Synonyms
Medical: Amotio retinae, Ablatio retinae
Definition Retinal detachment
A retinal detachment is a detachment of the retina from the back of the eye, i.e. the pigment epithelium (choroid). The detachment can affect the entire retina. Retinal detachment is a relatively rare disease.
However, it is very significant, because if untreated, the retinal detachment leads to blindness. In old age, this disease occurs much more frequently than in young people. In nearsighted people (from -6 diopters = severe nearsightedness), the occurrence of retinal detachment is at least three times more frequent than in people with normal vision.
This is due to the fact that the eyes of short-sighted patients (myopia) are longer in longitudinal section than normal-sighted eyes. Thus, the risk of retinal detachment is higher from a purely anatomical point of view. A familial clustering can also be observed.
What is the classification of a retinal detachment?
Primary retinal detachment This retinal detachment of unexplained cause is the most common form of retinal detachment. The tear in the retina occurs preferably in the periphery, not in the center. The reason for this is the detachment of the vitreous body in old age or in myopia.
This causes a pull on the retina, which leads to a tear in the retina. These tears are observed much more frequently in the upper half of the retina than in the lower half. This is due to the sinking vitreous following gravity.
Giant tearablatio A special form of retinal tears is the giant tearamotio. The tears can become so large that they affect over a quarter of the eye. The second eye is also always at risk.
Secondary retinal detachment This detachment of the retina is secondary, i.e. due to a cause that causes it. In most cases, diabetes has a previous history. Further causes can be: Exudative retinal detachment This is a disorder of the vascular permeability.
Fluid collects between the pigment epithelium and the retina.
- Occlusions of the retinal veins
- Consequence of retinopathy of prematurity
- Inflammations
- Retinal Surgery
- Contusions of the eye (can become symptomatic even years later)
- Perforating injuries of the eye
- Optic nerve (nervus opticus)
- Cornea
- Lens
- Anterior eye chamber
- Ciliary muscle
- Glass body
- Retina (retina)
The patients report “flashes of light”. These are caused by a pull on the retina.
Afterwards the patients notice “sooty rain” or a “swarm of mosquitoes”. Both represent the shadows of vitreous haemorrhages, which occur when the retina is torn. If the retina detaches after the tears, the patients notice shadows in the field of vision.
Thus, they no longer have a normal visual field in which to perceive the impressions of their entire surroundings. Parts are missing. For example, the lateral part may be missing, so that the patients cannot see everything on the affected eye that is located outside (med.
temporally). Here an ophthalmologist can intervene by means of an eye test. Flickering in front of the eyes is often confused with flashes of light.
However, flickering is more likely to indicate a migraine than a retinal detachment. The accompanying symptoms that occur can help to differentiate. A retinal detachment is usually painless.
A migraine, on the other hand, is usually associated with severe headaches and possibly eye, jaw or neck pain. If these complaints, among others, occur, a retinal detachment is probably not the cause of the flickering in front of the eye. A retinal detachment can be recognized by typical symptoms.
These include the appearance of flashes of light, which are particularly noticeable at dusk or in the dark. Some affected persons also describe a lateral glow in the eye, which has an arc-like shape. The flashes of light and the glow become more intense when the head is moved.
Shadows can be perceived in the eye, which are described as a wall or growing bubble. The perception of a sooty rain or a swarm of black mosquitoes are further characteristics of a retinal detachment. Some affected persons describe other sudden visual changes, such as the vision of cobwebs.
It is also characteristic that the retinal detachment is painless because the retina has no pain fibers. This often makes it easy to distinguish it from other eye and head diseases.Sometimes it is difficult to distinguish from a vitreous detachment. If the above mentioned complaints occur, a doctor should be consulted in any case.
Whether the retina is detached can be determined by the ophthalmologist (specialist in ophthalmology) by reflecting the fundus of the eye. For this purpose, eye drops are first applied, which dilate the pupil. This allows the examiner a better insight and overview of the fundus of the eye.
The mirroring is done with the help of a magnifying glass and a light source. If the retina is detached, the retinal tear must be searched for. In addition to mirroring, the retina can also be diagnosed by an examination called OCT (Optical Coherence Tomography).
Here, the retina is specifically displayed at the point of sharpest vision. Actually, this examination is more specialized in the detection of macular edema (accumulation of fluid under the retina at the point of sharpest vision). The ultrasound of the eyes can also provide information in case of a retinal detachment.
There are different procedures to treat a retinal detachment surgically. All procedures are based on 3 basic goals: The vitreous tract should be relieved, the retina should be closed and an artificial scar should be created. Depending on the type of retinal inflammation, different procedures are performed.
In case of an uncomplicated retinal detachment, a denting operation is usually performed. Here, a silicone seal is sutured onto the sclera of the eye. This seal dents the sclera, the choroid and the pigment epithelium.
Consequently, contact between them and the detached retina occurs again. Afterwards, the conjunctiva is closed by the seal. Sometimes, instead or additionally, a band, a so-called cerlage, is applied around the eye.
Holes at the posterior pole of the eye cannot be treated with this method. For retinal detachments with a central hole, in some cases the removal of the vitreous body and the insertion of a kind of “inner tamponade” is recommended. The inner tamponade usually consists of a silicone oil or a gas.
The silicone oil is removed after about 3-6 months, while the gas is spontaneously absorbed by the body itself after 8-14 days. For complicated retinal detachments, the denting operation and additionally the removal of the vitreous body are advisable. Often an internal tamponade is also used in this case.
