Retinal Detachment

– Separation of the sensory layers of the retina from the pigmented epithelium.

Causes and Incidence

The most common cause is a hole or tear in the retina; predisposing factors include degenerative changes associated with aging, myopia, cataract surgery, and trauma. Other causes may be seepage of vitreous fluid into the subretinal space as a result of inflammation, choroidal tumors, or systemic disease. Detachment may also occur as a result of vitreous traction placed on the inner lining of the retina from the contraction of fibrous band formations associated with diabetic retinopathy, sickle cell disease, or other retinal degeneration. Retinal detachment is most common after age 40 unless it is associated with trauma.

Disease Process

As vitreous fluid fills the subretinal space, the sensory layers of the retina progressively pull away from the pigmented epithelium. Separation may occur suddenly or may develop slowly over years.

Symptoms

Retinal detachment may be totally asymptomatic until the macular area is invaded, reducing central vision and often fracturing images. Lightning flashes or floaters also may be present, particularly if separation is fairly rapid.

Potential Complications

Untreated detachments may lead to severe vision impairment or blindness.

Diagnostic Tests

The diagnosis is made by indirect ophthalmoscopy, which reveals tears, breaks, and detachment.

Treatments

Surgery
Photocoagulation, diathermy, or cryothermy to burn or freeze tear margins and promote inflammation and scarring to seal the hole or tear; scleral buckle: an implant is used to encircle the eyeball, indent the sclera, and draw it flat against the retina in cases of large or multiple holes or tears.

Drugs
Mydriatics to dilate the pupil before and after surgery; prophylactic antiinfective drugs to prevent uveitis; steroids to control inflammation; antacids to prevent gastric irritation from steroids; narcotic analgesics to aid in maintaining sustained positions with scleral buckle.

General
Eye patches 1 to 2 days after surgery to promote rest of the eyes; with scleral buckle, strict bed rest and specific head positioning to promote adhesion (position is maintained with foam wedges for 4 to 5 days); orientation measures if eyes are bilaterally patched; avoidance of heavy lifting, vigorous exercise, head jarring, and constipation for 4 to 6 weeks after surgery.