Retinal Detachment

Retinal Detachment

Retinal Detachment describes an emergency in which a thin layer of tissue(the retina) at the back of the eye pulls away from its normal position. Retinal detachment is a medical condition in which the retina is torn down and separated from the choroid layer which results in loss of peripheral vision in the early stage. The retina is the thin layer of the eye that is light-sensitive and helps vision by providing signals to the brain through the optic nerve.

Layers of Retina:

• Sensory retina
• Rods and cones
• Retinal pigment epithelium

Classification of Retinal Detachment:

There are classified into three types

1. Rhegmatogenous detachment or Primary retinal detachment
2. Tractional retinal detachment
3. Exudative retinal detachment

1- Rhegmatogenous Detachment:

A hole or tear develops in the sensory retina allowing some of the liquid (vitreous) to seep through the sensory retina and detach it from the RPE.

2- Traction Retinal Detachment:

• Tension or a pulling force
• TRD can occur due to any scars
• Vitreous
• Hemorrhage can cause a traction effect

3- Exudative Retinal Detachment:

It occurs as a result of the production of serous fluid under the retina from the choroid. Conditions such as uveitis and macular degeneration may cause the production of serous f

Etiology of Retinal Detachment:

Predisposing factors: includes

• Age (40-60 years)
• Sex ( male and female 3:2)
• myopia (40%)
• Aphkia and pseudophakia
• Trauma
• Advanced Diabetics
• Inflammation and infection
• Senile posterior vitreous detachment (PVD)

Pathophysiology of Retinal Detachment:

• Due to etiology factors (a torn break in the retina)
• Vitreous fluids or serous fluids leak in between the layers of the retina or behind the retinal layer
• Detachment of retinal layer
• The retina can peel away from the underlying layers of blood vessels
• Lack of oxygenation in the tissue of the retina
• Vision disturbance

Causes of Retinal Detachment:

• Eyes injury
• Family history
• Ocular surgery
• Diabetic retinopathy
• Vitreous hemorrhage
• Retinal degeneration

Symptoms of Retinal Detachment:

• Occurs slowly or rapidly
• Maybe without pain
• Dark spots
• Photophobia
• Blurred vision
• Feeling of heaviness
• Visual field loss
• Floaters and flashes

Signs of Retinal Detachment:

1- IOP slightly normal or lower

2- Marcus Gunn’s pupil (RAPD) is present

3– ERG is subnormal and absent

4- VF charting reveals scotoma

Diagnostic Tests of Retinal Detachment:

• Ophthalmoscopy
• Slit lamp examination
• Visual test
• Physical examination
• History collection

Treatment of Retinal Detachment:

1. Surgical management
2. Retinal tears

• Vitrectomy
• Scleral buckling
• Pneumatic retinopexy

1. Laser surgery (Photo-coagulation)with the help of laser rays the tears are joined or sutured.
2. Freezing (cryopexy) will freeze and join the retinal tears.

Care of Retinal Detachment:

• Pain and eye protection eye drops and eye patches may be necessary to keep eyes, moist
• No soap enters to eye during bathing
• If air bubbles are infected prone position should be provided for 1-2 weeks
• Avoid increase altitude
• Avoid heavy lifting
• Follow-up should be done