Retinal Detachment

What is a Retinal Detachment?

A retinal detachment is when the retina is separated from the eye wall or back of the eye. When this occurs, the retina cannot work properly, and vision is affected. We are all born with a gel like substance inside our eyes called the vitreous, that sits in front of the retina. With time it shrinks and contracts into itself and can pull on the retina causing retinal tears and a retinal detachment. A detached retina is a very serious problem and needs to be assessed right away or permanent vision loss can occur.

Fundus photo of the left eye with a retinal tear and an associated retinal detachment.

Fundus photo of the left eye with a retinal detachment involving the fovea (focusing point of the eye). You can see a small hole on the far temporal edge of the detachment.

Fundus photo of the left eye after pars plana vitrectomy and laser for retinal detachment repair. The pigment on the far periphery of the photograph indicates prior laser treatment was done.

How do I know if I have a retinal tear or detachment?

Common symptoms for a retinal tear or detachment include flashes of light and floaters as the first sign. If it progresses, patients often see a shadow or a curtain covering any part of their vision. Eye pain is not commonly seen with this condition.

Who is at higher risk?

·      Having had a prior retinal tear or detachment

·      Family history of retinal tear or detachment

·      Prior trauma to eyes

·      Prior eye surgeries (cataracts, glaucoma)

·      Nearsightedness (needing glasses to see far away)

How is it diagnosed?

A trained Ophthalmologist performs a dilated eye exam by administering eye drops to dilate (open up) the pupil allowing the eye doctor to see the retina and determine if there is a tear or a detachment.

How is it treated?

Different treatment options exist depending on certain characteristics of your detachment. There are in-office procedures and operating room procedures. Some detachments are not suitable for in-office treatment and therefore we recommend going directly to the operating room.

·      In-office procedures
o   Laser surgery: a barrier of laser is used to seal off the detached retina to prevent it from expanding further
o   Pneumatic Retinopexy: a gas bubble is injected into the eye, the gas helps push the retina back into the eye wall. Additional laser and/or cryosurgery is done to help the seal the retina back in place.
·      Operating room procedures
o   Vitrectomy: this surgery involves removing the vitreous gel, flattening the retina against the eye wall, lasering the retina, and replacing the vitreous with air, gas or silicone oil. If gas or air is used patients cannot travel by plane for a number of weeks, however the gas or air evaporates by itself. If silicone oil is used, it needs a second surgery to be removed.
o   Scleral Buckle: in this procedure an encircling silicone band is placed over the outside of the eye to help indent the eye wall and bring it closer to the detached retina. The band is not visible from the outside and usually left in place permanently.
o   Combined: in this case a vitrectomy and a scleral buckle are performed. This is reserved for more complex retinal detachments or patients who have detached more than once.

What is the recovery from surgery like?

Retinal detachment surgery is an outpatient procedure which means you will be sent home to rest the day of surgery. You should coordinate to have a ride the day of surgery. The operated eye will have a patch and a shield. You will be seen at the doctor’s office one day after surgery and the patch and shield will be removed by the office staff. Postoperative eye drops are started at that first visit following surgery.

Most retinal detachment surgeries require the patient to position to optimize the surgery outcome. Your doctor may advise you to maintain a certain position for a few days after surgery to allow the gas or silicone oil bubble to maintain the retina flat against the eye wall. Depending on the characteristics of the detachment, face down positioning may be required for the first few days.

If a gas bubble is used, the vision will be very blurred the first few weeks following surgery as the gas changes drastically (but temporarily) the prescription of the eye. It is similar to looking through a fishbowl. Once the gas bubble dissolves the vision improves.

Depending on your line of work, some patients can go back to work after one or two weeks with some restrictions. However, some patients require longer to get back to work without limitations.