Retinal Tear/Detachment

Retinal Tear/Detachment

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What are flashes?

Flashes are often caused by the vitreous gel pulling on the retina. A sudden increase in flashes can occur due to a developing posterior vitreous detachment (PVD). This occurs when the vitreous gel in the back of the eye becomes more liquefied as part of the aging process. At some point, the vitreous may contract and suddenly pull away from its natural attachment to the retina. This may cause a retinal tear or detachment to develop. Anyone with a sudden increase in flashes should have an emergent dilated eye examination.

Flashes may also be caused by migraines. These flashes almost always occur in both eyes and last for several minutes. A severe headache usually develops after the flashes, but in some people the flashes and visual changes will resolve with no subsequent headache. This is called an ocular migraine. Flashes caused by a retinal problem are generally only in one eye and last for only a split-second at a time.

What are floaters?

Floaters are most often caused by condensations or debris in the vitreous that cast shadows on the retina. New floaters may be the result of a PVD. However, new floaters may also signal the development of a retinal tear or detachment. Anyone with a sudden increase in floaters needs to have an emergent dilated eye examination.

What is a retinal tear?

A retinal tear may develop as the result of a PVD. The retina is a very thin tissue, and this may be torn as the vitreous gel separates. A new shower of floaters often accompanies a fresh retinal tear. The risk of developing a tear as a result of a PVD is about 10%. New flashes and floaters are the most common symptoms of a retinal tear. Untreated retinal tears may cause a retinal detachment.

What is a retinal detachment?

A retinal detachment occurs when liquefied vitreous leaks underneath the retina through a retinal tear. The retina then separates, similar to peeling wallpaper off of a wall. This causes loss of side (peripheral) vision and eventually central vision as well. An untreated retinal detachment often leads to total blindness. New flashes and floaters are the most common symptoms of a retinal detachment.

Who is at risk?

Acute PVD is the most common cause of a retinal tear or detachment. This will typically occur in 50 to 60 year-old people. Several additional risk factors have been identified.

  • High myopia (extreme nearsightedness)
  • History of any type of intraocular surgery, including cataract surgery
  • Family history of tear or detachment
  • Severe head trauma
  • History of tear or detachment in other eye. The risk for the other eye over a lifetime is at least 10%.

What are the symptoms?

Flashes and floaters typically occur during an acute PVD, but may signal a more serious problem such as a retinal tear or detachment. A retinal detachment causes a veil or curtain that obstructs side vision and progressively worsens. There is never any pain associated with these conditions.

What will my doctor see?

A PVD or retinal tear/detachment can only be diagnosed during a dilated eye examination. The outside of the eye looks completely normal.

What treatments are currently available?

A typical PVD most often requires no treatment. Occasionally, treatment will be recommended to thin or weakened areas of the retina to prevent a tear or detachment.

A retinal tear, when accompanied by symptoms of flashes and floaters, generally needs urgent treatment. This can be done in the office with either a laser or freezing (cryotherapy) treatment. This is done with local anesthesia. Both treatments create a scar around the retinal tear which, in most cases, prevents a detachment. Patients are encouraged to limit strenuous activity for at least 10 days after treatment, to allow time for the scar to form properly.

Retinal detachment repair is more complex. In addition to treating the tear, the fluid underneath the retina must be removed. The appropriate treatment depends on the severity, duration, and location of the detachment.

Pneumatic retinopexy is one type of procedure used to reattach the retina. This is done in the office with local anesthesia, and typically takes about 30 minutes to complete. In addition to sealing the retinal tear with a freezing treatment, a small gas bubble is injected into the vitreous cavity. The bubble presses against the retina, flattening it against the wall of the eye. Since gas rises, this treatment is most effective for detachments in the superior (upper) portion of the retina. Specific position to support the retina is usually recommended for several days following the procedure.

A scleral buckle will often be recommended to repair a retinal detachment. Done in the operating room under either local or general anesthesia, this procedure typically takes about 90 minutes to complete. A silicone band is placed around the wall of the eye to support the retina, and freezing treatment is used to seal the tear. Quite often, fluid which has gotten underneath the retina is drained during surgery. The band used to reattach the retina elongates the eye slightly, and most people develop some increased nearsightedness.

A scleral buckle will often be recommended to repair a retinal detachment. Done in the operating room under either local or general anesthesia, this procedure typically takes about 90 minutes to complete. A silicone band is placed around the wall of the eye to support the retina, and freezing treatment is used to seal the tear. Quite often, fluid which has gotten underneath the retina is drained during surgery. The band used to reattach the retina elongates the eye slightly, and most people develop some increased nearsightedness.

A vitrectomy is recommended in some instances to repair a detachment, especially if the detachment is severe or associated with significant vitreous hemorrhage. This is done in the operating room under either local or general anesthesia, and typically takes about 90 minutes. Small instruments are used to remove the vitreous gel, and laser is used to seal the tear. A gas bubble is usually placed in the eye at the end of the surgery to allow the retina to heal properly. The gas will remain in the eye for 2 to 6 weeks. In some cases, silicone oil is placed in the eye to allow the best chance for recovery. This oil is typically removed a few months later.

A retinal detachment can be repaired with a single surgery approximately 90% of the time. If multiple procedures are needed, the ultimate success rate is about 98%. In some cases, even with successful repair, central vision will not return to normal for a variety of different reasons.

Can retinal tears and detachments be prevented?

In most cases, treatment is not recommended unless an actual tear or detachment has developed. Occasionally, a person felt to be at high risk may have treatment to thinner areas of the retina. If a retinal tear develops, a retinal detachment can be prevented in most cases if the tear is identified early and treated appropriately.

Future

A new medication which theoretically allows the retina to reattach without having to go to the operating room is currently being investigated. This medication is injected directly into the vitreous cavity and stimulates the pigmented cells underneath the retina to reabsorb fluid. It is unknown at this time whether this type of treatment will be effective.