When a retinal detachment develops a separation occurs between the neurosensory retina and the pigment epithelium.

What are the symptoms of a retinal detachment?

Retinal detachment is generally preceded by the formation of holes(s) or tears in the retina; symptoms of which may include sudden onset of flashes and floaters-multiple black spots or cobweb like floating objects in front of the affected eye.

When detachment occurs, further symptoms may include-shadow in front of eye, appearance of curtain falling in front of the eye, decreased vision or total obscuration of vision.

What causes a retinal detachment?

Nearly all retinal detachments develop because of a hole or tear in the retina. This usually occurs when the retina becomes 'thin', which can occur in short sighted people (Myopia) or if the vitreous (the jelly-like substance that fills the eye) separates from the retina. Previous eye surgery and any ocular trauma can occasionally be the cause of a retinal detachment.

The other causes for detachment include:

• Exudative detachment- in choroiditis/tumors/inflammation of eye
• Tractional detachment in diabetic patients

Examination & Diagnosis

You will have your vision tested followed by a comprehensive eye examination including a detailed retinal evaluation. Eye drops are put into both your eyes to make the pupils bigger, which helps the ophthalmologist to examine the back of the eye fully. The effect of these drops will wear off after a few hours, but your vision will be blurred temporarily preventing you from reading and driving.

Avoid driving yourself to hospital or to the local railway station whenever you come to have your retinas examined because your pupils will always need to be dilated.

If you are diagnosed with a retinal detachment, you will be advised to have surgery as soon as possible to reattach the retina.

TREATMENT OPTIONS

Treating a retinal hole or tear:

To seal the retina around the tear and prevent the retina peeling off you may be asked to have:

Laser - the retinal hole can be heat sealed (like spot welding) by directing a laser beam of light through the pupil of the eye. The scar produced seals the hole

OR

Cryotherapy - a freezing treatment applied by a pen shaped probe to the outside of the eye. This freezes through to the retinal hole and promotes scar tissues as a seal.

These procedures may be a little uncomfortable but not painful, and are usually performed under a local anaesthetic as an outpatient procedure. However, they are only effective for retinal holes or tears, without any detachment.

Treating the detached retina

In addition to the above treatment a detached retina will need a surgical procedure such as application of an encircling band or sponge to support the detached retina with or without drainage of sub-retinal fluid.

In patients with old detachment where retina is fixed and immobile, complicated vitreous surgery is generally required to put the retina back to its normal position. This is a time consuming surgery and takes 2-3 hrs. Usually silicone oil or gas is injected inside the eye to stabilize the retina.