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Retinal Detachment


About Retinal Detachment

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.


Causes and symptoms

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.


How is it Diagnosed

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.


How is it Treated


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.

Laser Photocoagulation

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 (Cryopcxy)

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.

Surgical Repair

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.


Information For Patients With Detached Retina

The below details are prepared to provide information pertinent to the management of your eye condition. There are three phases in the treatment which your are about to undergo.

  1. Examination and study.
  2. Hospitalization and Surgery
  3. Convalescence


Your particular case may require modification of the general rules prescribed in the following pages, it so your doctor will give you special instructions to follow. Otherwise, please follow the directions outlined.

A summary of the causes, prevention and treatment of retinal detachment is also included

1. Examination and Study

When? At the time of your first examination. When complicating factors. Are present, a longer preoperative study may be necessary.

What? 1. Eyes : Complete examination and detailed mapping of the retina of both eyes will be done. This examination is probably the most important part of the entire procedure. It is very thorough and may take as long as two or three hours to complete. If surgery is indicated, the map helps to plan it accurately. If  no operation is advised, the map is useful to predict possible changes occurring inside the eye between now and future examinations.

Medications will be given for use in the in the eye which is to be operated until the time of your admission to the hospital. For your comfort, you may wear sunglasses, especially when you are outside in the bright sunlight.

2. Chest x-ray, electrocardiogram and blood and urine test:
These are required before anaesthesia is given. You may be asked to have these done before admission to the hospital.

3. General Physical :
All patients are examined by a physician at the hospital soon after admission. This is essential in evaluating the status of your general health.

4. Consultations:
if your surgeon feels that it is necessary before proceeding with your surgery. examination by appropriate specialists will be arranged. You will be having medical examination prior to surgery. This is not an interference with your regular doctor, but is done to provide medical supervision during surgery and convalescence in the hospital.

Who?  Your surgeon and one or more assistants conduct your eye examination all assistants are experienced eye surgeons, who come hear for special post-graduate study in retinal problems.

Consulting specialists are staff members of Sankara Nethralaya.

Make known to the examining physician special medicine and diets, if any, which must be procured of prepared before admission. After operation you will need sunglasses. If you have a pair of any type, bring them with you.

You can help prevent infection during and after operation by following the simple rules given below before operation and for one month after the operation.

  • Wash your face, including eyebrows, with soap twice a day for two days, before surgery.
  • After each use of the bathroom wash your hands carefully with soap. Wash your hands frequently.
  • Do not use a handkerchief form your pocket to wipe your eyes, always use fresh tissue paper.

If you have questions concerning the financial aspects of hospitalization and the surgeon’s fee, discuss them frankly in order to avoid misunderstanding later on.

2. Hospitalization and Surgery

Before Operation : The Admitting Secretary will inform you of the day and time to report to the Hospital Admitting Office.

On the day before operation, your eye will be rechecked by your surgeon in the Retina Service at the hospital. This is the time for you to ask him any questions which are in your mind.

A doctor from the Anaesthesia Department may call on you after you are admitted and will prescribe sleeping pills and medication to calm apprehension.

On the day of operation. Do NOT EAT unless you are specifically allowed to have a light breakfast, do not even drink water for 5 hours before the scheduled time of surgery.

Surgery : If done under general anesthesia, an anaesthetic will be injected into a vein of your arm or hand after you arrive in the operating room. Aside form the prick of the needle you will be unconscious during the operation, 

If done under local anesthesia you will receive two or three pricks of needled in the skin around your eye. After this no pain will be felt.

Depending on the complexity of operation, time required to complete the operation will very form one to six hours. You probable will sleep until the next morning. And it is usually wise to discourage visitors until the day after surgery

If one of your family is a nurse, she is welcome to attend on you, but as a rule special nurses are not necessary.

After Surgery : When you wake up, you will find that the eye which has been operated on is covered with a tight bandage, but the other eye is uncovered. You may open the eye which has not had surgery and use it. Some degree of pain is to be expected. When first felt, report it to the nurse who will administer medicine to relieve it. If nausea develps, other medicines will help alleviate it. However, if you do vomit after anesthesia (most patients do not) this will not harm your eye.

Unless your surgeon has directed you otherwise, you may turn on either side on bed and request additional pillows for your comfort.

It is very important to pass urine as soon as possible after operation. If you are unable to urinate while lying down, the nurse will assist you to sit or stand to do so.

The day after the operation the bandage is removed form the eye which has been operated on and a light eye pad is applied over it for another day or two.. When this is removed, sunglasses are worn, either alone or clipped over your regular glasses.

Your eye will be examined daily, and its progress reported to you. You may read, write, or watch TV but your eyes will tire more quickly than before the operation. Stop and rest them frequently by closing both eyes.

Operation produces some watering and burning sensation in the eye. You should not rub it or touch the lid or eye with your fingers. On the first day after operation, hair may be combed and teeth brushed. Men may have a shave. Perform all activities slowly and gently without vigorously shaking the head. Also, it is advisable to get up and walk in order to encourage circulation of the blood in all parts of the body.

Unless your doctor prohibits it, walking along the corridors is good exercise. The patient’s visitors or the nursing staff will assist those with limited vision.

