Retinal detachment is an acute eye condition. If suspected, an ophthalmologist should be seen immediately to prevent possible blindness.
What is a retinal detachment?
Schematic diagram showing the anatomy and structure of the eye with retinal detachment. Click to enlarge. Retinal detachment within the human eye is a condition that occurs relatively rarely. However, once a retinal detachment has occurred, it represents an absolute ophthalmologic emergency, as progression toward the center of vision is often seen. Immediate extensive surgical measures are then required to preserve the patient’s vision. There are various causes of retinal detachment, but overall they are usually well treatable. The majority of affected patients are usually between 40-70 years old. This is therefore a typical disease of old age. The retina lies in the back part of the eye on a tissue section of pigments and contains sensory cells, the so-called rods and cones. These rods and cones are interlocked with the cells of the pigment tissue in a special way, this interlocking serves to maintain suction forces within the eye. The retina is responsible for transmitting the absorbed optical sensory stimuli to the brain. If it detaches from the pigment tissue on which it lies, it is called a retinal detachment.
Causes
When tensile forces act on the junctions between the retina and pigment tissue, these connections are broken and vision loss is imminent. People affected by retinal detachment are usually between 50 and 70 years old. This means that in most cases retinal detachment is age-related, although here the group of myopic patients has a greater risk of being affected by retinal detachment. With age, tears can develop in the retina as the vitreous humor of the eye changes over time. Adhesions may also form at the tears, causing the vitreous to pull the retina along with it as it begins to shrink. This pulling effect can be so severe that retinal detachment occurs. Some pre-existing conditions that also affect the eye can also be the cause of retinal detachment. These diseases include, for example, diabetes, Coats’ disease, Lyme disease, and tuberculosis. In these diseases, fluid exchange in the eye is disrupted. This leads to deposits that drive a wedge between the retina and the underlying tissue layer. As a result, retinal detachment occurs. A tumor of the eye can also be the cause of retinal detachment, as it can displace the retina.
Symptoms, complaints, and signs
Typical features of retinal detachment are manifested by changes in visual perception. Occurring flashes of light in the visual field are primarily seen in darkness. If affected persons move their eyes, the traction is transferred to the strained retina and triggers photopsia. In more severe cases, patients suffer from so-called sooty rain, which sometimes resembles flying swarms of mosquitoes. Tears or even hemorrhages lead to a momentum in their movement pattern. They do not remain in identical positions as in the case of cell clumps in the vitreous body. If the vision decreases completely in certain zones, physicians speak of a visual field loss (scotoma). This phenomenon often spreads slowly. Affected persons describe a slowly growing shadow that increasingly covers the field of vision. The course of the spread is usually opposite to the position of the detachment. A falling, dark curtain indicates problems of the lower retina. Such manifestations are considered an emergency and require immediate treatment by an ophthalmologist. All of the symptoms described are not necessarily encountered in isolation. A combination among each other is possible. Some symptoms only appear for a short time. Especially only spontaneously occurring flashes of light without further consequences are characteristic for detachment at the outer edge of the retina. Thus, smaller damages often remain unnoticed. If the sharpest point of vision (macula) is affected, patients suffer from markedly severe impairment of vision due to distortion and blurring. The location of the amotio retinae therefore remains decisive for the overall manifestation of the symptoms.
Diagnosis and course
In the patient himself, a retinal detachment first becomes noticeable through irritations of the visual field. Affected individuals suddenly see small flashes of light, dots, fog or lines. The signs of a retinal detachment can also become apparent in the form of a kind of “sooty rain”. The perception of shadows or a dark curtain is also possible. If such visual disturbances occur, an ophthalmologist should be consulted immediately and without hesitation, it could be a retinal detachment! The doctor will use special examination methods to determine whether a retinal detachment is present and initiate further measures for treatment.
Complications
Various complications can occur during the treatment of a retinal detachment. For example, after successful surgery, there is a risk that the retina will detach again, requiring another surgical procedure. In this case, a pars plana vitrectomy might also be required, in which the vitreous body of the eye is removed. In rare cases, materials used for the treatment of retinal detachment, such as foam plugs or tapes that are attached around the eyeball, can cause intolerance and defensive reactions on the part of the body. In such a case, the materials must be removed again. In a pars plana vitrectomy, the glass body of the eye is replaced with gas or silicone oil. The latter can lead to cataracts in the patient and must in any case be removed from the eye again after one year. In principle, all retinal procedures carry the risk of secondary glaucoma, in which the eye pressure increases. Even with successful treatment of a retinal detachment, the patient’s quality of vision in the affected eye remains impaired. If an inflammation or a tumor disease is the cause of the retinal detachment, successful treatment also depends to a large extent on the resolution of the inflammation or the removal of tumorous tissue. Retinal detachment should be treated in any case, otherwise it leads to blindness of the eye.
When should you go to the doctor?
