Retinal Detachment

Retinal detachment is where the the retina separates from the choroid underneath. This is usually due to a retinal tear that allows vitreous fluid to get under the retina and fill the space between the retina and the choroid. The outer retina relies on the blood vessels of the choroid for its blood supply. This makes retinal detachment a sight threatening emergency unless quickly recognised and treated.

 

Risk Factors

  • Posterior vitreous detachment
  • Diabetic retinopathy
  • Trauma to the eye
  • Retinal malignancy
  • Older age
  • Family history

 

Presentation

Retinal detachment is a painless condition that can present with:

  • Peripheral vision loss. This is often sudden and like a shadow coming across the vision.
  • Blurred or distorted vision
  • Flashes and floaters

 

Management

Patients presenting with painless flashes and floaters should have a detailed assessment of the retina by someone with the appropriate skillset to detect retinal tears or detachment. Any suspicion of retinal detachment requires immediate referral to ophthalmology for assessment and management.

Management of retinal tears aims to create adhesions between the retina and the choroid to prevent detachment. This can be done using:

  • Laser therapy
  • Cryotherapy

Management of retinal detachment aims to reattach the retina and reduce any traction or pressure that may cause it to detach again. This needs to be followed by treating retinal tears as above. Reattaching the retina can be done using one of three options:

  • Vitrectomy involves removing the relevant parts of the vitreous body and replacing it with oil or gas.
  • Scleral buckling involves using a silicone “buckle” to put pressure on the outside of the eye (the sclera) so that the outer eye indents to bring the choroid inwards and into contact with the detached retina.
  • Pneumatic retinopexy involves injecting a gas bubble into the vitreous body and positioning the patient so the gas bubble creates pressure that flattens the retina against the choroid and close the detachment.

 

Last updated April 2019
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