Sitting in a chair is permitted for meals, but otherwise is to be avoided because with the already sluggish circulation in the legs this may lead to blood clot formation. Do not dangle your legs over the edges of the bed. When not walking, lie down on the bed with your legs stretched; the bed may be cranked up to any angle you wish.

On the second or third day after surgery, you may be permitted shower-bath from the neck down, but do not have a shampoo.

Vision in the eye which has had surgery may not return for days or weeks, and a blur need not be cause for alarm. If your retina is re-attached, the surgical phase of treatment has been successful and gradual improvement of vision may be expected to continue for months. Most patients are discharged form the hospital within seven days after operation. Medications will be provided for the following week and an appointment for the examination at the hospital will be made before you leave.

3. Convalescence

If you live within a convenient distance of Madras you may plan to go directly home form the hospital.
Otherwise, it is recommended that you remain in Madras for a week after discharge.

During the first week out of the hospital your daily routine will be about the same as it was in the hospital. Daily cleansing of eyes and application of ointments must be continued. Bending over and walking up and down stairs are permitted, but proceed cautiously if you go to a strange place, try to have a companion. Be particularly careful of pets underfoot.

When it is necessary to travel by car, enter carefully to prevent striking your head. Avoid sudden starts and stops. If the drive is long, stop every one or two hours and walk for a few minutes to restore leg circuation.

If your eye is healing statisfactoryily, you will be permitted to go home and return to the care of your own eye doctor who will revceive, a detailed report of your entire stay here from our office. You may visit him as and when necessary after your return home. Further changes in your schedule of drops and medicines will be decided by him. and he will determine when you may return to work. In general, desk work may be resumed when reading is done in comfort, but strenuous physical labour must be postponed for at least two months after surgery.

After the second post-operative week, you may resume a normal life, including marital relations. Avoid sudden movements and strenuous or athletic activity for about three months.

We would like to examine your aye two  months and again six months after your operation. This is the only sure way of evaluating the result of the treatment and preventing complications. It you cannot return for these examinations, please request your doctor to send a complete report of your condition at the end of six months.

The Eye : A Complex Camera

The eye may be compared to a camera in which lenses focus the picture on a sensitive file (Figure 1). In the human eye, the cornea (transparent tissue resembling a watch crystal) and the crystalline lens focus images on the retina, a thin, light- sensitive film at the back of the eye. The resulting picture is to science. The space between lens and retina is filled with a transparent jelly the vitreous body. The sclera (white of the eye) is comparable to the box inside which the camera is built.

The iris is the coloured circle in the fornt part of eye, which acts like the diaphragm of a camera. In its centre is the black pupil which enlarges or constricts to regulate the intensity of light entering the eye.

What is Detached Retina?

The choroids is system of blood vessels, located between the retina and sclera, which provides nourishment to the retina. Which provides nourishment to the retina. When a portion of the retina becomes separated form the choroids this detached part looses its nourishment and results in a temporary decrease in vision. The vitreous body is a transparent jelly filling the space between the lens and the retina. It maintains the space of the eyeball, works as a shock absorber, and helps to hold the retina in place. Shrinkage of  the vitreous body sometimes causes traction on the retina in areas where the vitreous body is “ struck” to the retina (figure II). This traction may cause a tear in the retina. Fluid form the vitreous body  sometimes causes traction on the retina in areas where the vitreous body is ”struck”  to the retina (Figure II). This traction may cause a tear in the retina. Fluid form the vitreous body passes through the retinal tear and detaches the retina form the retinal tear and detaches the retina form the choroids just as a wallpaper separates form plaster when water seeps behind it.

How is detached retina treated ?

If the fluid can be prevented form passing through the hole or tear in the retina and the already accumulated fluid beneath the retina can be drawn off, the retina will return to its normal position. There are several ways of accomplishing this by surgery. but closing the retinal holes is the common aim of all techniques.

Treatment starts with the careful drawing made of the retina. More than one reinal hole is often found, and each one must be treated for a successful result.

Surgical techniques very according to the case. Every operation produces an international scar in the retina and choroid.The scarring process seals of the hole in the retina in almost the same way as a patch is vulcanized over a leak in an automobile tyre. In order to hold the scarred area of the choroids against the detached retina while the bond around the hole is hardening. Plastic material may be attached to the outside wall of the eye in such a way as to indent it. Creating an internal hump (Figure III) (Please see page 3). The term “buckling” which you may hear used by the doctors, refers to this internal hump. The “buckle” is the hump seen by the doctor when he looks into your eye. Ideally, the treated choroids and retina will lie so that the hole is on the buckle.

What causes the hole in retina ?

As mentioned before, the most frequent cause of  a hole in the retina appears to be pulling by a Shrinking vitreous body. Other types of breaks seem to be related to changes due to aging which occut in both the retina and vitreous body. In some cases. retinal holes are the result of  a direct blow to the eye which causes the retina to tear away form its attachment.

The mechanism by which retinal holes are produced is not yet completely understood. It is in this phase of the problem that intensive investigation appears most likely to be fruitful.

Hopefully a better understanding of the mechanisms which bring about retinal detachment will provide more effective measure for the prevention and further improvements in the results of treatment.



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