What is the Retinal Detachment ?

A retinal detachment is, in many cases, a medical emergency and needs to be assessed as soon as possible so that your ophthalmologist (eye doctor) is able to make decisions about any treatment you may need.

Retinal detachment occurs when the retina separates from the back of the inside of the eye, rather like wallpaper peeling off a damp wall. The retina needs to be attached to the back of the eye to survive and work properly, so if a retinal detachment is not detected and treated quickly it may result in the loss of some or all of your vision.

 

Symptoms of Retinal Detachment

Floaters

Floaters are caused by bits of debris in the vitreous gel casting a shadow on the retina. The brain then sees this as an object floating around in front of your vision. Floaters are very common and most people can all expect to have a few as they get older. People who are short sighted or have had eye operations in the past often have more floaters. Floaters can take many shapes being described as rings, spiders’ legs or cobwebs. They are not in themselves a cause for concern especially if they have been present for months or years.
However, if you experience a recent dramatic increase in the number of floaters or notice showers of dust-like floaters, this could be a sign that changes are happening at the back of your eye.
If you experience a recent onset of floaters or change to the nature or numbers of your floaters, you should have your eyes examined by an optometrist (optician) or by an ophthalmologist as soon as possible usually within 24 hours. If you see an optometrist and they suspect, or find or can’t rule out a tear in your retina then they will refer you urgently to an ophthalmologist.

Flashing lights

Many people experience flashing lights, most commonly around the edges of their vision. Flashing lights occur when the retina is stimulated by something within the eye rather than by the light entering the eye. They are often caused by the vitreous gel inside the eye moving and pulling on the retina.
In many cases flashing lights are caused by a gradual vitreous detachment and in most cases this doesn’t cause any long-term problems with your vision. However, 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 new flashing lights you should have your eye examined by an optometrist as soon as possible, especially if you also have new floaters.

Dark shadow

If your retina does detach then it can’t work properly anymore. You will see this as a solid dark shadow coming in from the edge of your vision which you cannot see round or through. If more of your retina detaches then the shadow will keep moving towards the centre of your vision.

If you experience a dark shadow moving up, down or across your vision you need to attend your local hospital eye clinic as soon as possible within the same day or within 24 hours.

Blurring of vision

Your vision can gradually become blurred for many reasons and a visit to the optometrist will help you find out why. If your vision suddenly becomes blurred, especially if any of the other symptoms of flashing lights, floaters or a shadow are present, then this is more serious and you need to consult your optometrist as soon as possible and usually within 24 hours.

 

Causes of Retinal Detachment

Most retinal detachments happen because a tear or hole in the retina allows fluid to leak between the retinal layers and this then causes the retina to detach. Holes in the retina can occur because of changes that happen as you age, whereas tears happen because the retina has been pulled and torn. Tears mostly occur when the vitreous gel suddenly becomes detached from the retina (known as acute posterior vitreous detachment or PVD). Most gradual PVD does not result in retinal detachment. A blow to the head cannot cause retinal detachment, though a direct blow to the eye may do so.

 

Prevention / Treatment of Retinal Detachment

If you have a healthy retina then there is no treatment that can reduce the risk of a detachment. Regular eye tests are an important way to make sure your eyes are healthy and you have no signs of any eye conditions. Most people should have their eyes tested every two years. However, some people may need more regular tests. Your optometrist will be able to recommend how often you need to have your eyes tested.

One of the causes of retinal detachment is trauma to the eye. Wearing eye protection for DIY, gardening or sport is something you can do to reduce the risk of an eye injury. Retinal detachment does not happen as a result of straining your eyes, bending or heavy lifting.

If you do experience symptoms of flashes and floaters and the eye clinic detects a hole or tear in your retina then this may be treated to reduce the risk of a retinal detachment developing. Not all tears or holes need treating. The treatment for retinal tears and holes is preventative – it stops the retinal tear or hole turning into a full detachment.

The treatment can be done two different ways, either using a using a laser which causes very small burns in the area around your retinal hole or tear which act to “weld” your retina more firmly to the back of your eye, or by using a cryoprobe which freezes the tiny area of the retina around your retinal tear or hole from the outside of the eye. The retinal tear or hole is surrounded by the treatments and this prevents fluid passing through the hole to cause a detachment.

You can have this type of treatment as an outpatient using a local anaesthetic. 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 reposition the retina against the back of the eye. The sooner treatment is carried out, the better the results are likely to be. If retinal detachment is not treated then you are likely to lose all the vision in the affected eye over time.

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.

After an initial assessment, the specialist eye surgeon (ophthalmologist) will decide how quickly surgery needs to be carried out – this maybe within 24 hours or within a few days.

Usually, only one operation is needed.

 

What do I do now?

A retinal detachment is a medical emergency. Should you be worried you have experienced any of these symptoms, you need to be seen by an ophthalmologist (eye doctor) as soon as possible. Contact your local optometrist (optician) as soon as you can.