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Retinal Detachment

Retinal detachment

Definition

Retinal detachment is a serious eye disorder in which the retina, a thin tissue of cells located in the back of the eye, separates from the underlying tissue layers.

Description

There are three layers of the eyeball. The outer, tough, white layer is called the sclera. Lining the sclera is the choroid, a thin membrane that supplies nutrients to part of the retina. The retina is located at the back of the eye and consists of three cellular layers.

The retina contains the light-sensitive receptors for sight and processes visual images. A retinal detachment occurs between the two outermost layers of the retina, the photoreceptor layer that receives light and the outermost pigmented epithelium. When a tear in the retina occurs, the fluids in the eye may leak and pull the retina out of place, or detach it from the layers. Because the choroid supplies the photoreceptors within the retina with nutrients, a detachment can basically starve the photoreceptors. If a detachment is not repaired within 2472 hours, permanent damage may occur.

Causes & symptoms

Several conditions may cause retinal detachment:

  • Scarring or shrinkage of the vitreous (substance comprising the insides of the eye) can pull the retina inward.
  • Small tears in the retina allow liquid to seep behind the retina and push it forward.
  • Injury to the eye can loosen the retina. Trauma is the most common cause of retinal detachment in children, although it is comparatively unusual in the adult population.
  • Bleeding behind the retina, most often due to diabetic retinopathy or injury, can push it forward.
  • Retinal detachment may be spontaneous. This occurs more often in the elderly or in very nearsighted (myopic) eyes.
  • Cataract surgery causes retinal detachment 2% of the time.
  • Myopia .
  • Diabetes.
  • Congenital factors (those that people are born with).
  • Family history of retinal problems.
  • High blood pressure.
  • Stress .
  • Tumors.

Retinal detachment will cause a sudden defect in vision. It may look as if a curtain or shadow has just descended before the eye. If most of the retina is detached, there may be only a small hole of vision remaining. If only a portion of the retina is involved, there will be a blind spot that may not even be noticed. Retinal detachment is often associated with floaters, which are little dark spots that float across the eye and can be mistaken for flies in the room. There may also be flashes of light. Anyone experiencing sudden flashes of light or floaters should contact his/her eye doctor immediately since these may be symptoms of detachment.

Diagnosis

Diagnosis of retinal detachment should be done by an ophthalmologist. A person who has flashes, floaters, or has a curtain-like blockage of their visual field should see an ophthalmologist immediately because early treatment is required to prevent loss of sight. An optometrist may also diagnose retinal detachment during a routine eye examination.

Treatment

No alternative treatment is recommended for acute retinal detachment. Vision may be lost if the problem is

not diagnosed and attended to promptly. However, some alternative therapies such as behavioral optometry prescribe eye relaxation exercises and use techniques that attempt to prevent and naturally heal myopia (near-sightedness). Nearsighted (myopic) people are at greatest risk for retinal detachment. Some alternative therapies that reduce stress to the eyes may promote general eye health. Also, alternative treatments to control high blood pressure such as diet, Chinese herbs, massage for stress relief, relaxation exercises, and yoga , may also indirectly prevent retinal damage by reducing high blood pressure and relieving stress. Antioxidants such as bilberry may also be used to decrease inflammation.

Allopathic treatment

Traditional treatment of retinal detachment involves immediate surgery to repair the retina. Small holes or tears may be sealed with a laser or with cryotherapy (freezing) under local anesthesia in a doctor's office. More extensive repairs are done in the hospital under general anesthesia. These may involve injection of silicone oil to help the retina reattach.

Expected results

Retinal detachment is a serious condition that can result in blindness. If retinal detachment is diagnosed in its early stages and repair is made quickly, the patient's sight usually returns to normal. If the retina is fully detached, and extensive surgery is needed, the patient's sight may be partially or fully restored. The amount of restoration depends on the severity of the damage and how soon it is treated.

Prevention

To prevent retinal detachment, people should be keenly aware of eye function and diseases that may affect it. Regular eye examinations can detect changes that the patient may not notice. In such diseases as diabetes, with a high incidence of retinal disordes, routine eye examinations can detect early changes. Good control of diabetes can help prevent diabetic eye disease. High blood pressure and stress should be controlled daily. Blood pressure control can prevent hypertension from damaging the retinal blood vessels, and stress management techniques can also reduce blood pressure. Wearing eye protection can also prevent direct injury to the eyes.

Early treatment can prevent both progressing to detachment, and blindness from other events like hemorrhage. Other diseases can cause the tiny holes and tears in the retina through which fluid can leak. Preventive treatment uses a laser to cauterize the blood vessels so that they do not bleed and seals the holes so they do not leak.

Resources

PERIODICALS

Butler, T. K. H., A. W. Kiel, and G. M. Orr. "Anatomical and Visual Outcome of Retinal Detachment Surgery in Children." British Journal of Ophthalmology 85 (December 2001): 1437-1439.

"Eye Disorders: Retinal Detachment." Harvard Health Letter (December 1, 1998).

Jonas, Jost B., et al. "Retinal Redetachment After Removal of Intraocular Silicon Oil Tamponade." British Journal of Ophthalmology 85 (October 2001): 1203.

ORGANIZATIONS

American Academy of Ophthalmology. P.O. Box 7424, San Francisco, CA 94120-7424. (415) 561-8500.

American Optometric Association. 243 North Lindbergh Blvd., St. Louis, MO 63141. (314) 991-4100.

Angela Woodward

Rebecca J. Frey, PhD

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Retinal Detachment

Retinal Detachment

Definition

Retinal detachment is movement of the transparent sensory part of the retina away from the outer pigmented layer of the retina. In other words, the moving away of the retina from the outer wall of the eyeball.

