Retinal detachments and tears can lead to the loss of sight and should be treated as emergencies. Focus spoke with retina surgeon Mohammad Dahrouj, MD, PhD, about the causes of retinal detachments and why it’s important to immediately seek medical attention if certain symptoms arise.
What is a retinal detachment and how does it occur?
A retinal detachment is when the retina – a layer of the eye tissue that senses light and sends images to the brain – is separated or lifts away from the back of the eye. When the retina is detached from the back wall of the eye, it separates from its blood supply and no longer functions properly, resulting in decreased vision.
There are multiple ways that the retina can detach, but the most common way is called a rhegmatogenous retinal detachment. This happens when gel-like fluid inside the eyes, called the vitreous, starts to liquify or shrink with age. As this occurs, the vitreous can pull on the retina and create a hole, or tear. This hole allows fluid to pass through and lift or separate the retina, causing a full detachment.
A second common cause of retinal detachment is trauma, or injury, to the eye. In such cases, a retinal tear can develop and lead to a retinal detachment. Other less common causes of retinal detachment include inflammation, tumors and diseases like diabetes, but those cases are treated differently than rhegmatogenous or trauma-related tears and detachments.
What are the early signs of a torn or detached retina?
A common warning sign of a retinal tear or detachment is seeing flashes of light (like a camera flash), which can be noticed in dark conditions or when you move your head from side to side. The flashing suggests that the vitreous is pulling on the retina, potentially causing a tear. It’s also common to see shadows appearing in your side vision or a gray curtain covering part of your field of vision.
Another warning sign is lots of new floaters all at once. Floaters are small dark shapes that float across your field of vision and often look like specks, lines or cobwebs. Many people have floaters that come and go, but an increase in floaters all at once is a sign that something may be wrong.
Why is it important to seek emergency medical attention?
A retinal detachment is a serious condition, and urgent treatment is necessary to decrease any long-term impact on vision. If discovered early, a torn retina or retinal tear can be treated and prevent the retinal detachment from happening. However, once a detachment occurs, permanent and irreversible vision loss can result.
If someone is experiencing signs of a retinal tear or detachment, they should call their eye doctor or go to their local hospital emergency department. In order to prevent permanent vision loss, it’s critical to be seen by a doctor within 24 hours. It’s also recommended that the person avoids strenuous activity or extensive reading until he or she is evaluated by a doctor. As part of the evaluation, the ophthalmologist will dilate and examine the affected eye.
How are detached and torn retinas treated?
If a retina is torn, treatment is needed to prevent progression into retinal detachment. This can include a laser procedure called photocoagulation or a freeze treatment called cryopexy. After these treatments, it’s recommended that the patient takes it easy for three to four days and has a follow-up appointment to confirm that the tear is healing.
A full retinal detachment requires urgent treatment to repair the retina, and there are multiple surgical and nonsurgical treatment options, including:
- Pneumatic retinopexy, where the retinal tear is treated with cryotherapy or a laser, followed by injection of a gas bubble inside the eye to push the retina into place so it can heal properly. This is done in an office setting; however, not everyone is a good candidate for this procedure.
- Vitrectomy, a surgical procedure done in the operating room that involves removing all the vitreous from the eye, reattaching the retina to the back of the eye, and then using a laser to repair any tears in the retina. A gas or oil bubble is placed inside the eye to keep the retina in the correct position as it heals. After surgery, the patient needs to be in a face down position for at least seven days as the retina heals.
- Scleral buckle, also a surgical procedure done in the operating room, where a silicone band is placed around the eye to gently press the eye inward to help the detached retina heal against the eye wall.
After an evaluation, the doctor will determine which repair method is best based on the characteristics of the retinal detachment and age of the patient.
Will vision return to normal after treatment?
Unfortunately, after retinal detachment, your vision is unlikely to go back to where it was previously. However, many patients will keep good functional vision in the affected eye if they seek immediate treatment.
If you’re unable to connect with your eye doctor or don’t have one, head to your nearest emergency room. If you live in the Greater Boston area, Mass Eye and Ear has a 24/7 Emergency Department with a team trained in emergency eye care. You can come see us or call (617) 573-3431 if you think you’re experiencing a retinal detachment.
About the Expert
Mohammad Dahrouj, MD, PhD, is a member of the Retina Service at Mass Eye and Ear, where he specializes in treating diabetic retinopathy, macular degeneration, and retinal detachment, as well as surgery for vitreoretinal disorders and ocular trauma. He sees patients at the Boston Main Campus and Longwood locations, in addition to Plainville, Providence and Stoneham.