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What are retinal tears and detachments? | Reasons for retinal detachment | Symptoms | Treatment

What are retinal tears and detachments?

The retina is a thin layer at the back of the eye that contains light-sensitive nerve fibers. In order for a person to see, light passes through the lens of the eye and focuses on the retina, which acts like the film in a camera that receives the image. The image is then transmitted through the optic nerve to the brain. A fluid, gel-like material called vitreous fluid fills the eyeball and is attached to the retina at the back of the eye. If the vitreous shrinks, it can pull part of the retina with it, causing it to tear . When a tear occurs, the vitreous can leak between the retina and the back wall, causing the retina to pull away from the wall of the eye. The result is a retinal detachment. Retinal tears and detachments are not visible from outside the eye; they must be observed during a comprehensive eye examination. Retinal detachment usually affects middle-aged or older people.

Reasons for retinal tears and detachment

The risk of retinal detachment increases with age. As we grow older, the vitreous fluid inside the eye shrinks and pulls away from the retina. This is a natural aging process and doesn't generally cause damage to the retina. In fact, in about fifty percent of the people over age fifty, the vitreous has separated from the retina. Sometimes as the vitreous shrinks, it may pull a piece of the retina away with it, leaving a tear in the retina.

Heredity also plays a role in retinal detachment.

A person who has myopia or is nearsighted is also at greater risk for retinal detachment, especially if the myopia is extreme.

Although it is uncommon, a direct blow to the eye can cause retinal tears and detachment. In addition, one to two percent of cataract patients develop a retinal detachment after surgery. Furthermore, diabetics are at an increased risk for retinal detachment.

Symptoms

Symptoms that indicate a retinal detachment has occurred are light flashes and/or a large number of floaters or cobwebs. Floaters are a normal part of the aging process and don't necessarily indicate a retinal problem. However, a sudden increase in floaters or their number may indicate a retinal detachment. Other symptoms include a shadow across the field of vision, a blind spot, blurred vision, or shadowy lines.

If a retinal problem is suspected, the person should see a doctor as soon as possible to prevent vision loss. Treatment needs to be started immediately.

If you are experiencing some of the symptoms described here, it does not necessarily mean you have retinal tears or detachment. However, if you experience one or more of these symptoms, you should contact your eye doctor for a complete exam. Click here for information on emergency or immediate care.

Treatment

Retinal tears

Small retinal tears are treated with laser photocoagulation which creates small burns around edges of the tear. This process produces scars between edges of the retina and the wall of the eye, sealing the borders of the tear to the wall of the eye. This prevents fluid from leaking under the retina and helps prevent retinal detachment. Photocoagulation can be performed on an outpatient basis. No surgical incision is necessary and there is minimal damage to surrounding tissues.

Cryopexy uses extreme cold to form scars and seal the edges of the retinal tear to the wall of the eye. It can be performed on an outpatient basis, but requires local anesthesia to numb the eye. The surgeon may inject liquid silicon into the eye to replace the vitreous fluid and to hold the wall and retina in place.

Retinal detachment

When retinal detachment occurs, fluid is drained from under the retina. A silicon band is used on the outside of the eye to push the back wall of the eye against the retina.

Ninety percent of retinal detachments are corrected with only one surgery. It is hard to predict how much the patient's vision will be corrected. However, without repair, vision will be poor. Within six months after surgery, forty percent of the people will achieve good vision. If the retina has been detached for awhile, results will not be as good. The remaining sixty percent of patients will generally achieve a lesser degree of improvement in their vision.

Vitrectomy

The surgeon cuts the vitreous away from the retina and removes it from the eye. If the retina is puckered or shrunken, the surgeon may fill the eye with air or gas to push the retina back against the wall. Clear fluid will seep from the bloodstream into the eye to fill the cavity.