Retinal Detachment - Symptoms, Causes, and Treatment

Introduction

Retinal detachment is a condition wherein the retina peels away from its underlying layer of assisting tissue. Initial detachment may be localized, but without immediate attention, the entire retina may additionally detach, leading to vision loss and blindness. It requires surgical attention. The retina is a light-sensitive tissue. It acts as a screen at the back of the eye that receives the signals and processes the images. The retina covers the focused image with neural impulses and sends them to the brain through the optic nerve. Occasionally, posterior vitreous detachment, injury, or trauma to the eye or head might also cause a small tear inside the retina. The tear permits vitreous fluid to seep through or beneath the retina and peel away like a bubble in wallpaper.

What Are the Symptoms of Retinal Detachment?

Since the retina is responsible for vision, any damage affects the vision in some form or the other. The various symptoms that may be associated with retinal detachment are:

1. Floaters: The presence of a floater can be seen in this condition. This may appear as bubbles in the vision. It may appear drifting in the vision when the retina is detached.

2. Flashes of Light: Flashes of light may appear in sight. It may appear in one or both of the eyes. This may occur when the retina may not detach incompletely.

3. The Blurring of Vision: There may be blurring of vision following the detachment of the retina. This may be present in both eyes.

4. Reduction of Peripheral Vision: There may be a reduction in peripheral vision when retina detachment occurs. This loss of peripheral vision occurs gradually and not suddenly.

5. A Shadow in the Visual Field: A shadow may be seen in the visual field. This may appear as a curtain when the retina detaches. It may be present in both eyes.

What Are the Risk Factors of Tractional Retinal Detachment?

1. Aging: Retinal detachment may worsen with age. The risk of detachment increases with age.

2. Previous History: Retinal detachment may increase when there is an increased risk.

3. Family History: There may be an increased risk of retinal detachment if there is a family history of retinal detachment.

4. History of Surgery: The previous history of surgery may increase the risk of retinal detachment.

5. History of Trauma: The previous history of trauma to the eye puts the eye at a greater retinal detachment.

What Are the Causes of Retinal Detachment?

Retinal detachment can be caused due to any of the following factors:

1. Tractional Retinal Detachment: This kind of detachment can arise whilst scar tissue grows at the retina's floor; this can cause the retina to move from its underlying structure. Tractional detachment is generally seen in patients with poor blood glucose control.

What Are the Causes of Other Types of Retinal Detachment?

Retinal detachment may also be caused due to few other conditions, such as:

1. Rhegmatogenous Retinal Detachment: This kind of retinal detachment is the most common one. Rhegmatogenous detachments occur because of a tear within the retina that allows fluid to bypass through and accumulate beneath the retina, pulling the retina away from underlying tissues. The regions where the retina detaches lose their blood delivery, eventually losing its function. Once the retina loses its blood supply, the vision is affected to a great extent.

The most common reason for rhegmatogenous detachment is aging. As you age, the gel-like substance that fills the eye, known as the vitreous medium, may also change in consistency and reduce or become more liquid. Usually, the vitreous separates from the retina's surface without any complications — an unusual circumstance referred to as posterior vitreous detachment. One complication of this separation is a tear. As the vitreous medium separates from the retina or peels off from the retina, it has sufficient pressure to create a retinal tear. Left untreated, the liquid vitreous can bypass through the tear into the distance at the back of the retina, causing the retina to become indifferent.

1. Exudative Retinal Detachment: In this type of retinal detachment, the fluid accumulates beneath the retina, but there are not any tears within the retina. Exudative detachment can be due to age-related macular degeneration, damage to the eye, tumors, or inflammatory problems.

How to Diagnose Tractional Retinal Detachment?

The diagnosis of retinal detachment can be made through a combination of various methods. A conclusion can be achieved when we compare the various methods, such as clinical diagnosis, physical examination, and laboratory diagnosis. The various methods used in the diagnosis of retinal detachment are:

1. Patient History: The patient may give a history of floaters or flickers in the eyes. This may be present suddenly or may have been present for some time. Patient history like this should not be taken lightly and should be taken as a possible retinal tear. Patients with progressive vision loss should also be taken as retinal detachment unless proven otherwise. Patient history combined with prior history of trauma or surgery or retinal detachment should be considered.

2. Physical Examination: The doctor may evaluate patients with symptoms of retinal tear. The visual acuity, visual field, and intraocular pressure can be checked before dilating the eyes. The anterior and posterior segments of the eye should be examined post-dilation. It should be checked if there is any dilation of the separation of media in the eyes. Checking for hemorrhage is a crucial part of the diagnosis.

3. Laboratory Diagnosis: Various lab diagnoses such as an ultrasound, fluorescein imaging, and B-scan ultrasound may be necessary to rule out other disorders and to identify a retinal detachment.

How to Treat Tractional Retinal Detachment?

The treatment of tractional retinal detachment depends on the cause of the detachment. For the correction of the detachment, it is important to diagnose the exact reason. In most cases of retinal, surgery is the most preferred method of treatment.

Surgical Approach to Retinal Detachment:

Surgical correction is the most preferred treatment for detachment. Surgical treatment prevents the condition from further deterioration and helps minimize vision loss. Surgical intervention is offered to patients depending on the underlying cause and extent of the tractional retinal detachment. For instance, a patient with detachment secondary to proliferative diabetic retinopathy that does not threaten the macula can be monitored intently. The main surgical goal in these instances is to relieve the retinal traction. Traction may be relieved with scleral buckling strategies or with vitrectomy. Traction of the retina that may be secondary to other conditions requires more extensive care.

How Can Retinal Detachment Be Prevented?

Retinal detachment cannot be entirely prevented. However, if preventive measures are taken, it may reduce the chances of its occurrence. The various preventive measures that can be taken include:

1. Periodic eye checkups.

2. Use protective eyewear when there are chances of eye injury.

3. In case of injury, immediate medical care should be obtained.

Conclusion:

Retinal detachment is a condition of the eye that cannot be prevented. It mostly occurs suddenly or may develop secondary to any other condition. If left untreated, it can even lead to vision loss. Hence if symptoms of retinal detachment are noted, then medical care should be obtained at the earliest to prevent vision loss and for a speedy recovery.