A retinal detachment is a medical emergency and can lead to blindness. The retina is the lining of the inside back surface of the eye and is composed of light-sensitive cells. In front of the retina, between it and the lens (which is suspended behind the iris), is the biggest area of the eye. It is a cavity filled with a gel called vitreous humor (or just “vitreous”). It moistens the retina and helps maintain the eye’s round shape. It is a clear fluid so that light can travel through it to the retinal cells.
Behind the retina is a membrane called the choroid. Behind the choroid is the sclera, which we see in the front of the eye as the “white” of the eye. These three layers – retina, choroid, and sclera – are closely connected and form the total wall around the eyeball.
What Happens With Retinal Detachment
The most common type of retinal detachment forms due to a retinal tear. Retinal tears may occur due to high risk factors such as nearsightedness, prior eye surgery, or due to vitreous separation (an age related event usually).
If the retina is somehow pulled away from the choroid, it cannot function for vision. The large optic nerve is the conduit carrying image information to the brain for interpretation. It has many small branches throughout the retina.
If the retina is torn or pulled forward away from the choroid, the nerves are damaged in that area. Tiny blood vessels may be broken and then leak. Fluids can build up behind the retina, further detaching the retina. Intervention is essential to preserve vision.
You can read more about retinal problems, including detachment causes, on our Retinal Vitreous Disease page. If you have diabetes or Age-Related Macular Degeneration (ARMD) and you are at increased for retinal detachment.
Surgical Treatments
Vitrectomy: Vitrectomy removes the vitreous and scar tissue membranes on the surface. Additionally, a gas bubble may be injected into the vitreous cavity. The gas bubble prevents further detachment by closing the retinal tears and stabilizing the reattached retina. The gas bubble will resolve on its own after a period of weeks and is replaced by clear water like solution that your eye keeps regenerating. This prevents fluid building up behind the retina. The gas bubble applies pressure to push the retinal tissue against the choroid, preventing further tearing or separation.
Laser Photocoagulation: A medical laser is used to create a tiny scar or adhesion around the retinal tear. This seals it and prevents fluid from seeping behind the retina. The same effect can be created through cryopexy – freezing the tissue around the retinal tear.
Pneumatic retinopexy: A gas bubble is injected into the eye without removing the vitreous. Then freezing or a laser is used to seal off the retinal hole. For several days, the head must be kept positioned so that the bubble is next to the retinal tear. Because of the osmotic pressure between the vitreous and the choroid, the retina is “sucked” back into position. Any fluid that has spread beneath the retina is pulled out and the retinal tissue can reconnect itself.
Scleral Buckle Surgery: One or more silicone bands are sutured to the outside of the eyeball near the detachment. They push the eye’s wall inwards against the retinal tear. This seals the retinal tear to prevent fluid from getting behind the retina, helps the retinal tissue to reattach itself, and relieves any tractional forces that may pull the retina and redetach it. Typically, the bands are left in place.
Silicone Oil: Sometimes, instead of a gas bubble placed after vitrectomy, silicone oil may be injected. This functions similarly to a gas bubble except that it does not resolve on its own (whereas the gas bubble goes away on its own). This allows the retina to be stabilized and supported longer than a gas bubble, and silicone oil may not require strict head positioning like a gas bubble does. When oil is placed another surgical procedure is needed to remove it.
At Horizon Eye Care, our ophthalmologists are highly equipped and qualified to treat retinal detachments and all related problems. We urge you to come for your routine eye care so that we can catch any developing problems early.
To learn more about how the eyes work and how various diseases affect them, please see our 3-D Eye Library, where there are many animations with commentary. If you click on Retinal Conditions you will find a short animation on Retinal Tear.
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To schedule a personal consultation please email our ophthalmology office today.
