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Retinal Detachment

23rd April 2004: “Pele rushed to hospital” screamed the headlines, “Pele undergoes emergency surgery in left eye at Albert Einstein Hospital in Sao Paulo!” If you’re pondering, vaguely remembering reading this but not recollecting what it was that he was admitted for, don’t sweat it out…it was a detached retina that gave hundreds of his fans the shivers.

What is Retinal Detachment?

Retinal Detachment is that medical emergency when a layer of the retina (the screen at the back of your eye) gets separated from the layer that contains blood vessels. This leaves the retina without oxygen and nutrients which puts the affected eye at the risk of permanent loss of vision. In some people, this loss of vision does not get reversed even after surgery.

Do I have Retinal Detachment? (Signs and Symptoms)

The symptoms of retinal detachment can be summarized as the four Fs:
1. Flashes are like streaks of light and are similar to what can be seen when the flash of a camera goes off. This occurs because of the retina getting tugged which causes improper stimulation of the retina which is interpreted as light by the brain.
2. Floaters are semi-transparent or cloudy specks, particles or blobs in your vision that are seen when you look at a plain light colored surface.
3. Failing vision or blurriness of vision
4. Falling curtain: A grey curtain or a shadow may suddenly fall on your field of vision especially in the periphery.

All the above symptoms are especially important if they are seen in one eye and have a sudden onset, or there is a sudden increase in the number or size of floaters or flashes.

What causes Retinal Detachment?

Retinal tears: Holes or tears in your retina are the most common cause. Eye fluids may leak through this opening causing the retina to separate from the underlying tissues. (This is just like what happens when a bubble gets under the wallpaper). Tears in the retina can be caused by:
• Vitreous Detachment (Separation of the gel inside the eye): Usually the shrinking of the vitreous happens without causing any problems as part of the natural aging process. But sometimes, the vitreous may pull the retina hard enough to cause it to tear.
• Trauma
• Severe nearsightedness

Tractional Detachment: A pull on your retina may occur if you have:

• Uncontrolled Diabetes
• Had a retinal surgery earlier which left a scar
• Chronic Inflammation

When your retina detaches, the blood vessels begin to bleed which then causes clouding of the inside of your eye which earlier only contained the transparent gel called the vitreous. Your central vision could get affected very severely if the central part of your retina called the macula gets detached as this region is majorly responsible for fine vision.

What are the tests for Retinal Detachment?

Your ophthalmologist will perform tests to check your retina, and your pupil (the hole in the center of the coloured part of your eye) response. The following tests may be done:
• Visual Acuity Testing
• Refraction Test
• Slit lamp Examination
• Measurement of the pressure inside your eye
• Ophthalmoscopy
• Fluorescein Angiography
• Electroretinogram which is a record of the electrical signals that are produced in your retina when you see objects.
• Retinal Photography
• Ultrasound of the Eye

How is Retinal Detachment treated?

If you have had a retinal detachment, you should receive proper medical care within 24 hours. You would most probably require a surgery to prevent loss of vision.
Sometimes, if you have been detected with retinal tears, you might require a surgery that can be done on an outpatient basis, meaning that you need not stay in the hospital overnight. These are:
• Laser Surgery or Photocoagulation: This can be used to seal small tears or holes in your retina before you go on to develop retinal detachment. Here, small burns are made around the retinal tear. These burns go on to form scars which seal the retina to the underlying tissue and prevent a detachment.
• Cryotherapy: This is a freezing treatment in which intense cold is applied to freeze the retina around the tear. The resultant scar that is formed helps attach the retina to the eye wall.
• Pneumatic Retinopexy: If you have a retinal detachment that is small, you can undergo this procedure wherein a small gas bubble is placed in your eye. This gas bubble helps to push your retinal tear back into place against the back wall of your eye. The hole is then sealed with a laser or cryotherapy. The bubble will gradually disappear.
However, there are other times, when you have developed a full blown retinal detachment and this means that you would need a surgery that requires you to be hospitalized. This may be:
• Scleral buckle: In this surgery, a flexible band or scleral buckle is placed around your eye so that the force that is pulling your retina out of shape can be counteracted. The fluid under your detached retina is drained and your eye wall is gently pushed up against your retina.

• Vitrectomy: This surgery is done when you have large tears or detachments. The vitreous gel which is tugging on your retina is removed from your eye. This may be replaced with a gas bubble or an oil bubble. If a gas bubble has been used, it will get replaced naturally by your body fluid. However, if an oil bubble is used, a second surgery will be required to remove it later.

How can I prevent Retinal Detachment?

• Use protective eye wear to prevent trauma to your eye.
• Keep a strict control over your blood sugars if you are a diabetic
• Visit your eye specialist every year especially if you are at risk for a retinal detachment.
• If you suffer from a serious eye injury, see your eye doctor right away.