RETINAL TEAR AND DETACHMENT
A variety of
factors can cause the retina to tear and detach from the back wall
of the eye. When detachment occurs, vision can only be saved by
immediate surgery to repair any existing tears and reattach the
delicate membrane. About one in every 13,000 people in North
America are affected by retinal detachments every
year.
The
back cavity of the eye contains a clear gel-like substance known as
the vitreous. The vitreous fills the cavity in young people but, as
a person ages, the vitreous body tends to shrink and pull away from
the back of the eye. In doing so it can sometimes pull part of the
retina away with it creating a retinal tear. Once the retina is
torn, fluid from the vitreous cavity can seep in through the tear
and collect behind the retina, causing it to detach from the wall
of the eye. When the retina is detached it is no longer sensitive
to light and blindness results.
Although
the elderly are most likely to experience retinal tears and
detachments, other people who are at risk are those who are
nearsighted or who have had eye surgery or
injuries.
The
most common symptoms of retinal tears or detachments
are:
*
New Floaters: It is common to have some floaters in the vision,
because the vitreous is not completely transparent, but a sudden
increase couldindicate a retinal problem.
*
Flashes: The sudden appearance of flashes in the vision may
indicate hat the vitreous gel is pulling on the retina and creating
traction.
*
Shadow, veil or curtain over vision: Retinal detachments are often
accompanied by the appearance of a dark shadow, usually in the
peripheral (side) vision. The shadows occur because the detached
portions of the retina are no longer able to respond to
light
*
Decreased vision: A sudden decrease in vision may also indicate a
retinal tear or detachment.
The
good news about retinal tears and detachments is that most can be
repaired. The amount of vision restored depends on the amount of
the original damage and the promptness of the treatment. Anyone who
has experienced symptoms of a retinal tear or detachment should
contact an ophthalmologist immediately, preferably a retinal
specialist.
Retinal
tears are easier to repair than retinal detachments. They are
usually repaired in the office by treatments with laser or freezing
(cryopexy). These treatments create a scar around the torn area,
thereby preventing further tears or future
detachment.
Retinal
detachments require surgical repair. Select retinal detachments can
be repaired with pneumatic retinopexy, an in-office procedure that
uses an injection of gas into the eye, in conjunction with laser or
freezing, to reattach the retina. Following this procedure, the
head must be held in a specific position for several
days.
The
most common method of reattaching the retina is the surgery known
as a scleral buckle. This procedure involves sewing a permanent
silicone band to the outside of the eye, often with drainage of
fluid from beneath the detached retina.
Sometimes,
in order to reattach the retina, a vitrectomy may be performed.In
this procedure, the vitreous is surgically removed from the eye
with miniaturized instruments under an operating microscope. Air or
gas is injected into the cavity to push the retina back into place.
Both scleral buckling and vitrectomy surgery are usually performed
in a hospital operating room, although a prolonged admission to the
hospital is usually not required.
The
amount of vision restored by these procedures depends on such
factors as the size and location of the damage, the length of time
between the detachment and the reattachment and whether or not a
hindering fibrous growth has formed on the retina. Of those people
who have retinas reattached, many regain excellent vision and most
of the others regain much of what was lost.
DIABETIC EYE CENTER of New York
Gary M Glickman MD PC Ophthalmology Diseases and Surgery of the Retina
