Retinal detachment – Symptoms, causes, surgery
Retinal detachment is characterized by the formation of a fluid-filled sac beneath the retina. It is an ophthalmological emergency requiring rapid diagnosis and relatively urgent surgical intervention. It is most often caused by vitreous detachment and a retinal tear , which leads to the fluid leaking from under the retina. Retinal detachment should be considered when you suddenly experience visual disturbances in one eye, without pain or redness. You may see floaters (myodesopsia), flashes of light (phosphenes), or a shadow in your field of vision (visual field defect). From the first symptoms, an ophthalmological examination of the fundus (back of the eye) is essential to check the retina. Early diagnosis of retinal detachment allows for rapid surgical treatment and a good visual recovery. The preferred technique is vitrectomy, and its alternative is cryoindentation .
What is retinal detachment?
Retinal detachment is caused by the presence of fluid under the retina, leading to vision loss in the detached area. This fluid pocket forms due to:
A tear or hole in the retina – This is called a rhegmatogenous retinal detachment. It accounts for the vast majority of retinal detachments.
A traction of vessels on the retina – This is tractional retinal detachment, rarer and most often linked to diabetes.
Inflammation of the retina – This is called exudative retinal detachment. It is a rare form of retinal detachment and cannot be treated surgically.
Regarding rhegmatogenous retinal detachment, without prompt treatment, the detachment will inevitably progress. Each year in France, retinal detachment affects 1 to 2 people per 10,000.
What is the retina? General information
Often compared to the film in a camera, the retina lines the back of the eye, which can be likened to a darkroom.
In other words, it is the organ responsible for vision, on which, after entering the eye through the pupil, light (and the image it carries) is imprinted.
The visual information is then transmitted via the optic nerve to the brain, which reconstructs the image.
The central area of the retina is called the macula or fovea. It is the most precious element of the retina since it is this area that is responsible for sharp and central vision (as opposed to the peripheral field of vision).
What are the symptoms of retinal detachment?
The eye is neither painful nor red. The symptoms appear suddenly and are most often unilateral. The following signs should be noted:
Myodesopsia, described as "floaters" by the patient. They generally indicate opacities related to the onset of posterior vitreous detachment.
Phosphenes, often peripheral flashes of light, persist even with eyes closed and in the dark. They indicate vitreous traction on the retina, leading to a risk of retinal tear. Phosphenes should be distinguished from scintillating scotoma, the latter being indicative of ocular migraines.
A loss of vision, which signifies vision loss due to retinal detachment. A significant decrease in vision and blurred vision indicate that central vision is affected (macula detachment).
A shower of soot is a sign of intravitreal hemorrhage which may accompany a tear and/or detachment of the retina.
Vision loss – When the central retina, called the macula, detaches, vision drops sharply.
Diagnosis of retinal detachment
The diagnosis of retinal detachment is clinical. It is made by an ophthalmologist, on an emergency basis, during a fundus examination. A typical consultation includes the following steps:
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History of symptoms and background.
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Rapid measurement of visual acuity.
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Pupil dilation in the waiting room for approximately 15 minutes.
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An OCT (retinal scan) can be performed during the waiting period to determine the proximity of the macular detachment and to rule out certain differential diagnoses.
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Fundus examination in the examination room – The ophthalmologist looks at the retina through the pupil, using a lens. He observes a retinal detachment, analyzes its extent and locates the tear.
Once the diagnosis is made, the ophthalmologist will inform you or confirm the diagnosis. If they are not a specialist in retinal surgery, they will refer you to the on-call retinal specialist at the practice so that you can be seen within 24 to 72 hours.
Peeling/Tearing, what's the difference?
The tear precedes and causes the retinal detachment.
The tear manifests with the same symptoms (floaters, flashes of light) as a retinal detachment. At this stage, an outpatient procedure using an Argon laser can often halt the progression towards a retinal detachment.
