Detached Retina Needs Immediate Treatment 

 What's a detached retina?

The retina is a thin tissue located at the back of the eye. If your eye is like a camera, the retina acts as the film that absorbs light, converts it into a signal, and sends it to your brain. This is how you see: your brain interprets that signal.

To connect to the blood vessels that supply the eye with oxygen and other nutrients, the retina must be located on the back wall of the eye. Retinal detachment occurs from the eye's back wall. Due to malnutrition, the retina may be harmed and could eventually die.

Main Retinal Detachment Causes

Rhegmatogenous retinal detachment (most prevalent)

• A retinal tear or break allows fluid to flow underneath and separate it from the surrounding tissue.
• Age, severe myopia, eye damage, and cataract surgery are risk factors.

Tractional retinal tear

• Contracting retinal scar tissue pulls the retina away.
• This phenomenon occurs in diabetic retinopathy and other blood vessel growth disorders. 

Severe retinal exudation

• Fluid accumulates beneath the retina in the absence of a tear.
• This condition is associated with inflammatory, neoplastic, or vascular problems.

Who risks more?

• Over 50
• With age, the retinal tissue becomes thinner and tears more easily.
• Extreme nearsightedness
• Long eyeballs stretch the retina, causing it to become thinner and more brittle.
• Previous eye surgery
• Cataract surgery, in particular, has been linked to retinal tears.
• Injury to the eye
• Blunt or piercing injuries can damage the retina.
• A family history: Biological tendency.
• This condition is linked to conditions such as diabetic retinopathy, lattice degeneration, and uveitis.

Families with retinal detachment

• Predisposition is genetic.
• The other eye detached before
• When one eye is compromised, the other is at risk.
• Weak retinal regions (lattice degeneration) are thin spots that can readily tear.

Common Initial Signs

• Photographic flashes
• Short flashes, particularly in peripheral vision, may indicate retinal traction.
• Rise in floaters
• Small dark spots, threads, or cobwebs may appear in vision.
• There appears to be a sudden increase in the number of floaters.
• Visual distortion
• It may be hazy or blurry.
• A dark curtain-like shadow over the field of view is a characteristic symptom.
• Reduced peripheral vision
• Retinal detachment is characterised by a gradual or sudden loss of side vision, often leading to a loss of central vision.

Why These Signs Matter

• Medical emergencies include retinal detachment.
• Without treatment, detached retinas lose blood supply and function, which can lead to permanent vision loss.
• Early diagnosis and treatment of retinal detachment can save 90% of a person's eyesight.

Retinal Detachment Types

Rhegmatogenous Retinopathy

A retinal tear lets vitreous fluid flow underneath. Rhegmatogenous retinal detachment (RRD) is the most frequent kind, produced by a retinal tear or hole that lets fluid flow underneath the retina and separate it from the tissue. To avoid permanent vision loss, this medical emergency must be treated immediately. Retinal breaks detach the neurosensory retina from the retinal pigment epithelium, causing RRD.

Diagnosis

• A dilated ophthalmoscopic eye exam should be performed.
• An OCT or ultrasonography should be performed if the retina is clouded.

Tractional retinal tear

• The retina is pulled away from the back of the eye when retinal scar tissue contracts.
• It is common in proliferative vascular disorders, such as diabetic retinopathy.
• The causes of retinal detachment are less common than those of rhegmatogenous separation.
• Tractional retinal detachment (TRD) is a rare but dangerous condition. In contrast to rhegmatogenous detachment, tractional retinal detachment (TRD) occurs when scar tissue or fibrovascular membranes contract and pull the retina away from the underlying tissue.

Definition:

• Mechanical traction from scar tissue leads to retinal separation without causing a tear.
• The retina develops abnormal blood vessels and fibrous tissue as a result of chronic illness. 
• Contracting tissue pulls the retina from its natural position.

Causes and Risks

• Most common cause: diabetic retinopathy
• Proliferative diabetic retinopathy leads to abnormal blood vessel development and scarring.
• Prematurity retinopathy
• This condition is seen in premature babies who have defective retinal vascular development.
• Sickle cell retina
• This can lead to ocular abnormalities and scarring.
• Eye injury or infection
• Scarring and traction can result.
• Other proliferative vitreoretinopathies
• This can lead to retinal ischemia or chronic inflammation.

Symptoms

• Vision is blurring gradually.
• Dark spots or missing portions in vision can occur.
• Flashes and floaters occur less frequently in cases of lattice degeneration compared to rhegmatogenous detachment.
• Without a retinal tear, the loss of vision occurs gradually.

Diagnosis

• Dilated fundus exam: Fibrovascular membranes pull the retina.
• OCT: Verifies traction and separation.
• If hemorrhage obscures the view, use ultrasound.

Treatment Choices

• Laser photocoagulation or cryotherapy can treat small retinal tears before they lead to separation.
• Scleral buckle surgery involves wrapping a silicone band around the eye to press the eye wall against the retina.
• The vitreous gel is removed, and gas or silicone oil is used to reconnect the retina.
• Pneumatic retinopexy: A Gas bubble is injected to reposition the retina.