A sudden decrease in vision should be presented to a doctor immediately. If vision decreases significantly within a few minutes or hours, there is an acute health condition that should be presented to a physician immediately. Without prompt medical consultation, there is a risk of further loss of vision. In severe cases and without treatment, blindness of the affected person will occur. Blurred vision, perceptual disturbances or an inability to recognize certain objects must be examined and treated immediately. If the usual outlines of people or buildings from the immediate environment can no longer be clearly defined, there is a disease of the eye in which rapid action is required. If the affected person can no longer clearly recognize or assign movement patterns of people or passing cars, there is cause for concern. If the affected person has the feeling that there is a swarm of mosquitoes in front of his field of vision or reports other peculiarities of visual perception, a doctor should be consulted. Distortions or color changes in vision are other signs of an existing irregularity. If the affected person reports a black curtain that he perceives in front of his field of vision, a physician must be consulted. From the patient’s point of view, the curtain appears to be slowly coming off and this is continuously worsening vision.
Treatment and therapy
If the suspicion is confirmed that a retinal detachment has occurred, then surgical treatment of the affected eye is usually unavoidable. The type of treatment ultimately chosen by the ophthalmologist depends on the exact causes and extent of the retinal detachment in question. If there are only small tears on the retina, then these can be repaired with the help of laser probes. Cold probes are also sometimes used. If the vitreous body has retracted inward and in this way pulled the retina with it, then it must be artificially expanded. This is done by using silicone plugs. If the vitreous body is already too deformed, then it may have to be removed and replaced by other suitable materials, such as a special silicone oil.The vast majority of retinal detachment cases are surgically curable, although a few patients may experience permanent vision deterioration after retinal detachment.
Outlook and prognosis
Without treatment, there will be progressive deterioration of the retinal detachment resulting in blindness. The sooner diagnosis and treatment begin, the better the prognosis usually is. In addition to the specific cause of the retinal detachment, the area of the retina affected also proves to be very important for the prognosis. Almost fifty percent of all retinal detachments can be avoided by preventive measures. Rupture-related (rhegmatogenous) retinal detachment has the best prognosis – almost all rhegmatogenous retinal detachments can be repaired via surgery. If a retinal detachment persists for a longer period of time, it can promote a so-called proliferative vitreoretinopathy. This is a reactive tissue proliferation around the vitreous body. The consequences are severe visual disturbances – blindness is not excluded. A further complication can manifest itself in the affection of the second eye. If, for example, a tear-related (rhegmatogenous) retinal detachment is present in one eye, there is a twenty percent risk that a retinal detachment will also develop in the other eye over time. For this reason, high-risk patients should undergo a retinal examination about once a year from the age of forty. In case of retinal holes in healthy eyes it seems advisable to treat them prophylactically via laser or even cold application. In any case, an ophthalmologist should be consulted immediately in case of sudden deterioration as well as (re)appearance of symptoms of retinal detachment.
Prevention
An important prerequisite for successful treatment of a retinal detachment once it has occurred is timely consultation of an ophthalmologist. For this reason, every alarm signal, no matter how small, should be taken very seriously. If sudden visual disturbances or visual deterioration occur, there is no reason to think twice. The doctor should be consulted quickly, because it could be a retinal detachment. People over 40 and diabetics are advised to see an ophthalmologist once a year, who can detect possible changes in the retina and initiate treatment before a retinal detachment occurs. All in all, it can be stated that retinal detachment has lost its horror nowadays. With mindful adherence to the above advice on what to do when retinal detachment is suspected, in the vast majority of cases vision impairment as a result of retinal detachment can be prevented by treatment in an ophthalmologist’s office.
Follow-up care
After surgical treatment of retinal detachment, check-ups with an ophthalmologist take place at regular intervals. The first examination takes place a few days after discharge from the hospital. Follow-up appointments extend over several months. Depending on which surgical procedure is used, postoperative pain may occur after the procedure. However, it can usually be treated well by administering painkillers. In addition, the patient receives an eye ointment or eye drops afterwards. How long they have to be administered depends on the respective findings. The patient does not have to undergo special rehabilitation measures. However, he should refrain from lifting heavy loads and from sports or similar physical activities. The same applies to the rapid back and forth movement of the eyes, such as when reading. On the other hand, watching television is possible without any problems, as is walking, washing hair and taking a shower. However, any restlessness or rubbing of the eyes should be avoided. During the first week, the patient wears a bandage or protective goggles by day. Caution is advised especially during the first six weeks after surgery, because the risk of complications is highest during this period. If symptoms such as deterioration of vision, darkening or flashes appear, treatment by an ophthalmologist or eye clinic must be sought immediately.
Here’s what you can do yourself
Retinal detachment is always a medical emergency that requires immediate specialist examination and treatment. There is no possibility in the field of self-help in everyday life to treat a retinal detachment by yourself.Precisely because retinal detachment also requires treatment as soon as possible, any consideration of waiting or taking medications such as painkillers is not advisable. The treatment for retinal detachment is surgery as soon as possible to repair the detachment. There is no other way to prevent vision loss. In this respect, the possibility of self-help is rather limited to recognizing possible symptoms of retinal detachment and then acting quickly. In principle, a retinal detachment can affect anyone and does not necessarily have to announce itself in advance. Nevertheless, people who belong to a group of people at risk due to individual risk factors should know which symptoms can indicate a detachment of the retina. After a successful surgery, patients have to attend all follow-up examinations regularly and take medications as scheduled, for example against intraocular pressure. Consistent cooperation from the patient’s point of view is the best prevention against retinal detachment again in the area of self-help.
