer to the retina so that the retina returns to its position. In severe conditions, silicone will be installed around the eye permanently, but does not block vision.
Retinal Detachment Complications
Retinal ablation that is not treated immediately can cause complications in the form of permanent blindness or only being able to distinguish between dark and light.
Patients may also experience complications due to retinal ablation treatment, such as:
- Infection or bleeding in the eye
- Glaucoma
- Cataract
- Recurrent retinal detachment
Retinal Detachment Prevention
Retinal detachment is difficult to prevent. However, the risk of this condition can be reduced through the following efforts:
- Have regular eye examinations , at least once a year, especially for people with diabetes.
- Control blood sugar and blood pressure levels, so that the condition of the blood vessels in the retina remains healthy.
- Use eye protection when doing activities that risk eye injury.
- See a doctor if floaters , flashes of light appear, or any changes to the visual field
References :
Shah, D., et al. (2020). Exudative Retinal Detachment in Ocular Inflammatory Diseases: Risk and Predictive Factors. American Journal of Ophthalmology, 218, pp. 279–87.
Sultan, Z., et al. (2020). Rhegmatogenous Retinal Detachment: A Review of Current Practice in Diagnosis and Management. British Medical Journal Open Ophthalmology, 5(1), pp. 1–9.
National Institutes of Health (2021). MedlinePlus. Retinal Detachment.
National Institutes of Health (2020). National Eye Institute. Retinal Detachment.
National Institutes of Health (2020). National Eye Institute. Types and Causes of Retinal Detachment.
Mayo Clinic (2020). Diseases & Conditions. Retinal Detachment.
Boyd, K. American Academy of Ophthalmology (2021). Eye Health A–Z. Detached Retina.
Bedinghaus, T. Verywell Health (2022). What Is a Detached Retina?
Gabbey, A. Healthline (2022). Retinal Detachment.
Pandya, H. Medscape (2021). Retinal Detachment Clinical Presentation.
Seltman, W. WebMD (2020). Retinal Detachment.