Introduction

Retinal detachment is an uncommon condition which affects approximately 1 in every 10,000 persons each year.  Most cases occur spontaneously and are more common in patients who are nearsighted, who have retinal degeneration, who have had previous eye surgery, or who have had eye injuries.  Most retinal detachments (90%) can be repaired by surgery.  Without surgery, retinal detachments commonly progress and lead to blindness.

The retina lines the back of the eye and is extremely thin (.1 to .2 millimeters thick, less than the thickness of a hair).  When stimulated by light rays, the retina generates nerve impulses.  These nerve impulses are transmitted to the brain through the optic nerve.

A retinal detachment is caused by holes or tears in the retina.  Fluid from the central cavity of the eye passes through the retinal hole and accumulates beneath the retina, which separates the retina from the underlying layer.   Where the retina is detached, light rays are unable to generate the proper nerve impulses and vision is lost.  If the hole in the retina passes through a blood vessel, bleeding may develop within the eye.

Symptoms

When a hole or retinal detachment develops, flashes of light may be seen, black spots, and floaters may appear.  Some patients note a "curtain" or a "veil" in front of their vision or loss of vision.   These symptoms require an immediate examination by an ophthalmologist.

The retinal detachment causes a gray shadow, similar to a shade or curtain being drawn over the eye.  When the central part of the retina detaches (the macula), loss of reading vision occurs.

Surgery

In order to repair the retina, all the retinal holes and tears must be sealed.   During the eye examination, all of the retinal holes are identified and recorded on a drawing of the retina.  Retinal detachment surgery can be done under local or general anesthesia.  The conjunctiva, the thin membrane on the outside of the eye, is opened, and the retinal holes are treated by applying a probe to the outside of the eye over the hole.  This can be accomplished by rotating the eye from side to side.   Cryotherapy (freezing the outside of the eye) is performed to form a scar and seal the retinal holes and tears.  Frequently, a piece of silicone plastic is sewn to the outside of the eye (the sclera) to indent the sclera over the retinal tears or holes and thus close them.  Usually the fluid under the retina is drained through a small puncture to allow the retinal holes and tears to settle on the scleral buckle.  Tiny sutures are used to fixate the silicone rubber or sponge and to close the puncture site used for the drainage of fluid.  In some cases, removal of the vitreous jelly from inside the eye (vitrectomy surgery) is necessary to reattach the retina.  Most of the time, the retina is attached with the first operation.  However, in some cases, further surgery is needed to reattach the retina.  In extremely severe cases of retinal detachment, some retinas cannot be repaired despite multiple surgical procedures.

After successful retinal detachment surgery, the vision may gradually improve over many weeks and months.  However, if the center of the retina (macula) is detached before surgery, the vision may not return to the same vision as before the detachment, although the retina has been repaired.  After surgery, a change in glasses is usually required several months later to provide the best vision.  After surgery, the surgeon will prescribe eyedrops or ointments for a few weeks to help the healing process.  Additionally, instructions regarding activity will be given to the patient.  After three to four weeks, healing of the eye is usually complete and one can return to work, although strenuous activity or activities which risk injury to the eye are prohibited for one to two months.

Laser surgery cannot be used if a significant retinal detachment has developed. Laser surgery is only useful in treating retinal holes or tears before a retinal detachment has developed.