Description

There are three layers of the eyeball. The outer, tough, white sclera. Lining the sclera is the choroid, a thin membrane that supplies nutrients to part of the retina. The innermost layer is the retina.

The retina is the light-sensitive membrane that receives images and transmits them to the brain. It is made up of several layers. One layer contains the photoreceptors. The photoreceptors, the rods and cones, send the visual message to the brain. Between the photoreceptor layer (also called the sensory layer) and the choroid is the pigmented epithelium.

The vitreous is a clear gel-like substance that fills up most of the inner space of the eyeball. It lies behind the lens and is in contact with the retina.

A retinal detachment occurs between the two outermost layers of the retinathe photoreceptor layer and the outermost pigmented epithelium. Because the choroid supplies the photoreceptors with nutrients, a detachment can basically starve the photoreceptors. If a detachment is not repaired within 24-72 hours, permanent damage may occur.

Causes and symptoms

Several conditions may cause retinal detachment:

  • Scarring or shrinkage of the vitreous can pull the retina inward.
  • Small tears in the retina allow liquid to seep behind the retina and push it forward.
  • Injury to the eye can simply knock the retina loose.
  • Bleeding behind the retina, most often due to diabetic retinopathy or injury, can push it forward.
  • Retinal detachment may be spontaneous. This occurs more often in the elderly or in very nearsighted (myopic) eyes.
  • Cataract surgery causes retinal detachment 2% of the time.
  • Tumors can cause the retina to detach.

Retinal detachment will cause a sudden defect in vision. It may look as if a curtain or shadow has just descended before the eye. If most of the retina is detached, there may be only a small hole of vision remaining. If just a part of the retina is involved, there will be a blind spot that may not even be noticed. It is often associated with floaters little dark spots that float across the eye and can be mistaken for flies in the room. There may also be flashes of light. Anyone experiencing a sudden onset of flashes and/or floaters should contact their eye doctor immediately, as this may signal a detachment.

Diagnosis

If the eye is clearthat is, if there is no clouding of the liquids inside the eyethe detachment can be seen by looking into the eye with a hand-held instrument called an ophthalmoscope. To evaluate the blood vessels in the retina, a fluorescent dye (fluorescein) may be injected into a vein and photographed with ultraviolet light as it passes through the retina. Further studies may include computed tomography scan (CT scan), magnetic resonance imaging (MRI), or ultrasound study. Other lenses may be used to examine the back of the eyes. One example is binocular indirect ophthalmoscopy. The doctor dilates the patient's eyes with eyedrops and then examines the back of the eyes with a handheld lens.

Treatment

Reattaching the retina to the inner surface of the eye requires making a scar that will hold it in place and then bringing the retina close to the scarred area. The scar can be made from the outside, through the sclera, using either a laser or a freezing cold probe (cryopexy). Bringing the retina close to the scar can be done in two ways. A tiny belt tightened around the eyeball will bring the sclera in until it reaches the retina. This procedure is called scleral buckling and may be done under general anesthesia. Using this procedure permits the repair of retinal detachments without entering the eyeball. Sometimes, the eye must be entered to pump in air or gas, forcing the retina outward against the sclera and its scar. This is called pneumatic retinopexy and can generally be done under local anesthesia.

If all else fails, and especially if there is disease in the vitreous, the vitreous may have to be removed in a procedure called vitrectomy. This can be done through tiny holes in the eye, through which equally tiny instruments are placed to suck out the vitreous and replace it with saline, a salt solution. The procedure must maintain pressure inside the eye so that the eye does not collapse.

Prognosis

Retinal reattachment has an 80-90% success rate.

Prevention

In diseases such as diabetes, with a high incidence of retinal disease, routine eye examinations can detect early changes. Early treatment can prevent both progressing to detachment and blindness from other events like hemorrhage. The most common problem is weakness of blood vessels that causes them to break down and bleed. When enough vessels have been damaged, new vessels grow to replace them. These new vessels may grow into the vitreous, producing blind spots and scarring. The scarring can in turn pull the retina loose. Other diseases can cause the tiny holes and tears in the retina through which fluid can leak. Preventive treatment uses a laser to cauterize the blood vessels, so that they do not bleed and the holes, so they do not leak.

Good control of diabetes can help prevent diabetic eye disease. Blood pressure control can prevent hypertension from damaging the retinal blood vessels. Eye protection can prevent direct injury to the eyes. Regular eye exams can also detect changes that the patient may not be aware of. This is important for patients with high myopia who may be more prone to detachment.

Resources

ORGANIZATIONS

American Academy of Ophthalmology. 655 Beach Street, P.O. Box 7424, San Francisco, CA 94120-7424. http://www.eyenet.org.

American Optometric Association. 243 North Lindbergh Blvd., St. Louis, MO 63141. (314) 991-4100. http://www.aoanet.org.

KEY TERMS

Cauterize To damage with heat or cold so that tissues shrink. It is an effective way to stop bleeding.

Diabetic retinopathy Disease that damages the blood vessels in the back of the eye caused by diabetes.

Saline A salt solution equivalent to that in the body-0.9% salt in water.

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retinal detachment

retinal detachment (detached retina) n. separation of the inner nervous layer of the retina from the outer pigmented layer (retinal pigment epithelium), causing loss of vision in the affected part of the retina. The condition can be treated surgically by creating patches of scar tissue between the retina and the choroid (see cryosurgery, photocoagulation); this, combined with plombage, allows reattachment of the retina.

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