What Is Retinal Detachment And How Is It Treated?

Introduction

What is the retina? 

Our eyes have three main layers. Firstly, the retina, which is the innermost layer located at the back of our eyes.¹ Next, the macula, which is in the centre of the retina and is important for our central vision.² Lastly, the vitreous gel-like fluid in our eyes maintains the eye’s shape and allows light to reach the retina. 

Light enters our eyes through each lens and is focused on the retina, which then sends electrical and chemical messages to our brain to perceive a visual image. Retinal cells also have rich blood vessels that supply our eyes with nutrients and oxygen. The retina therefore plays a key role in forming our vision. 

Definition of retinal detachment

Retinal detachment is when the retina separates from its normal position at the back of our eye(s). This allows vitreous fluid to leak through and can accumulate in the back of the retina.¹ 

Importance of prompt treatment

It is among one of the most common eye emergencies, and is associated with 13 out of 100,000 people presenting with the condition in the UK each year. If left untreated for long enough, retinal detachment may lead to:

• Permanent visual loss if the retinal detachment extends across the macula 
• Distorted vision if a thin layer of scar tissue (epiretinal membrane) grows over the retina 
• Vitreous haemorrhage if there is blood in the normally clear vitreous gel 
• Secondary glaucoma as a result of increased intraocular (fluid) pressure from the retinal detachment 

Early and immediate treatment can help prevent permanent damage to your vision.³ 

Types of retinal detachment

There are three main types of retinal detachment:  

1. Rhegmatogenous retinal detachment

This is the most common type and occurs when the vitreous gel leaks to the back of the retina through a retinal tear.

2. Tractional retinal detachment

This is often found in people with proliferative diabetic retinopathy. The retinal layer is separated and pulled away from the normal position because of abnormal growth of the blood vessels in the eye.

3. Exudative retinal detachment  

This is a rare type of retinal detachment caused by an accumulation of fluid behind the retina without any tears or holes in the retina. This can be caused by cancer or severe eye inflammation.

Treatment options

Treatment usually involves surgery and depends on the type and severity of the retinal detachment. Always discuss with your doctor the benefits and risks of the treatment options available to you.

Laser surgery

Laser treatment (photocoagulation) is suggested to prevent a retinal tear or hole from progressing into a retinal detachment. A laser beam will pass through the pupil of the eye, which creates a scar that will seal the tear or hole and help prevent a detached retina from forming.

Pneumatic retinopexy

Pneumatic retinopexy is a less invasive option that involves injecting an expanding bubble of gas into the centre of the eye (vitreous cavity). A freezing device is then used and the bubble will push the detached area of the retina to stop the fluid from leaking behind the retina.⁴

Scleral buckling

During scleral buckling, the surgeon will sew (suture) silicon to the white part of your eye (sclera) over the affected area. The indents made on the eye wall relieve some of the force caused by the retina tugged by the vitreous gel. Next, a small buckle may be permanently placed around the outside of the eyeball like a belt to keep the retina in place without blocking vision.⁵

Vitrectomy

Vitrectomy may be performed with or without scleral buckling. The surgeon will drain the vitreous gel to alleviate the tugging on the retina. The fluid is then replaced with air, gas, or fluid in the vitreous space to flatten the retina. These will eventually resorb, and the vitreous space will refill with natural bodily fluid. However, another surgical removal of silicone oil may be required.

Recovery and follow up

Recovery process

Depending on the procedure, the recovery time can vary from four to eight weeks. It is normal to have significantly reduced vision after any of these procedures. Improvement of vision may take several months, however, some people may never fully recover their lost vision.

Follow-up care

Monitoring:

Seek medical support immediately if you notice any of the following symptoms:

• Reduced vision 
• Signs of eye infection such as redness, swelling, or worsening of the pain
• New or sudden onset of flashes or floaters 

Rehabilitation:

Depending on the treatment performed, it is recommended to follow your doctor’s advice. This may include:

• Keeping your head in a certain position
• Avoiding air travel 
• Avoiding swimming 
• Avoiding getting shampoo and soap into your eye(s)
• Avoiding driving until you reach the minimum eyesight standard 
• Ensuring your medications are taken as advised, such as eye drops 
• Follow-up appointments to check whether the procedure was effective 

Prevention

Tips for preventing retinal detachment

It can be difficult to prevent retinal detachment. However, there are multiple ways to reduce its likelihood. It is important to physically protect the eyes to prevent eye injuries. This can be done by wearing safety goggles when doing activities such as contact sports, DIY projects, watching fireworks, or any activity with a risk of small objects flying and hitting the eye.

Recommendations for high-risk groups

It is advised to have a comprehensive eye health check regularly. You should monitor any medical conditions including following your doctor’s advice, getting regular exercise, a healthy diet, and managing your medications.

Causes and risk factors

Causes of retinal detachment

There are many causes of retinal detachment:

• Ageing which leads to progressive loss of shape and consistency of the vitreous gel
• Advanced diabetic retinopathy which leads to bleeding and scarring from the abnormal growth of blood vessels in the retina
• Degenerative myopia which is a severe form of nearsightedness (myopia)
• Lattice degeneration which involves thinning of the retina  
• Other causes include any eye condition: injury, inflammatory diseases, or Coats' disease

Risk factors for retinal detachment

Although anyone is susceptible to retinal detachment, certain people are more at risk of developing the disease than others. Some risk factors include:

• If you are over 60 years old
• If you have previously had retinal detachment
• If you have previously had posterior vitreous gel detachment 
• If you have extreme nearsighted vision (myopia) 
• If you have previously injured or had surgery to your eye
• If you have had glaucoma and/or on glaucoma medications that make the pupil small 
• If you have cataracts
• If a family member has had retinal detachment
• If you have any weak areas in the retina

Symptoms and diagnosis

Common symptoms of retinal detachment

Warning signs and symptoms of retinal detachment can include any of the following:

• Reduced and/or blurred vision 
• Sudden appearance of floaters 
• Sudden appearance of flashing lights (photopsia) 
• Progressive loss of side (peripheral) vision which can have a “curtain”-like shadow 

Diagnostic procedures

A doctor or optician will go through your symptoms and medical history. You may be referred to an eye specialist (ophthalmologist). The following eye tests may be performed to diagnose retinal detachment:

• Retinal examination — an instrument with special lenses and a bright light will be used to see a detailed view of the entire eye and check the retina 
• Ultrasound imaging — to check if there is any bleeding in the eye 

If no retinal tear is identified at this appointment, you may be requested to return within a few weeks to check if there has been any delayed development of a retinal tear. However, if you experience new symptoms, it is important to immediately seek medical help. 

You may wish to have someone accompany you after your appointment as the eye drops used during the eye tests may affect your vision for a couple of hours afterwards.

Support

Loss of vision can significantly impact your lifestyle. Discuss with your doctor the support available to you. This can include:

• Specialist referral 
• Home adjustment 
• Transportation support 
• Support groups 
• Counselling 

Summary

Retinal detachment is a serious eye problem which requires immediate medical attention to prevent permanent visual loss. If you experience any of these retinal detachment symptoms and/or are concerned about your risk for retinal detachment, seek immediate expert medical support from an eye doctor or hospital emergency department. 

Nisha Gurung

Nisha is a current Medical Student at St George’s University of London. She completed her MSci degree in Cell Biology at UCL. She fulfils multiple responsibilities including as a research assistant, peer mentor for In2MedSchool and advocates for careers.

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