Retinal Detachment

Retinal detachment is reaction to the retina, which is a thin membrane located at the rear of the eye, becoming detached from the blood vessels in the eye that provide it with oxygen. Without treatment retinal detachment can cause blindness, though in most cases people develop signs that the retina is coming loose before they experience problems with their vision and effective treatment is sought.

Retinal detachment is rare and it is estimated that around 1 in 10,000 develop the condition every year in England. Retinal detachment tends to affect older people, aged between 50 and 75 but it can be caused by injuries to the eye in younger people. Retinal detachment tends to affect only one eye.

What causes retinal detachment?

The condition is often a result of ageing because the retina becomes thinner and weaker as we age, increasing the risk of small holes forming inside the retina. Once holes have formed, fluid can leak through from the lens below the retina. If fluid builds up this increases the pressure inside the eye and causes the retina to begin drawing away from the blood vessels which provide it with oxygen. If oxygen cannot reach the retina the nerve cells will start to die. Age-related retinal detachment is most common in people who have short-sightedness (known as myopia). This is because people with myopia usually have a slightly thinner retina than normal.

Other possible causes of retinal detachment include:

• Eye injuries.
• Prior eye surgery (for example, cataract removal).
• Poorly controlled diabetes (this can cause the fluid at the front of the eye to become thicker than normal, which causes the retina to start to pull away).
• Other eye conditions causing fluid to leak and collect behind the retina, such as uveitis.

Symptoms of retinal detachment

Symptoms of retinal detachment include:

• Sudden development of floaters (these are dark dots or strands which appear in your area of vision).
• Seeing streaks of light (these appear and disappear very quickly).

If retinal detachment is left untreated you may start to experience loss of vision with most people describing the experience as a shadow creeping across the eye.

If you experience any of the symptoms listed above or notice changes in your vision, you should arrange to see your GP as quickly as possible; the sooner retinal detachment is treated the better.

How is retinal detachment diagnosed?

If your GP thinks you may have retinal detachment they will refer you to an eye specialist (an ophthalmologist). When you see your specialist they will examine your eye using an instrument known as an ophthalmoscope and look for signs of damage to the retina and any abnormalities within the structure and position of the retina. An ultrasound scan may also be required to examine the eye and check for fluid build-up.

Treatment for retinal detachment

The only means of treating retinal detachment is surgery. If surgery is not carried out it is relatively assured that an individual will lose their sight. Surgery is effective in 90 percent of cases.

Surgery can be carried out under local or general anaesthetic and you will need to fast for a period of time before the procedure (your doctor will explain this when your operation is scheduled). Before the anaesthetic is administered eye drops will be inserted into the eye to dilate the pupil (this means to make it wider).

There are two surgical procedures used to treat retinal detachment, which include:

• Scleral buckling: this is the most commonly used procedure and involves placing very fine strands of silicone or sponge on the sclera (this is the white of the eye) in the location in which the retina has come away. The strands push the sclera towards the centre of the eye, allowing the damaged retina to rest against the eye wall. Lasers are then used to form a seal and close the tear.
• Vitrectomy: this procedure involves taking out the fluid located in within the eye. Once the fluid has been removed it is replaced with silicone or gas, which sets the retina in the correct position. This procedure is usually recommended when fluid at the front of the eye is abnormally wide.