Retinal detachment (RD) is one of the most common causes for emergency room visits for critical eye issues. The retina is a thin layer of tissue in the back of the eye. When the retina detaches, it is lifted or pulled from its normal position. With a full detachment, the retinal cells no longer are being nourished by blood and essential nutrients. Total retinal detachments require surgery for repair, and within 24 hours, or there will be permanent vision loss. The sooner the surgery, the better. The next highest categories of visits to the emergency room related to eye issues are central retinal artery occlusion, chemical burns to the eye, and endophthalmitis that require immediate attention.
In the event you have symptoms that lead you to believe you may have a retinal detachment, you must seek immediate attention from an ophthalmologist. In the meantime, you should do the following: Lie down very quietly and stay in this position. This occasionally allows the retina to fall into place. Do not make any sudden moves - either with your head or eyes. Try to stay relaxed until you can see an ophthalmologist.
The retina is built of a number of layers, broadly divided:
- Inner neurons and photoreceptors
- Outer retinal pigment epithelium (RPE) (epithelium is a thin lining tissue), Bruch's membrane, and the choroid (fine blood vessels)
The retina can detach when vitreous fluid from within the eye leaks through a retinal tear, resulting in separation of the retina from its underlying tissue. The detachment may be small and not dangerous, or it could involve the entire retina, resulting in blindness if not treated quickly and properly.
These are typical signs and symptoms for a retinal detachment.
- Flashes and floaters. The sudden awareness of bright light spots or streaks and dark moving specks are due to the vitreous traction on the retinal (light flashes) and solid vitreous material or blood (floaters). Note that flashes and floaters can also commonly occur from simple causes, without retinal tears or detachment.
- Partial loss of vision. Retinal detachments can also proceed unnoticed until a large section of the retina is detached, at which time you may notice that part of your sight is missing (the missing sight could be vision loss from above, below or off to one side). It is sometimes described as a veil, curtain or shade covering a part of the vision.
The detachment might or might not be dangerous. Therefore if you have symptoms of sudden awareness of bright spots or streaks or sudden partial loss of vision you should always see an eye doctor.
Types of Retinal Detachment
Retinal detachments can also proceed “unnoticed” until a large section of the retina is detached. At this time, you may notice that part of your sight is missing (it could be vision loss from above, below, or off-to-one side). Sometimes patients describe this as if a veil, curtain, or shade has been drawn on that part of their visual field.
Rhegmatogenous. This type results from fluid leaking out from a tear or break in the retinal tissue, causing it to separate from the pigment epithelium (RPE), which provides the essential blood and nutrients to the retina. Tractional. Though this type is less common, it is due to existing scar tissue in the retina causing stress on the retinal layers, resulting in a detachment from the RPE. Existing scar tissue may be the result of chronic inflammation, past leakages, bleeding, etc.
Exudative. This type results from fluid leakage in the retina that builds up pressure, often due to such eye conditions as wet macular degeneration, diabetic retinopathy, macula edema, or possibly eye trauma.
Causes of Detached Retina
- Severely nearsighted (greater than -6 diopters)
- Have had an eye injury or cataract surgery
- Have a family history of retinal detachment
- Take glaucoma medications that decrease pupil size or cause eye muscle spasms
- Are over age 50 or have had age-related retinal tears
- Experience a blow to the head
- Have diabetic retinopathy or chronic eye infections that cause scarring
- Have other eye disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degeneration
Note that people who are nearsighted (myopic) are at a higher risk of retinal tears and detachments due the shape of the eyeball being more oval than round, causing more stress on the retina and a potential thinning of the retina.
See "Drugs That Harm the Eyes" for a description of potentially harmful drugs.
Retinal Detachment News
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There are other conditions which may have similar symptoms or be due to similar causes:
- Diabetes. "Tractional" retinal detachment may occur in advanced diabetic retinopathy, a complication of diabetes. In this condition scar tissue may form on the surface of the retina, pulling it away.
- Glaucoma. About 10% of patients having surgery for retinal detachment are found to have glaucoma.1 On the other hand, it is well known that after surgery for retinal detachment the ocular tension does not remain at its normal level and there is a tendency towards glaucoma development.2
- Retinal breaks and tears
- Central serous choroidopathy. Fluid builds up under the retina, causing vision distortion, but also increasing the risk of retinal detachment.
- Peripheral vitreoretinal disease - this relates to the broad group of conditions involving the retina and vitreous.
Studies and Information
1. C.D. Phelps, T.C. Burton, Glaucoma and retinal detachment, Archives of Ophthalmology, March, 1977.
2. J.G. Sebestyen, MD, et al, Retinal Detachment and Glaucoma, I. Tonometric and Gonioscopic Study of 160 Cases, Archives of Opthalmology, 1962. 3. B. Eliassi-Rad, MD, et al, Elevated intraocular pressure associated with retinal procedures, January, 2015