What is a Retinal Detachment?

Your eye is effectively a highly sophisticated and incredibly intricate camera, one of nature’s most beautiful creations. At the back of the eye, just like in a traditional camera lies the camera film or retina, a complex thin layer of specialised cells designed to sense and process light, and to transmit that information to your brain. To function, the retina must remain attached to the back wall of the eye, from which it obtains some of its blood supply. Several conditions can cause the retina to detach, in whole or in part. When this occurs suddenly, then urgent surgery or laser is required to prevent complete and irreversible blindness in that eye. This treatment is best performed by an experienced Consultant Vitreoretinal Surgeon.  

kam balaggan retinal detachment

Why has this Happened to Me?

It is important to realise that in most instances, you have not done anything in particular to develop this condition. Although classically thought of being due to trauma, such as boxing injuries, the vast majority of retinal detachments are actually not caused by trauma. Retinal detachments are more common if you are short-sighted (myopic), or have a history of retinal detachment in your other eye or in your family. You are also more prone to retinal detachment if you have conditions such as Marfan or Stickler syndrome. You are also at higher risk if you have undergone cataract surgery or refractive lens exchange surgery, particularly if you suffered a complication known as posterior capsular rupture (PCR).

Why has this Happened to Me?

It is important to realise that in most instances, you have not done anything in particular to develop this condition. Although classically thought of being due to trauma, such as boxing injuries, the vast majority of retinal detachments are actually not caused by trauma. Retinal detachments are more common if you are short-sighted (myopic), or have a history of retinal detachment in your other eye or in your family. You are also more prone to retinal detachment if you have conditions such as Marfan or Stickler syndrome. You are also at higher risk if you have undergone cataract surgery or refractive lens exchange surgery, particularly if you suffered a complication known as posterior capsular rupture (PCR).

kam balaggan retinal detachment

Causes of Retinal Detachment

There are 3 main causes of retinal detachments.

Retinal Breaks

retinal tear kam balaggan

The most common cause of retinal detachment is the development of breaks in the retina which allow fluid in the vitreous cavity to pass under the retina, causing it to detach. Most retinal detachments occur later in life as an abnormal response to the natural ageing of the vitreous gel. The process causes the vitreous to separate from the retina causing a posterior vitreous detachment. Whilst this is completely harmless in most people, in a small minority, the vitreous gel can split the retina giving rise to a retinal tear. Trauma is a much less common cause of developing retinal detachment.

Retinal Scar Tissue

Kam Balaggan Traction Detechment

In some cases, your retina may be pulled away by the development of severe scar tissue along the surface of your retina. This traction (pulling) often occurs due to the uncontrolled growth of blood vessels in your eye as a result of conditions such as severe diabetic retinopathy, retinal vein blockages (occlusions), trauma or inflammation. These tractional detachments tend to be more difficult to repair, highlighting the importance of seeking a Consultant Vitreoretinal Surgeon with experience in treating such complex disorders.

Fluid Under Retina

exudative Retinal detachment

Rarely, your retina may detach as a result of inflammation or leakage within your retina or adjacent layers. This is known as an exudative retinal detachment, and you will typically already have been diagnosed with a condition called posterior- or pan-uveitis, or wet macular degeneration. Most of these cases are not treated surgically, but surgery may be employed in select cases. Such cases are typically very complex, again highlighting the desirability of choosing an experienced Consultant Vitreoretinal Surgeon to perform your surgery.

Symptoms

Most retinal detachments, in particular the most common type due to retinal tears which occur later in life, develop rapidly over hours to a few daysIn these cases, you will usually initially experience sudden new-onset eye floaters and flashing lights). These symptoms signify posterior vitreous detachment, the precursor to retinal detachment. (see PVD) If a retinal tear develops which is untreated, then you may develop a retinal detachment which initially will cause you to experience dark shadow or curtain in your peripheral vision which enlarges over hours to days. At this stage your reading vision in the middle of your field of vision will be intact as the retinal detachment will not have reached your central retina. This is called a macular-on retinal detachment. If untreated, this will usually progress resulting in enlargement of the shadow in your vision and loss of your central vision (macular-off retinal detachment) Eventually, you will ordinarily experience total loss of vision in that eye without surgery.

Floaters

Flashes

Dark curtain

Diagnosis

As prognosis is generally very good with treatment in the early stages of retinal detachment, it is vital that you seek medical attention as soon as possible. Initially, you may be seen by your optician, GP or in your local Emergency Department. Opticians and hospital-based ophthalmologists are trained to examine your retinas and will have the necessary specialist equipment to do so. You will initially have a test of your vision and then have drops instilled into your eyes to dilate the pupils. This will allow for a thorough examination of your retinas to diagnose or exclude retinal tears and retina detachment. This is a highly skilled examination, and small retinal breaks in the retina can sometimes be difficult to detect. A retinal detachment, however, will be more obvious. If this is suspected, then you will be referred to a vitreoretinal surgeon for confirmation and treatment

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