What You Need to Know About Retinal Detachments

Experiencing floaters or flashing lights in your vision might have you scheduling a trip to your eye doctor, and those symptoms could be signs of a more serious condition, a retinal detachment. For most cases, a detachment occurs from a natural, physiological process, with no pain, and is not caused by trauma.

“Think of your retina as the wallpaper on the inside of your eye," says Haroon Chaudhry MD, of TriHealth Evendale Hospital. “If you have a little hole in your wallpaper, it can be easy to ignore, but if you don’t do anything about it, eventually the wallpaper peels off the wall.”

What is a Retinal Detachment?

Your eye is filled with a transparent gel, known as vitreous gel, which is adherent to the inner lining of your eye, known as the retina. In some cases, the gel is either so tightly adherent at a certain point, or there’s a weak point in the retina, that a rip, known as a retinal tear, can occur. “When you have a tear in your retina, we describe it almost as if you have a hole in your wallpaper,” Dr. Chaudhry says. “Fluid gets through that retinal tear, and causes the retina to peel off the back wall of the eye, which is a retinal detachment.”

As we age, our vitreous gel turns into a liquid, causing it to separate from the retina and form small bubbles. Dr. Chaudhry says this process happens to everyone and is known as vitreous detachment, which usually does not damage the retina.

While a vitreous detachment is the most common cause of a retinal tear, other risk factors include:  

• Trauma
• Extreme nearsightedness
• Family history of retinal detachments

People usually notice two symptoms once they have a vitreous detachment:

• Floaters – pieces of vitreous gel moving around in the liquid
• Flashing lights – When gel is stuck tightly to the retina and trying to release, the affected cells are stimulated and don’t know if it’s a light telling them to fire or something mechanical tugging on them. The sensation of seeing a flashing light occurs from within the eye.

Additional symptoms may include:

• Blurred vision
• Shadow or blindness in part of affected eye

Types of Retinal Detachments:

Most retinal detachments start in the peripheral and Dr. Chaudry says it’s important to catch the detachments before it extends into the macula, the portion of your eye that is responsible for fine vision.

There are two types of retinal detachments:

• Macula-on detachment: macula is still on, but the peripheral has a defect
• Macula-off detachment: macula is no longer on

While both conditions need repair, the macula-on detachment is more of an emergency. “If the macula is still on, we like to reattach within 24 hours, because there is a risk of the tear extending to that center portion of the eye, and you want to preserve that central vision and not let it be involved,“ Dr. Chaudhry explains. “Once the center part detaches, even if you get it back on, it may not see as well as it used to.”

Procedures for Retinal Detachment:

• Pneumatic retinopexy: A gas bubble is injected into the eye that pushes your retina back into place, and a laser is used to seal the tear. Head positioning is important during the healing process to allow for the gas bubble to rise and push against the tear. The gas bubble will evaporate on its own in the days/weeks following the procedure.
• Vitrectomy: This is the most common way to fix a retinal detachment. Small cuts are made in the sclera (white portion of eye) and the vitreous gel is removed and the eye is filled with a gas bubble. The remaining portion of the surgery follows the pneumatic retinopexy procedure. For some cases a silicone bubble is used, but it does not evaporate and requires a second surgery for removal.
• Scleral buckle: This is the original method used to fix a retinal detachment. A silicone band is placed around the eye and used to push the wall of the eye to meet the retina.

Risks associated with the procedures:

• The tear will not heal
• Scar tissue will cause a new tear to develop
• Infection and pain associated with the band in the scleral buckle
• Increased risk of cataracts
• Possibility of becoming more nearsighted

Life after Correcting a Retinal Detachment:

Recovery time for the procedures, on average, is two weeks. More extensive cases, such as using a longer or silicone gas bubble, may require a couple of months or longer to heal. Avoid heavy lifting, strenuous activities, and maintain proper head positioning for the weeks following the procedure to ensure adequate healing.