Serious Retinal Exudation

• This condition is caused by fluid collection under the retina without a tear.
• This condition is associated with inflammation, malignancies, or vascular anomalies.
• Blurred vision or visual field abnormalities, which occur without flashes or floaters, are symptoms.
• Recurrent (serous) retinal detachment is also crucial. 
• Exudative detachment occurs when fluid accumulates behind the retina without a retinal break or traction.
• The retina separates from the retinal pigment epithelium as a result of fluid leakage or inflammation.
• The mechanism involves abnormal fluid accumulating under the retina, which causes it to lift.
• One major difference is the absence of a retinal tear or scar.

Causes and Risks

• The inflammatory disorders
• These include systemic autoimmune diseases, uveitis, and scleritis.
• Blood vessel issues
• The main reasons for retinal detachment are epiretinal serous chorioretinopathy, high blood pressure
• Tumors
• Fluid can seep from choroidal melanoma or metastases.
• Systemic illnesses
• Fluid imbalance can result from kidney disease, preeclampsia, and other conditions.

Symptoms

• The symptoms typically include blurred vision in the centre.
• There may also be issues with the visual field.
• This condition may cause flashes or floaters, which are different from those seen in rhegmatogenous separation.
• The underlying cause determines whether eyesight loss occurs suddenly or progressively.

Diagnosis

• Dilated fundus exam reveals a smooth, dome-shaped retinal elevation.
• An OCT scan: Verifies subretinal fluid
• Fluorescein angiography: it finds leaks.
• If hemorrhage or tumors obscure the retina, ultrasound can assist in diagnosis.

The video about the treatment of detached retina

Treatment Choices

• Address the root cause:
• Corticosteroids or immunosuppressants for inflammation.
• Vascular anti-VEGF treatment.
• Cancers can be treated with chemotherapy or radiation.
• Conditions such as central serous chorioretinopathy may resolve on their own.
• Manage systemic conditions such as hypertension, renal disease, and autoimmunity.

Main Treatment Options

• Freezing or laser photocoagulation
• Look for tiny retinal tears or holes before separation. Scar tissue repairs the break and prevents fluid from leaking.

Retinopexy pneumatic

• The vitreous cavity receives a gas bubble.
• The bubble presses the retina back into place, while laser treatment or cryotherapy seals the tear.
• Best for simple, superior retinal detachments.

Scleral buckle surgery

• Indent the eyewall and relieve retinal tension with a silicone band.
• This procedure is typically used for larger or more complex detachments.
• These types of retinal detachment can be combined with other methods.

Vitrectomy

• Silicone oil can replace vitreous gel.
• It can directly mend retinal tears and eliminate scar tissue.
• This condition is often seen in complex instances or tractional detachments, such as those caused by diabetic retinopathy.

Also read https://www.medicaloptics.ie/conditions/retinal-detachment/.

Important Considerations

• Vision preservation requires immediate treatment.
• Retinal reattachment succeeds in 90% of patients with prompt surgery; however, vision recovery relies on macula detachment duration.
• Recovery: After undergoing pneumatic retinopexy, patients may need to keep their head in a specific position and avoid air travel until the gas bubble dissipates.
• Following up is necessary to prevent the recurrence of issues such as cataracts or glaucoma.

Useful Prevention Methods

• Regular eye exams
• Comprehensive dilated eye exams reveal retinal tears, weak spots, and early changes before detachment.
• Prevent eye trauma
• Protect your eyes during sports, construction work, and other hazardous activities.

Managing chronic conditions

• Reduce the risk of tractional or exudative detachments by managing diabetes, hypertension, and autoimmune disorders.
• Monitor high-risk populations
• Eye exams should be more frequent for individuals with excessive myopia, a family history of eye issues, or those who have undergone cataract surgery.

Seek prompt treatment for warning signs

• Light flashes, floaters, or a curtain-like shadow require immediate ophthalmologic attention.
• Spare yourself stress
• Safe regular activities, but avoid heavy lifting or rapid head trauma if at risk.
• After surgery, be alert
• To detect retinal tears early after cataract surgery or other eye procedures, follow-up exams are essential.

Lifestyle & System Intervention

• Controlling blood sugar levels helps prevent diabetic retinopathy, which is the major cause of tractional detachment.
• Keep BP: Reduces retinal vascular stress.
• Quitting smoking increases vascular health and lowers the risk of eye disease.
• Hydration and nutrition balance: Antioxidants (vitamins A, C, and E; zinc; and lutein) protect retinal health.

Conclusion

Retinal detachment is a sight-threatening emergency caused by three mechanisms: rhegmatogenous (tears and fluid leakage), tractional (scar tissue pulling on the retina, often from diabetic retinopathy), and exudative (fluid accumulation beneath the retina without a tear).

Early detection and treatment can prevent vision loss from retinal detachment, but preventing the condition itself is not always possible. High-risk groups, including individuals with severe myopia or diabetic retinopathy, need education on risk factors and warning signs.