Retinal Detachment - Other Common Eye Diseases Of Later Life: The Aging Eye Preventing And Treating Eye Disease

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Retinal detachment

Occasionally, floaters and flashes can be a sign of something more serious: retinal detachment. In this condition, the vitreous gel pulls on the retina with enough force to tear the retina. This separation of the retina from the back of the eye allows fluid from inside the eye to enter through this tear and detach the retina from underlying tissues that nourish it (see Figure 13).

Figure 13: Retinal detachment Degeneration of the retina or pulling on it by the vitreous humor may cause a retinal tear. When this happens, blood may ooze into the vitreous gel, and a person will see black spots or floaters. In some cases, fluid may collect behind the retina, detaching it from underlying tissue and causing a blank space to develop in the person's field of vision.

People who are middle-aged and older are the most likely to experience this problem. Nearsightedness increases the chances for detachment, as do cataract removal and eye injuries.

Retinal detachment is a serious condition and can lead to a permanent loss of vision. If you suspect one, contact your ophthalmologist immediately; if unable to reach your own doctor, go to an emergency room for evaluation. If a tear is caught early, treatment may prevent a retinal detachment. When not treated, the condition may worsen until the retina separates completely from the inner wall of the eye, remaining connected only at the optic nerve in the back of the eye and the ciliary body in the front of the eye. The worst cases cause blindness.

Because the underlying disorder that causes retinal tears may occur in both eyes, your ophthalmologist will want to examine both eyes thoroughly. Your other eye may also have retinal deterioration or other pathology that requires treatment.

Examination with dilated pupils and an indirect ophthalmoscope (a device that is mounted on special headgear) enables the doctor to determine the extent of the detachment, the location of any holes or tears, and the best way to treat the problem. Some retinal tears don't require treatment, especially if they are old. But most cases of retinal detachment call for surgery to reposition the separated retina against the back wall of the eye.

Laser photocoagulation. In this procedure, done on an outpatient basis with topical anesthesia, the doctor uses pinpoints of laser light to create tiny burns around any small holes or tears in the retina. The resulting scar tissue forms a barrier, essentially welding the retina to the back wall of the eye so that it is less likely to detach.

Cryopexy. An ophthalmologist may also repair tears that have not yet caused detachment by applying a freezing treatment called cryopexy. Like laser photocoagulation, this approach functions as spot welding for the eye: It induces an adhesion that reduces the likelihood of the tear leading to a detachment. This procedure is performed on an outpatient basis using local anesthesia and may be used when the location of a tear makes laser surgery too difficult.

Pneumatic retinopexy. This approach is gaining popularity as a treatment choice for repairing a detached retina, because it can be done on an outpatient basis and involves the fastest visual recovery. However, the decision whether to use this method or opt for scleral buckling or vitrectomy depends on the location of the detachment and any other complications.

For this procedure, you receive local anesthesia to numb the eye. The ophthalmologist first uses laser surgery or cryopexy (see above) to create a barrier with scar tissue. The ophthalmologist then injects a gas bubble into the vitreous cavity. As the gas bubble expands over the next few days, it reattaches the retina. Eventually the gas bubble dissipates, and is replaced with fluid in the eye.

The most challenging aspect of this procedure may be the recovery. To ensure that the retina reattaches properly, you may have to spend a significant time each day in a face-down position to keep the bubble in the correct position. (If necessary, you can rent special equipment to achieve the right position.) Until the gas bubble disappears, you should also position pillows in your bed in a way that keeps you from lying on your back. Your physician can provide more specific advice.

Scleral buckling. If the retina has already started to pull away from the choroid and the gap has filled with fluid, the situation may call for scleral buckling. This procedure, done in an operating room and under local or general anesthesia, involves draining the fluid so the retina falls back against the choroid, then sealing the hole. Then a silicone buckle is sutured around the outside of the eyeball, slightly indenting the sclera (the white outer layer of the eyeball) so that it makes better contact with the retina.

Vitrectomy. This surgery involves the removal of the vitreous humor, which reduces the traction on the retina (typically the cause of retinal tears). In this delicate procedure, performed under local or general anesthesia, the surgeon uses microsurgery to remove the vitreous gel that might be causing traction or tugging on the retina. A cryo laser is then applied, and a gas or oil bubble is inserted into the eye. (The gas bubble will dissipate on its own; the oil bubble must be removed during a follow-up operation.)

Last updated:	June 19, 2007