Retinal detachment is a condition where the retina pulls away from the tissue underneath it. It may start in a small area, but without quick treatment, it can spread across the entire retina, leading to serious vision loss and possibly blindness. Risk rises with age, and other risk factors include nearsightedness (myopia), eye injury, cataract surgery, and inflammation.
Retinal detachment is usually diagnosed through a dilated eye exam.
- Rhegmatogenous retinal detachment is caused by a tear or break in the retina. This allows vitreous humor, the fluid that normally sits in the center of the eye, to build up behind the retina. This is the most common type of retinal detachment.
- Exudative retinal detachment occurs when fluid accumulates beneath the retina, causing it to detach.
- Floaters suddenly appearing in the field of vision or a sudden increase in the number of floaters. Floaters may resemble cobwebs, specks of dust, or shapes such as ovals or circles
- Flashes of light in vision (photopsia)
- Experiencing a "dark curtain" or shadow moving from the peripheral vision toward the central vision
- Sudden blurred vision
Rarely, a retinal detachment may be caused by atrophic retinal holes, in which case symptoms such as floaters or flashes of light may not occur. While this process is typically harmless and often presents without symptoms, it can lead to retinal holes or tears that may progress to a full retinal detachment if left untreated.
Risk factors
Factors that increase the likelihood of posterior vitreous detachment and therefore, retinal detachment, include:
- Age: The vitreous liquefies as a normal part of aging, increasing the risk for subsequent detachment.
- Myopia (nearsightedness): Individuals with myopia have a longer axial length of the eyeball, which increases their risk of developing posterior vitreous detachment.
- Inflammation: Inflammatory eye conditions, such as uveitis, are associated with an increased risk of posterior vitreous detachment.
- Cystic retinal tuft: A small, raised spot present on the retina from birth that increases the risk for tears and detachment. It processes visual information and transmits it to the brain. This impairs its function, potentially leading to vision loss. Retinal detachment often requires urgent medical intervention to prevent permanent vision loss. OCT can detect fluid behind the retina, involvement of the macula (the central part of the retina), and other abnormalities within the retinal layers.
MRI and CT scans are less commonly used for the diagnosis of retinal detachment, but they may be useful in certain cases.
Pneumatic retinopexy
Pneumatic retinopexy is an office-based procedure often used for small and uncomplicated retinal detachments, particularly those involving a single tear in the superior part of the retina. Additionally, freezing (cryotherapy) or lasers are used to seal the retinal tears and prevent further detachment. In this technique, the vitreous gel is removed from the eye to relieve the pulling force on the retina. Patients treated with a gas bubble are advised to maintain a face-down position and refrain from air travel, high altitudes, and scuba diving. In patients treated with silicone oil, a follow-up surgery is required to remove the oil. The band typically remains in place permanently unless complications occur. Additionally, the prevalence of rhegmatogenous retinal detachment is increasing alongside the rising rates of myopia worldwide.