Retinal detachment is quite a rare problem in which the retina at the back of the eye comes away from the tissue underneath. This usually happens because blood or fluid gets underneath when a blood vessel in the eye ruptures, usually as a result of an accident or because of damage to the eye caused by diabetes. It can also occur if scar tissue forms after a cataract operation and pulls at the retina. Rarely, the retina can detach spontaneously in older people, particularly if retinal detachment runs in their family. Fortunately, retinal detachment can be treated very effectively by either laser treatment or surgery.
The retina is the thin layer of cells at the back of the eye that, when stimulated by light, create the nerve impulses that pass to the brain to be interpreted as the images that we see. It’s not too surprising that the main symptom of retinal detachment is a change in the quality of vision.
Retinal detachment is not painful, and you will not be aware of any sensation within the eye, as there are no pain receptors in this area. The primary symptom is the perception of a dark patch or shadow in the field of vision of just one eye. This may be accompanied by occasional bright flashes or floating dark spots.
Most people will experience some of these symptoms from time to time, but if they occur regularly and seem to be getting worse, it is vital that you contact your GP. If treated quickly, retinal detachment can be repaired and most of your sight saved, however, if left unchecked, you could lose the sight completely in that eye.
There are several treatments for retinal detachment but all involve some type of surgery. You may have laser surgery or traditional surgery – the treatment chosen will depend on the shape and size of the hole that has caused the retinal detachment and the extent to which the retina has come away. In most cases, you will only need one operation.
Surgery for retinal detachment usually takes one of two forms – either a mechanical process, pushing or pulling the retina back into place, or a sealing process, creating scar tissue behind the retina to block the tear.
Mechanical surgical techniques that can be used to repair a detached retina include:
Scleral buckle surgery – in this process, fine silicone bands are sewn onto the outer layer of the eye. These cause the eye to bulge inwards towards the tear, blocking the hole and allowing the retina to reattach.
Pneumatic retinopexy – in the process, pressure is applied to the tear from the inside by the introduction of a bubble of gas above the hole. This can be an uncomfortable procedure as the patient may have to hold their head at an appropriate angle for several days to ensure the bubble remains in contact with the hole.
Vitrectomy – in this process, some or all of the vitreous gel in the eyeball is removed and replaced with either a gas bubble or silicon oil to provide pressure on the tear and allow the retina to reattach. If oil is used, you will need a second operation to remove it between 2 and 8 months later.
Usually, the mechanical surgical processes are combined with sealing processes to make sure the detached retina stays put once it has reattached. These include:
Cryotherapy – in which the tissue below the retina is frozen in order to form scar tissue.
Photocoagulation – in which a laser is used to create the scar tissue.
In both cases, the scar tissue blocks the hole, preventing any further fluid from getting behind the retina and prevents any recurrence of retinal detachment.
Retinal detachment treatment carries the general risks associated with having a general anaesthetic and with a surgical procedure. In addition, you may experience:
Bleeding in the eye
Bruising around the eye
Swelling in the eye
Cloudy lens
Double or blurred vision
Allergic reaction to the drugs used
Eye infection
An immune system reaction affecting your other eye
These are all relatively rare and, in most cases, retinal detachment surgery has a very successful outcome.
Retinal detachment surgery is not painful, although you may experience some bruising and redness in the days following the procedure. Eye drops will be provided to prevent infection and aid healing. Perhaps the most difficult part of the recovery is resisting the temptation to rub your eye. You may experience an itching sensation, or your eye may become sticky or moist, but it is important that you do not rub it until it has healed, which can take up to six weeks.
In most cases of retinal detachment, only one operation is needed. Although your sight may be saved by the treatment, your eye will never fully recover from the trauma of the detachment and the surgery and your vision may not be exactly the same as before. After the eye has settled down, it is wise to visit a good optician and ensure that any vision problems that you have are corrected as far as possible by glasses or contact lenses.
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