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Eye DisordersRetinal Detachment
- About Retinal Detachment
- Causes and symptoms
- How is it Diagnosed
- How is it Treated
- Information For Patients With Detached Retina
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What is Retinal Detachment?
It is one of the ocular emergencies causing acute painless vision loss and hence Immediate attention is necessary
Retinal detachment will affect one out of every 10,000 people each year. It is serious eye problem that may occur at any age, although usually it occurs in middle aged or older individuals, it is more likely to develop in people who are nearsighted or in those whose relatives have had retinal detachments. A hard solid blow to the eye may cause the retina to detach as well eg cricket ball injury. If not treated early, retina detachment may lead to implairment or Loss of vision.
The retina is a thin, transparent tissue of light-sensitive active fibers and cells. It covers the inside wall of the eye like wall-paper. The retina functions like the film in a camera light passes through the lens of the eye and is focused on to the retina. The light sensitive retina fibers are responsible for “taking the picture”, and transmitting the light image via optic nerve to the brain.
Most retinal detachments are caused by the presence of one or more small tears of holes in the retina. Normal aging can sometimes cause the retina to thin and deteriorate, but more often shrinkage of the vitreous body, and its separation from the retina – PVD ( Posterio Vitrious Detachment) is responsible for deterioration and retinal tears.
The vitreous is firmly attached to the retina in a several places around the back walll of the eye. As the vitreous shrinks, it may pull a piece of the retina away with it. Leaving a tear or tear or hole in the retina. Though some shrinkage of the vitreous body occurs naturally with aging and usually causes no damage to the retina. In most cases, a significant change in the structure of the vitreous body occurs before the development of a retinal detachment. Once a retinal tear is present, watery fluid from the vitreous space may pass through the hole and flow between the retina and the back wall of the eye. This separates the retina from the back of the eye and causes it to: detach” The part of the retina that is detached will not work properly and there will be blur or a blind spot in vision hence the patient complaints of seeing a curtain which is blocking his visual field.
It should be noted that there are some retinal detachments that are caused by other diseases in the eye such as tumors, severe inflammations, or complications of diabetes.
Middle-aged and older persons may see floating black spots called floaters, and flashes of light in their vision. in most cases, these symptoms do not indicate serious problems. However, in some eyes the sudden appearance of spots or flashes of light may indicate substantial shrinkage of the vitreous with tears in the retina. A Comprehensive dilated fundus examination by an ophthalmologist is necessary to check the inside of the eye to determine if retinal tears are present. Such an examination is desirable as soon as symptoms develop because fresh retinal tears may be treatable without prolonged surgery before they lead to a more severe retinal detachment.
Patients may notice a wavy or watery quality in their overall vision or the appearance of a dark shadow in some part of their side vision. Further development of the retinal detachment will blur central vision and create significant sight loss in one eye unless the detachment is repaired.
A few detachment may occur suddenly and the patient will experience a total loss of vision in one eye. Similar rapid loss of vision may also be caused by bleeding into the vitreous area of the eye which may happen when the retina is torn along a blood vessel – Vitreous hammerage.
Detection and Diagnosis
A detached retina cannot be viewed from the outside of the eye. The ophthalmologist thoroughly examines the retina and the interior parts of the eye with an instrument called an indirect ophthalmoscope. The instrument ‘s bright light and magnification allows the ophthalmologist to locate area of retinal tearing or weakness which need to be corrected during treatment.
If the retina is torn and retinal detachment has not yet occurred, a retinal detachment may be prevented by prompt treatment. Once the retina becomes detached, it must be repaired surgically by an ophthalmologist. Successful reattachment of the retina consists of sealing the retinal tear and preventing the retina from pulling away from the back of the eye again. There are several surgical procedures that may be used.
When new small retinal tears are found with little or no nearby retinal detachment, the tears are sometimes sealed with a laser light. The laser places small burns around the edge of the tear. These produce scars that seal down the edges of the tear and prevent fluid from passing through and collecting under the retina Ophthalmologic laser surgery is frequently done as an outpatient treatment and requires no surgical incision. The laser walls of the tear ans prevents migration of the subretinal fluid.
Freezing the back wall of the eye behind a retinal tears also will stimulate scar formation and seal down the edges, Freezing is often an outpatient procedure but requires local anesthesia to numb the eye.
Once a significant amount of fluid has collected under the retina and seprates it from the back of the eye a more complicated operation is necessary to treat the detachment, such operations vary depending on the extent of the detachment and resulting damage, but each is designed to press the wall of the eye against the retinal holes, holding both tissues together until scarring seals the tears Sometimes fluid must be drained from under the retina to allow it to settle back onto the eye wall. Once a silicone band or pressure pad is placed on the outside of the eye to gently push the back wall of the eye against the retina.
During such operations, either freezing or a laser, is used to produce a scare to seal the retinal tear.
In more complex retinal detachments, it may be necessary to use a technique called vitrectomy. This operation cuts the connected bands of vitreous away from the retina and removes the shrunken vitreous body from the eye. In some cases, when the detached retina itself is severely shrunken and puckered, it may have to be pushed back to the wall of the eye by temporarily replacing the vitreous cavity with Silicone oil or gas.
Over 90% of all retinal detachments can be reattached by modern surgical techniques. Occasionally more than one operation may be required. Hence retinal surgey might have to be done as astage wise procedure initially with scleral buckling in the first stage followed by vitrectamy with silicon oil.
If the retina is successfully reattached, the eye will retain some degree of sight, and blindness will have been prevented. However, the degree if vision which finally returns about six months after successful surgery depends upon a number of factors. In general there is less visual recovery when the retina has been detached for a long duration, or there is a fibrous growth on the surface of the retina. Approximately 40% of successfully treated retinal deatachments achieve excellent vision. The remainder attain varying amount of reading and/or traveling vision
These operation may be performed under local anesthesia, it is seldom necessary to keep patients with retinal detachments immobile for prolonged periods of time before or after surgery. Patients who require air/gas injection or silicone oil however, must maintain fixed head positions eg. Prone position with oil as much, as possible for several days after the operation. Those patients with uncomplicated retinal detachments are usually allowed to walk to day after surgery and are discharged from the hospital on same day. Generally, eye drops and ointments are the only medications required after discharge. Occasionally, glasses or contact lenses may be prescribed after retinal surgery if vision needs correction.
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