Retinal detachment

What is retinal detachment?

The retina is the light-sensitive tissue lining the back of the inside of the eye. It’s made up of different layers, including the light-sensing cells known as photoreceptors that are essential for sight. A layer of underlying supporting tissue contains blood vessels that supply the photoreceptors with the food and oxygen they need to stay healthy.

The layers of the retina need to stay in place to stay healthy and working correctly. A retinal detachment is when the layer of photoreceptors begins to pull away from the supporting tissue underneath it. A detached retina can cause permanent sight loss in the affected eye if it isn’t detected and repaired with surgery quickly.

A retinal detachment needs urgent assessment by a specialist eye surgeon. Thankfully, the condition is rare, affecting around one in 10,000 people each year in the UK.

What causes retinal detachment?

The main cause of a retinal detachment is when a tear or break in the retina allows fluid from the middle part of the eye, the vitreous cavity, to leak through and get underneath it - resulting in retinal detachment.This most commonly occurs when, as a result of ageing the watery vitreous gel in the eye separates from the retina - typically in the 50-70 year-old age group. It is more common in short sighted patients.

Occasionally either before or after surgery to repair detached retinas scar tissue can form on the retinal surface. This scar tissue can contract and pull at the retina, preventing successful reattachment or occasionally causing the retina to redetach after after successful repair. An eye injury, or blow to the head or some other medical conditions that affect the retina may also lead to a retinal detachment.

Anyone can develop a retinal detachment at any time, but it is most common in those over the age of 40 – and very rare in children under 16. People who are very short-sighted, have had eye surgery in the past, or who have a family history of retinal detachment are at an increased risk of developing the condition. If someone has experienced a detached retina in one eye, they also have a higher chance of it happening in their other eye.

What are the signs and symptoms of retinal detachment?

The symptoms of a retinal detachment can either happen very suddenly or else may come on more gradually. A person may notice that their sight becomes blurred – or a dramatic change to the number or type of floaters (the tiny specks and spots that seem to float across a person’s visual field) in their eye. Other signs are starting to see flashes of light around the edges of their vision, or a dark ‘curtain-like’ shadow descending from the top of their eye or across from the side.

If a person is experiencing any of these symptoms, they should see an eye health professional (such as an optician or hospital eye doctor) within 24 hours. Although these symptoms don’t always mean they have a retinal detachment, it’s really important to have an eye examination to check.

How is retinal detachment diagnosed?

An eye health professional will usually examine the back of a person’s eyes using a bright light and a special lens – to look for any holes, tears or detachments to the retina. They may also carry out imaging tests to look more closely at the layers of retinal tissue for any signs of damage.

How is retinal detachment treated?

A retinal detachment can be treated with surgery to re-attach the photoreceptor layer to the underlying support tissue. In general, the sooner an operation can be carried out, this increases the chances of a good outcome.

There are different types of surgical approaches for retinal detachment and the most appropriate option will be very individual to each person. A hospital eye doctor will examine their eye and decide how quickly surgery needs to happen – this may be within 24 hours or a few days.

Surgery is successful at reattaching the retina in about 80-90% of cases with the first operation, but how well a person’s sight recovers will depend on a number of factors such as the location, cause, and extent of the detachment, and if they have any other complicating factors such as other eye conditions. But if a retinal detachment is left untreated, a person is likely to eventually lose all sight in their affected eye.

If a person has a tear or hole in their retina that hasn’t yet led to a detachment, they may be offered laser surgery or cryotherapy (a procedure involving a freezing probe) to help prevent this from happening. These treatments aim to weld the retina firmly to the underlying support tissue and seal the damaged area to prevent fluid passing through that may cause a detachment.

What can I do?

If you experience any signs of a retinal detachment, it’s important to have someone examine your eye within 24 hours. You may see an optician, but they may refer you straight away to your local A&E department so that you can see an ophthalmologist (hospital eye doctor) as soon as possible.

If you have had an examination for a retinal detachment before and you are concerned about further symptoms, you should follow the instructions you were given, which will usually direct you to contact your hospital eye clinic as quickly as possible.

There is no way to prevent a tear or hole developing in the retina but getting any possible symptoms checked out quickly – and treated if necessary – can reduce the risk of a detachment occurring. Wearing eye protection during activities such as DIY or sports can reduce the risk of an injury that can cause a detachment.

Have your eyes tested every two years even if you think your vision is fine. An eye test can spot some eye conditions and, if caught early, treatment may prevent further deterioration.

Last updated July 2019
Approved by David Steel, Honorary Professor of Retinal Surgery at the Institute of Genetic Medicine at Newcastle University

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