Retinal detachment

Retinal detachment
SynonymsDetached retina
Slit lamp photograph showing retinal detachment in Von Hippel-Lindau disease EDA08.JPG
Slit lamp photograph showing retinal detachment.
SymptomsIncreased number of floaters, flashes of light, worsening of the outer part of the visual field[1][2]
ComplicationsPermanent loss of vision[3]
Usual onset60s and 70s[1]
CausesRetina separates from the layer underneath[1]
Risk factorsPosterior vitreous detachment, injury to the eye, inflammation of the eye, short sighted, previous cataract surgery[1]
Diagnostic methodEye exam, ultrasound[1][3]
TreatmentScleral buckling, pneumatic retinopexy, vitrectomy[1]
PrognosisGenerally good if treated early[3][4]
Frequency~1 per 10,000 per year[5]

Retinal detachment is a disorder of the eye in which the retina separates from the layer underneath.[1] Symptoms include an increase in the number of floaters, flashes of light, and worsening of the outer part of the visual field.[1][2] This may be described as a curtain over part of the field of vision.[2] In about 7% of cases both eyes are affected.[5] Without treatment permanent loss of vision may occur.[3]

The mechanism most commonly involves a break in the retina that then allows the fluid in the eye to get behind the retina.[1] A break in the retina can occur from a posterior vitreous detachment, injury to the eye, or inflammation of the eye.[1] Other risk factors include being short sighted and previous cataract surgery.[1] Retinal detachments also rarely occur due to a choroidal tumor.[1] Diagnosis is by either looking at the back of the eye with an ophthalmoscope or by ultrasound.[1][3]

In those with a retinal tear, efforts to prevent it becoming a detachment include cryotherapy using a cold probe or photocoagulation using a laser.[1] Treatment of retinal detachment should be carried out in a timely manner.[1] This may include scleral buckling where silicone is sutured to the outside of the eye, pneumatic retinopexy where gas is injected into the eye, or vitrectomy where the vitreous is partly removed and replaced with either gas or oil.[1]

Retinal detachments affect between 0.6 and 1.8 people per 10,000 per year.[5] About 0.3% of people are affected at some point in their life.[4] It is most common in people who are in their 60s or 70s.[1] Males are more often affected than females.[1] The long term outcomes depend on the duration of the detachment and whether the macula was detached.[1] If treated before the macula detaches outcomes are generally good.[3][4]

Signs and symptoms

A rhegmatogenous retinal detachment is commonly preceded by a posterior vitreous detachment which gives rise to these symptoms:

  • flashes of light (photopsia) – very brief in the extreme peripheral (outside of center) part of vision
  • a sudden dramatic increase in the number of floaters
  • a ring of floaters or hairs just to the temporal (skull) side of the central vision

Although most posterior vitreous detachments do not progress to retinal detachments, those that do produce the following symptoms:

  • a dense shadow that starts in the peripheral vision and slowly progresses towards the central vision
  • the impression that a veil or curtain was drawn over the field of vision
  • straight lines (scale, edge of the wall, road, etc.) that suddenly appear curved (positive Amsler grid test)
  • central visual loss

In the event of an appearance of sudden flashes of light or floaters, an eye doctor needs to be consulted immediately.[6] A shower of floaters or any loss of vision, too, is a medical emergency.

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