Retinal detachment involves the neurosensory layer of the retina (containing photoreceptors and nerves) separating from the retinal pigment epithelium (the base layer attached to the choroid). This is usually due to a retinal tear, allowing vitreous fluid to get under the neurosensory retina and fill the space between the layers.
The neurosensory retina relies on the blood vessels of the choroid for its blood supply. Therefore, retinal detachment can disrupt the blood supply and cause permanent damage to the photoreceptors, making it sight-threatening.
Risk Factors
- Lattice degeneration (thinning of the retina)
- Posterior vitreous detachment
- Trauma
- Diabetic retinopathy
- Retinal malignancy
- Family history
Presentation
Retinal detachment is a painless condition that can present with:
- Peripheral vision loss (often sudden and described as 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 to detect retinal tears and retinal detachment. Any suspicion of retinal detachment requires immediate ophthalmology referral.
Management of retinal tears aims to create adhesions between the retina and the choroid. The options are:
- 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. The options for reattaching the retina are vitrectomy, scleral buckle or pneumatic retinopexy.
Vitrectomy involves keyhole surgery on the eye, removing the vitreous fluid, fixing the tear, and then inserting gas or oil into the eye to hold the retina in place.
Scleral buckling involves using a silicone “buckle” to put pressure on the sclera from outside the eye, squashing the eye inwards to reconnect the layers of the retina. It acts like a corset, squeezing the eye contents together.
Pneumatic retinopexy involves injecting a gas bubble into the vitreous body and positioning the patient so the gas bubble presses the separated layer back into place.
Last updated October 2023