The laser method is usually painless and has relatively few side effects. But the laser cannot be used to treat an existing retinal detachment. It is only possible to successfully seal a retinal hole or precursors of retinal tears within the scope of a laser treatment.
This is done by arranging laser scars in the form of a 2- or 3-row chain around the hole. The energy of the laser is only absorbed by the choroid and the pigment epithelium. The retina itself cannot absorb the laser energy.
However, it can be drawn into the zone of action, provided it is attached to the pigment epithelium. As a result, it can scar with the pigment epithelium. This is therefore only possible if the retina is still attached, whereas the laser is ineffective if the retina is already detached.
There is no drug treatment for retinal detachment. If a preliminary stage of retinal detachment or a predisposition is known, one can try to minimize the risk factors as far as possible. This does not prevent retinal detachment, but it may reduce the risk.
For example, in the case of the colloquial “diabetes mellitus”, a so-called diabetes mellitus, an adapted lifestyle should be adopted. This is because, among other things, the late effects of diabetes mellitus can lead to retinal detachment. Furthermore, insufficiently healed infections can have a negative effect on the retina.
Inflammations should always be well cured. Negative stress and overexertion during sports should be avoided as far as possible if there is a previous strain. The immune system should be strengthened by a balanced diet and lifestyle.
Flying should also be reduced or in some cases even stopped completely. In case of a preliminary stage of a retinal detachment, medical consultations and check-ups are highly recommended. Patients should not read for up to one week after treatment.
This rule applies in order to prevent the jerking of the vitreous humour, which can occur during the retinal detachment process. The most common causes of retinal detachment include degenerative changes in the retina and vitreous humour that lead to tears in the retina.The retina attaches itself to the eye virtually from the inside. At its origin it is fused with the underlying pigment epithelium, the choroid.
At the papilla, it is also fused with its underlayer. The papilla is the term used to describe the exit of the nerve fibers of the optic nerve from the eye. If there is a hole in the retina, fluid can accumulate underneath.
Such holes can have various causes: Particularly at risk are highly short-sighted people. Their eyeball is particularly long and thus favors the detachment of the retina, as it is stretched very much. Statistically speaking, there is also an increased risk after cataract surgery (operation on cataracts), i.e. removal of the lens, which is usually cloudy due to age.
- Retinal and vitreous shrinkage
- Injury of the eyeball
- Diabetic Retinopathy
The preliminary stage of retinal detachment are tears in the retina. These must be detected by regular visits to the ophthalmologist. These cracks can be scarred by laser (they practically stick to the choroid underneath) and thus further detachment of the retina can be prevented.
Particularly nearsighted people (myopia) and patients who have already suffered from retinal detachment should be particularly careful and have the retina thoroughly examined by the ophthalmologist as regularly as possible. The prognosis depends on the severity of the retinal detachment. In the case of an uncomplicated detachment, a success rate of up to 90% can be achieved.
The smaller the retinal detachment and the faster the treatment, the better the prognosis. The prognosis of vision depends on whether the macula (yellow spot= the point of sharpest vision) was impaired. The duration of retinal detachment must be distinguished from the duration of a retinal tear or hole.
Neither an untreated retinal detachment nor an untreated retinal tear or hole heals on its own. If the adjacent retinal hole is lasered, it can take about 2 weeks until a scar is formed. This scar should prevent a retinal detachment.
On the other hand, if the retinal detachment is operated on, it takes a few days for the retina to settle down and form a scar. After about 2-3 weeks after the operation, the patient can continue his or her life without any restrictions. How long it takes to regain the attainable vision depends on various circumstances.
The regeneration of the retina is influenced by the extent and duration of the retinal detachment. It also plays a role in how long the so-called macula (the yellow spot) was elevated. Often it takes weeks or months until the vision has improved satisfactorily after surgery.
After a longer macular detachment, it can take up to a year until the vision is regained to the extent that it could have been. Untreated retinal tears, holes or retinal detachments have a progressive course. This means that they continue without therapy.
Often a vitreous hemorrhage and a retinal detachment occur together. In this case, the discomfort caused by the vitreous hemorrhage can subside as the bleeding heals. The duration of the decrease in bleeding and the associated symptoms is highly variable.
The duration depends on the extent of the bleeding and other individual factors. The symptoms caused by the retinal detachment itself do not disappear on their own. Only through surgery is it possible to reduce the symptoms.
A retinal detachment can only be successfully treated by surgery. According to some authors, an uncomplicated retinal detachment could be successfully treated with the denting method in 85-95% of cases. The chances of recovery increase the earlier the retinal damage is detected and treated.
In cases of complicated retinal detachment and/or in combination with other eye diseases, the diagnosis is less favorable. However, the removal of the vitreous humour and the insertion of an internal tamponade can often achieve satisfactory visual improvements. The extent to which visual performance improves depends on many factors.
Some studies show that stress may play a role in retinal detachment. It is suspected that there is a connection with increased release of the hormone cortisol. It is assumed that many different factors are associated with a retinal detachment.If there is a preload on the retina, stress could be a risk factor to promote retinal detachment.
Stress as the sole or general cause of retinal detachment is unlikely. A vitreous hemorrhage can develop into a retinal detachment. The vitreous body of the eye borders the retina at the back and attaches to it.
Through this connection with each other, a vitreous detachment can have an effect on the retina. Consequently, a vitreous detachment can cause a pull on the vessels. If the detachment happens suddenly, the vessels can be torn by the pull.
This can lead to vitreous hemorrhage and cause a retinal tear or hole. If fluid is then flushed under the retina, there is a risk that it will detach. This topic may also be of interest to you: Vitreous detachment