In the stage of a fully developed retinal detachment, a visual field defect or opacity is generally added to the symptoms of the tear. In this case, urgent surgical treatment is unavoidable.
The causes
Rhegmatogenous retinal detachment
The most common type. From the Greek rhêgma = tear, rupture, it is secondary to a retinal tear. The mechanism follows the chronology below and may be related to the symptoms described previously.
Posterior vitreous detachment – The vitreous humor, which lines the retina, dehydrates with age and detaches. In this case, it can tear away a piece of the retina and cause a retinal tear.
Retinal tear – At this stage, there is no detachment yet. An outpatient argon laser treatment may be sufficient.
Retinal detachment – Taking advantage of a retinal tear (a split in the retina), vitreous fluid seeps under the retina and detaches it, much like a punctured swimming pool liner inevitably peels away. Treatment is always surgical.
Extension of the detachment to the macula – If the detachment progresses, it will be accompanied by a clear decrease in vision related to the detachment of the macula (so-called Macula-off detachment).
Exudative retinal detachment
It is rarer and is found particularly in cases of eye tumors or inflammatory diseases.
Tractional retinal detachment
It is observed in pathologies such as diabetic retinopathy and is linked to the growth and traction of uncontrolled blood vessels.
Risk factors
There are many risk factors for retinal detachment. The most common are:
Myopia – especially high myopia, because the retina is thinner and more fragile in myopic patients.
Cataract surgery – Because the operation mobilizes the vitreous humor and increases the risk of tearing.
Heredity – A family history of retinal detachment makes you a higher risk patient.
Eye trauma – In the event of a violent physical impact, the retina can tear and detach.
These are not risk factors
There are many misconceptions about the causes of retinal detachment. The following are not risk factors for retinal detachment:
Stress, tears, and emotional trauma.
Recent infections, bouts of fatigue, or vaccines.
Screens and prolonged reading.
Intense eye rubbing.
Carrying heavy loads, weight training and playing wind instruments (trumpet).
Course of action
Consult an ophthalmologist urgently
It is essential to seek medical help quickly because the spontaneous evolution of tears and detachments is very poor: it leads to the inexorable extension of the retinal detachment, with irreversible damage that can cause blindness.
An examination of the fundus of the eye and the performance of an OCT will allow the diagnosis of retinal detachment and the search for the causal tear.
Treatment of an isolated tear with argon laser
In the case of an isolated tear WITHOUT retinal detachment, the Argon laser will be performed immediately in the office.
A follow-up will be necessary in the following days, sometimes requiring additional laser treatments.
Management of retinal detachment
If a retinal detachment is present, the only treatment is surgical. The procedure must be performed urgently in order to reattach the retina and save the eye.
What is the emergency situation in case of retinal detachment?
The urgency depends on the date symptoms began and the rate of progression of the retinal detachment. A useful timescale to remember is:
24 to 48 hours for a recent retinal detachment of the macula NOT detached.
3 to 4 days for an old retinal detachment or detached macula.
There's no need to rush to the emergency room in the middle of the night; retinal detachments are treated in the operating room during the day. Arrive calmly in the morning, on an empty stomach, when the clinic opens.
Frequently Asked Questions
How can you tell if you have a retinal detachment?
The only way to confirm a retinal detachment is to consult an ophthalmologist urgently for a dilated fundus examination. The ophthalmologist will see a retinal detachment and the hole or tear causing it.
How to prevent retinal detachment?
There are many ways to prevent retinal detachment!
Avoid combat sports (blows to the face).
Consult a doctor quickly if you experience sudden onset of floaters or flashes of light.
Treat any retinal tear with laser treatment without delay.
What are the symptoms of retinal detachment?
The symptoms of retinal detachment can be divided into 3 phases:
Early – Tear phase – Floaters (myodesopsia) and phosphenes (flashes)
Intermediate – Retinal detachment WITHOUT macular involvement – Visual field loss
Late-onset retinal detachment with macular involvement – Decreased profound vision