Retinal Tears and Detachments

The retina is the layer of photoreceptor nerve cells lining the back, inside wall of the eye. Just like the film in a camera, the retina reacts to the presence of light. The photoreceptor nerve cells generate a nerve impulse whenever they are exposed to light. These nerve impulses travel via the optic nerve to the brain where an image is perceived. Just like a picture cannot be created by a camera with defective film, vision is not possible in an eye with a defective retina.

Retinal Tears involve a rip or tear in the tissue comprising the retina. They usually arise from degenerative changes in the peripheral retina.

Retinal Detachments are a separation of the retinal tissue from the inside wall of the eye. Similar to wallpaper coming lose from a wall, the retinal tissue may develop folds or come completely away from its proper position along the interior of the eye resulting in loss of vision.

These conditions may be caused by a number of factors, ranging from injury to the head to spontaneous occurrences. Regardless of the cause, a retinal tear or detachment requires immediate medical attention. Treatment with a laser or surgical intervention is necessary to repair a retinal tear or detachment. The chances of successfully restoring vision are dramatically improved when intervention occurs as soon as possible following the onset of symptoms.

Causes

The central portion of the eye is filled with a clear, gel-like material known as vitreous. In young people, the vitreous fills the back cavity of the eye. As a person ages, it is normal for the vitreous material to shrink and pull away from the interior wall of the eye. As it pulls away from the interior wall of the eye, it occasionally pulls a portion of the retina away with it. This results in a retinal tear. They usually occur in the peripheral areas of the retina.

When the retina is torn, vitreous fluid is able to seep through the tear and accumulate behind the retina. This causes the retina to detach from the inside lining of the eye. Once a retinal detachment has started, it usually continues until most of the retina has completely separated from the interior of the eye. The retina is no longer sensitive to light in areas where it is detached, resulting in blindness in the affected region.

The risk of spontaneous retinal tears and detachments increase as we grow older. Nearsighted individuals are at an increased risk for retinal tears and detachments. Persons who have had cataract surgery or experienced a blow to the head or injury to the eye are also at risk for retinal tears or detachments.

Symptoms

Retinal tears and detachments commonly offer the following symptoms:

* New Floaters: The presence of some floaters is common because the vitreous is not completely transparent or uniform in consistency. However, a sudden increase in the number and size of floaters perceived in your vision is a warning sign that a retinal tear is in progress.
* Flashes: The sudden appearance of flashes in vision may indicate that the vitreous material is pulling away from the retina, which is the first stage of a retinal tear or detachment.
* Shadow or curtain over vision: The onset of a growing, dark shadow or the appearance of a curtain being pulled over a portion of the vision in one eye is an indication of a retinal detachment. These symptoms usually occur in the peripheral (side) vision. The growing shadow results from the increasing area of retinal tissue being pulled away from the back wall of the eye and no longer able to react to light.
* Decreased vision: Another common symptom of a retinal tear or detachment is a sudden decrease in vision.


Treatment of Retinal Tears and Detachments

Advances in surgical technology and techniques have resulted in a good success rate for the repair of retinal tears and detachments. The success of these surgical procedures is directly related to the size of the tear or detachment (amount of damage) and the timeliness of the treatment. The sooner surgery occurs after the onset of the retinal tear or detachment, the better the chances of success. With this in mind, it is wise to seek the care of an ophthalmologist at the first symptoms of a retinal tear or detachment.

Surgery to repair retinal tears usually involve the use of lasers or a specialized freezing instrument known as a cryoprobe. These instruments are used to create a scar around the torn area, which usually prevents further tears or future detachments.

The most common surgical method of repairing retinal detachments is through the creation of a scleral buckle. The creation of a scleral buckle involves the placement of a band on the eye's white, outer layer (the sclera). This pushes the wall of the eye inward, placing it in closer proximity to the separated retinal tissue. Often, this allows the retinal tissue to re-attach itself to the interior wall of the eye. Thanks to microsurgical techniques, the scleral buckle is very small and not visible after surgery.

Another surgical option for the repair of retinal detachments is a vitrectomy. During this procedure, the vitreous is carefully removed from the eye and then air or gas is injected into the cavity to push the retina back into its proper position. The gases are gradually replaced by natural fluids produced inside the eye.

The success of these surgical techniques depends upon the size and location of the damaged area of the retina, the length of time that elapses between the onset of the tear or detachment and the surgery to repair the damage, and whether or not other complicating factors are present. Many persons who have undergone retinal reattachment surgery regain all of their previous vision, while some regain only functional vision. Even in these latter instances, the treatment is usually effective in preventing further damage to the retina and more vision loss.

As with most any surgery, follow-up care is necessary after retinal surgery. Each person's reaction to the procedure is unique. Some require upwards of six months to heal. Others require repeated treatments. Following scleral buckle surgery, it is common that there will be a change in your glasses.