Mr Nicholas Glover  - Consultant Cataract & Vitreoretinal Surgeon
 
 

















A retinal detachment is a medical emergency and if it is not treated you may lose all the vision in the affected eye.
 
Retinal detachment occurs when the retinal layers separate  rather like wallpaper peeling off a damp wall. The retina needs to be attached to work properly, so if it is not detected and treated quickly it can result in the loss vision. 

If you have the sudden onset of any symptoms such as floaters, flashing lights and/or a dark shadow across your vision you should see your eye health care professional as soon as possible.

Retinal detachments happen because a tear or hole in the retina allows fluid to leak between the retinal layers. Holes in the retina occur because of changes that happen in your retina as you age. A retinal detachment caused by a hole or tear is called Rhegmatogenous

Eye conditions such as  
diabetic retinopathy can result in fibrous scar tissue forming on the surface of the retina. This scar tissue can then pull on the retina. This type of retinal detachment is called Tractional.
 
Fluid from the retinal vessels can leak into the retina. This is a less common cause of detachment and happens because of another condition such as an inflammation or a tumour. This type of retinal detachment is called Exudative.
 
Rhegmatogenous retinal detachment is the most common form of retinal detachment. It only occurs in about 1 in 10,000 people each year. 

Retinal detachment can happen to someone of any age but is very rare under the age of sixteen and most commonly happens to people aged between 60 and 70 years. 

  You have an increased risk of retinal detachment if you:
 
  • Are very short sighted (more than minus 6.00 D)
 
  • Have had a trauma (injury or blow) to the eye
 
  • Previous detachment in one eye. (Detachments occur in both eyes in 2-10%)
 
  • Have a family history of retinal detachment.
 
Flashing lights occur when the vitreous gel moves or pulls on the retina, flashing lights can indicate that there is a tear in the retina. There is no way you can tell whether your flashing lights are caused by your vitreous or by a retinal tear. If you suddenly experience flashing lights you should have your eye examined by an optometrist , within 24 hours.
 
Floaters are caused by debris in the vitreous casting a shadow on the retina. Floaters are very common and most people can expect to have a few as they get older. People who are short sighted often have more floaters, however, if you experience a dramatic increase in the number of floaters, you should have your eyes examined by an optometrist within 24 hours.
 
If your retina does detach then you will see this as a dark shadow in the corner of your vision; as more of your retina detaches the shadow will move towards the centre of your vision.
 
If you have been checked for retinal detachment in the past you should have been given clear instructions on what to do if you have further symptoms. This usually involves contacting the hospital eye clinic if you have any concerns.
 
If the eye clinic detects a hole or tear in your retina then this may need treatment to reduce the risk of a retinal detachment developing. Not all tears or holes need treating. The treatment can be done two different ways, either using a cryoprobe which freezes the retina around your retinal tear or hole from the outside of the eye, or by using a laser which causes  small burns in the area around your retinal hole or tear.
 
The retinal tear or hole is surrounded by the treatments and this prevents it expanding into a detachment.You can have this type of treatment as an outpatient using a local anaesthetic, which means you would be awake during the operation. Your vision is not usually affected by this type of treatment because only a very small localised area of the retina is treated.
 
Retinal detachment can be treated. The treatment involves an operation to reattach the sensory retina to the underlying retinal pigment epithelium. The sooner treatment is carried out, the better the results. If retinal detachment is not treated then you will lose all the vision in the affected eye.
 
Surgery for retinal detachment is complicated and very individual to each case. The type of treatment needed depends on the type of detachment and any complicating factors, such as any other eye conditions you may have.
 
You can have a local or general anaesthetic for surgery. Most people go home the same day as the operation but some people may need to stay in hospital for a day
 

A vitrectomy is the usual way to treat a detachment. This procedure involves removing the vitreous gel from inside the eye and replacing it with a gas bubble. The gas bubble then holds the detached retina flat from the inside.

If your retinal detachment is more extensive, then a sclera buckle may be used. This involves attaching a tiny piece of silicon, sponge or harder plastic to the outside of your eye. This presses on the outside of the eye, causing the inside of the eye to slightly move (buckle) inwards which helps your retina to reattach. The buckle is usually not removed and is not visible once surgery is finished.
 
After the operation your eye will feel bruised for 24 - 48 hrs. You will be given eye drops to help prevent infection and to control any swelling
 
If you have had a gas bubble put into your eye, your vision will be very blurry for a while. This is only temporary. As the gas is absorbed you may see a wavy line across your vision which is the divide between the gas and liquid content of the eye. This will slowly move and then disappear over a period of weeks.
 
Posturing is lying or sitting with your head in a certain position. You may be asked to do this after your operation to help keep a gas bubble in place, so that it continues to put pressure on the part of the retina being reattached. You may need to do this for up to seven days after the operation.
 
It is not safe to fly until the gas bubble has been completely reabsorbed. Once any period of posturing is finished you can resume normal activities, including sex, as soon as possible.
 
Your ophthalmologist will tell you which activities you should avoid directly after your operation and the advice may be different depending on the type of surgery you have had. Most people will have some restriction for the first two weeks after the operation.
 
Once your eye has healed from the operation you can continue the sports or activities you enjoy. Usually full contact sports such as boxing, kick-boxing and martial arts aren't recommended for someone who has had retinal reattachment surgery.
 
Surgery is very successful at reattaching the retina. If your macula, remained attached then results are often very good and your central vision may not be affected at all. If the macular had detached then central vision can return but it may be distorted. Many people find they adapt to this distortion with time.
 
Unfortunately for some people, their operation may be successful at reattaching the retina but it may not bring back detailed central vision or areas of peripheral vision. This can happen in any circumstance but the risk is higher the longer the retina has been detached without any treatment
 
If the first operation does not succeed, it is usually possible to have one or more operations to re-attach the retina. At each stage, your surgeon will discuss with you the likelihood of success and the need to have more treatment.