Retinal detachment

Published by Bupa's Health Information Team, February 2011.

This factsheet is for people who have retinal detachment, or who would like information about it.

Retinal detachment is when the retina separates from the inner wall at the back of the eye (where it’s usually attached). This can permanently damage vision, so emergency surgical treatment is needed to reattach it.

About retinal detachment

The retina is a thin layer of nerve tissue that lines the inner wall at the back of your eye. When you look at an object, light rays pass into your eye through the cornea (the clear part at the front of your eye) and lens, to the retina at the back of your eye. The light-sensitive cells in the retina then send this information via the optic nerve to your brain. Your brain interprets this as the image you see. Just to the side of the optic nerve lies a specialised part of the retina called the macula. The macula is the part of the retina that is used for seeing fine detail, for example when reading, writing and recognising faces.

Retinal detachment affects about one in 10,000 people. It tends to occur as you get older – usually around age 60.

Types of retinal detachment

There are three ways that the retina can detach from the back of your eye.

Rhegmatogenous retinal detachment

If you have a hole or tear in your retina (often as a result of changes associated with ageing) this can allow fluid in your eye to seep underneath the retina and to separate it from the back wall of your eye. This is the most common type of retinal detachment.

Exudative retinal detachment

If you have excess fluid underneath your retina, it may push the retina off the back of your eye. There are many possible causes for this, such as eye inflammation.

Tractional retinal detachment

The retina and vitreous (also known as vitreous humour, which is the clear jelly-like fluid inside your eye), can become tightly stuck together as a result of an injury, inflammation, or the abnormal growth of blood vessels (sometimes seen in people with diabetes). If the vitreous pulls at your retina, it may start to lift the retina away from the back of your eye.

Symptoms of retinal detachment

The most common symptom of retinal detachment is a gradual deterioration in vision. It’s often described as a shadow spreading across the vision of one eye. It may only affect parts of your vision at first.

You may have symptoms such as flashes of light or spots before your eyes. These symptoms are usually caused by posterior vitreous detachment, which often precedes retinal detachment. Posterior vitreous detachment is a natural part of ageing – the jelly-like vitreous in your eye becomes more liquid in the middle as you get older and tends to shrink away from the retina. As it shrinks away, the attached parts of the vitreous can tug on the retina, which can result in a tear. If the tear isn’t treated, it can result in retinal detachment.

If you’re having problems with your vision, see your GP or optometrist (a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses).

Complications of retinal detachment

The most serious complication of retinal detachment is total or partial loss of vision.

In a small number of people with retinal detachment, the retina can become scarred and stiff. This is usually because of your body trying to heal itself. This condition is known as proliferative vitreoretinopathy. If the retina has become stiff and crinkled, it can be more difficult to get it flat up against the back of your eye and to restore your vision.

Causes of retinal detachment

The exact cause of retinal detachment will depend on the type you have. Causes include the following.

• Ageing. As you get older you’re more likely to get posterior vitreous detachment, which can cause retinal detachment.
• Short-sightedness (myopia). If you are very short-sighted, you are likely to have a thinner retina, which can tear or break more easily.
• Previous eye surgery. For example, a cataract operation where the jelly inside your eye has been disturbed.
• Injury or trauma to your eye. This may cause retinal detachment immediately, or it can happen months or even years later.
• Inherited conditions such as Stickler’s syndrome.
• Inflammatory conditions such as scleritis.
• Diabetic retinopathy. Abnormal growth of blood vessels from the retina can result in bleeding, scarring and pulling on your retina.
• Eye cancer. Tumours in your eye, which can be cancerous or non-cancerous (benign).
• Eye diseases such as glaucoma, a cataract, or retinopathy of prematurity (when a baby is born prematurely before the retina has developed properly).
• Retinal detachment in one eye. Once this has happened, there is a small risk of developing retinal detachment in the other eye.

Diagnosis of retinal detachment

Your GP or optometrist will ask about your symptoms and examine you. He or she will carry out some tests to check your eyesight. This may involve flashing a torch in your eyes and examining your eye with an ophthalmoscope. An ophthalmoscope is an instrument that is used to take a closer look at the inside and back of your eye.

If your GP or optometrist suspects that your retina has become detached, he or she may urgently refer you to an ophthalmologist (a doctor who specialises in eye health, including eye surgery) for further tests. Retinal detachment is a medical emergency. The sooner you get treatment, the less chance there is of permanent damage to your vision.

Treatment for retinal detachment

You will usually need to have surgery to reattach the retina and deal with any breaks or scar tissue. There are two main types of surgery used to treat a detached retina: scleral buckle surgery and vitrectomy. Both treatments aim to make the retina lie flat on the inside of your eye again.

Scleral buckle surgery

This procedure involves putting pressure on the outside of your eye using a thin band of synthetic material.

First, any tears or holes in the retina are treated using laser or freezing (cryotherapy) techniques. A fine strip or band of silicone (a buckle) is then stitched to the tough white coat of your eye (the sclera). The translucent outer coat of your eye (the conjunctiva) is then stitched over the top of the buckle to conceal it. The buckle indents the wall of your eye at the site of the tear, allowing your eye to effectively ‘heal’ itself.

The buckle can be left in place – it’s not usually necessary to remove it and it shouldn’t be noticeable.

Vitrectomy

This involves removing the vitreous from the back of your eye and replacing it with either a gas or silicone bubble to hold the retina in position from the inside.

Your surgeon will make tiny cuts in the white of your eye. He or she will then pass an instrument through the cuts to suck up the vitreous and cut the fine strands that run through it. After the jelly is removed, the fluid under the retina will be drained and any tears or holes will be treated using a laser or cryotherapy so that the surrounding retina is stuck down. A special lighter-than-air gas (or sometimes silicone oil) may be used to fill up the empty space left once the jelly has been removed. This holds the retina in place while treatment to a tear or hole takes effect.

Over the following weeks and months, the gas slowly escapes from your eye and will be replaced with the watery fluid that normally circulates in the jelly. The gas may cause your vision to be blurry after the surgery because it affects the way light passes to the retina.

After your treatment

After surgery, you will be given antibiotics and corticosteroid drops. These will help prevent infection and reduce any inflammation.

If you have had gas put into your eye, you may be asked to keep your head in a certain position for several days after the operation. You will also be advised not to travel on an airplane while any gas remains in your eye.

If your central vision has been affected, it may take several months after your operation for your vision to recover. In some cases, your vision may never completely recover – it often depends on if and for how long the macula was detached. Occasionally, it may not be possible to restore the retina to its correct position and your vision may be lost completely. Surgery is most successful when the macula hasn’t become detached. This is why it is important to seek medical attention as soon as possible after noticing changes in your vision.

Prevention of retinal detachment

If your family has a history of retinal detachment and your doctor finds a weakness in your retina, you may be able to have preventive laser or cryotherapy treatment. However, for most people, it isn’t possible to prevent retinal detachment.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.