A retinal detachment is a separation of the retina from its attachments to the underlying tissue within the eye. Most retinal detachments are a result of a retinal break, hole, or tear. These retinal breaks may occur when the vitreous gel pulls loose or separates from its attachment to the retina, usually in the peripheral parts of the retina. The vitreous is a clear gel that fills two-thirds of the inside of the eye and occupies the space in front of the retina. As the vitreous gel pulls loose, it will sometimes exert traction on the retina, and if the retina is weak, the retina will tear. Most retinal breaks are not a result of injury. Retinal tears are sometimes accompanied by bleeding if a retinal blood vessel is included in the tear. Many people develop separation of the vitreous from the retina as they get older. However, only a small percentage of these vitreous separations result in retinal tears.
Once the retina has torn, liquid from the vitreous gel can then pass through the tear and accumulate behind the retina. The buildup of fluid behind the retina is what separates (detaches) the retina from the back of the eye. As more of the liquid vitreous collects behind the retina, the extent of the retinal detachment can progress and involve the entire retina, leading to a total retinal detachment. A retinal detachment almost always affects only one eye at a time. The second eye, however, must be checked thoroughly for any signs of predisposing factors that may lead to detachment in the future.
Flashing lights and floaters may be the initial symptoms of a retinal detachment or of a retinal tear that precedes the detachment itself. Anyone who is beginning to experience these symptoms should see an eye doctor for a retinal exam. The symptoms of flashing lights and don’t always a tear or detachment and can merely result from a separation of the vitreous gel from the retina. This condition is called a posterior vitreous detachment (PVD). Although a PVD occurs commonly, there are no tears associated with the condition most of the time.
The flashing lights are caused by the vitreous gel pulling on the retina. This retinal traction stimulates the retinal cells resulting in a flash of light. The lights are often described as resembling brief lightning streaks in the outside edges (periphery) of the eye. The floaters are caused by condensations in the vitreous gel and frequently are described by patients as spots, strands, or little flies
If the patient experiences a shadow or curtain that affects any part of the vision, this can indicate that a retinal tear has progressed to a detached retina. In this situation, one should immediately consult an eye doctor since time can be critical. The goal for the ophthalmologist is to make the diagnosis and treat the retinal tear or detachment before the central macular area of the retina detaches.
A Vitrectomy is the surgical removal of the vitreous gel from the middle of the eye. During a vitrectomy, the surgeon inserts small instruments into the eye, cuts the vitreous gel, and suctions it out. After removing the vitreous gel, the surgeon may treat the retina with a laser (photocoagulation), cut or remove fibrous or scar tissue from the retina, flatten areas where the retina has become detached, or repair tears or holes in the retina or macula.
At the end of the surgery, silicone oil or a gas bubble is injected into the eye to support the retina against the wall of the eye. Oil cannot be absorbed by the body, so if an oil bubble is used, you’ll need a second procedure to remove the oil after the retinal detachment has healed.
Sometimes a silicone band called a Scleral Buckle is used as a treatment for retinal detachment. The need for a scleral buckle will depend on the characteristics of the retinal detachment.