Vitreous gel, the clear material that fills the eyeball, is attached to the retina in the back of the eye. As we get older, the vitreous may change shape, pulling away from the retina. If the vitreous pulls a piece of the retina with it, it causes a retinal tear. Once a retinal tear occurs, vitreous fluid may seep through and lift the retina off the back wall of the eye, causing the retina to detach from the back of the eye.
Symptoms of a retinal tear or detachment can include:
- A sudden increase in size and number of floaters, indicating a retinal tear may be occurring.
- A sudden appearance of flashes, which could be the first stage of a retinal tear or detachment.
- Having a shadow appear in the periphery (side) of the field of vision.
- Seeing a gray curtain moving across the field of vision.
- A sudden decrease in vision.
The American Academy of Ophthalmology (AAO) has a vision simulator to illustrate how one's vision may be affected by a retinal tear or detachment.
The retina is the light-sensitive tissue lining the back of the eye. Light rays are focused onto the retina through the cornea, pupil and lens. The retina converts the light rays into impulses that travel through the optic nerve to the brain, where they are interpreted as images.
The middle of the eye is filled with a clear gel called vitreous that is attached to the retina. Sometimes tiny clumps of gel or cells inside the vitreous will cast shadows on the retina, and you may sometimes see small dots, specks, strings or clouds moving the field of vision. These are called floaters. Floaters can often be seen when looking at a plain, light background, like a blank wall or blue sky.
As the eye ages, the vitreous may shrink and pull on the retina. When this happens, flashing light may be noticed, lightning streaks or the sensation of seeing "stars." These are called flashes.
Retinal Tear or Detachment
Usually the vitreous moves away from the retina without causing problems. But sometimes the vitreous pulls hard enough to tear the retina in one or more places. Fluid may pass through a retinal tear, lifting the retina off the back of the eye — much as wallpaper can peel off a wall. When the retina is pulled away from the back of the eye, it is called a retinal detachment.
The retina does not work when it is detached and vision is blurry. A retinal detachment is a very serious problem that almost always causes blindness unless it is treated.
Patients at risk for a Retinal Detachment
People with the following conditions have an increased risk for retinal detachment:
- Previous cataract surgery
- Severe eye injury
- Previous retinal detachment in the other eye
- Family history of retinal detachment
- Weak areas in the retina
Diagnosing a Retinal Detachment
A retinal tear or detachment can be diagnosed during a dilated eye exam. Some retinal detachments are found during a routine eye examination.
Treating a Retinal Detachment
Most retinal tears need to be treated by sealing the retina to the back wall of the eye with laser surgery or cryotherapy (a freezing treatment). Both of these procedures create a scar that helps seal the retina to the back of the eye. This prevents fluid from traveling through the tear and under the retina, which usually prevents the retina from detaching. These treatments cause little or no discomfort and Dr. Westrich or Dr. Metelitsina can perform the procedure at Eye Care Specialists.
Almost all patients with retinal detachments must have surgery to place the retina back in its proper position. Otherwise, the retina will lose the ability to function, possibly permanently, and blindness can result. The method for fixing retinal detachment depends on the characteristics of the detachment.
With a scleral buckle, a flexible band (scleral buckle) is placed around the eye to counteract the force pulling the retina out of place.
The fluid is drained from under the detached retina, allowing the retina to settle back into its normal position against the back wall of the eye. This procedure is performed in an operating room.
A Pneumatic retinopexy is when a gas bubble is injected into the vitreous space inside the eye in combination with laser surgery or cryotherapy. The gas bubble pushes the retinal tear into place against the back wall of the eye. Sometimes this procedure can be done at Eye Care Specialists.
You will need to constantly maintain a certain head position for several days. The gas bubble will gradually disappear.
Vitrectomy surgery is performed in an operating room. The vitreous gel, which is pulling on the retina, is removed from the eye and usually replaced with a gas bubble. The body's own fluids will gradually replace the gas bubble. Sometimes vitrectomy is combined with a scleral buckle.
Most retinal detachment surgery is successful, although a second operation is sometimes indicated. Some retinal detachments cannot be fixed. If the retina cannot be reattached, the eye will continue to lose sight and ultimately become blind.
After successful surgery for retinal detachment, vision may take many months to improve and, in some cases, may never return fully. Unfortunately, some patients do not recover any vision. The more severe the detachment, the less vision may return. For this reason, it is very important to see your eye doctor at the first sign of any trouble such as a decrease in vision, flashes of light, or an increase in floaters.