Retinal detachment

Overview: What is a retinal detachment?

Retinal detachment is a very serious eye condition that requires quick action. You must have them treated immediately, or vision will decline and blindness is imminent.

In retinal detachment, the layer containing the light-sensitive sensory cells (the photoreceptors) lifts away from the underlying pigment epithelium and choroid. The latter is crisscrossed by many small vessels and supplies the retina with oxygen and nutrients. If the retina detaches from its support, this supply is interrupted. Without quick treatment, the retina takes permanent damage. Medical professionals also call retinal detachment ablatio retinae or amotio retinae.

The most common cause is a tear or hole in the retina, often due to vitreous detachment. Vitreous fluid then penetrates the opening and accumulates under the retina – thus detaching the retina from its normal position. But also diseases, inflammations or tumors of the retina can be behind retinal detachment. The first signs of this are seeing flashes of light and dark spots. Then symptoms such as a restricted visual field and reduced vision are added.

Treatment depends on where and how far the retina has already detached. Laser treatment and eye surgery are used.

Retinal detachment – frequency and age

Retinal detachment is a rather rare eye disease. Physicians estimate that about 1 person in 10,000 is affected each year. Most often, severely nearsighted people in middle age become ill. Rarely, retinal detachment occurs in younger and normally sighted people. It is also more common in men than in women.

Retinal detachment: causes and risk factors

In retinal detachment, the retina separates from the choroid and fluid from the vitreous accumulates between the two layers. The retina bulges into the eyeball like a bubble. In the area of detachment, the retina is no longer supplied with oxygen and nutrients from the choroid. The consequences are visual disturbances – up to blindness. Retinal detachment can have several causes. According to this, ophthalmologists distinguish the following forms:

• Retinal detachment due to tearing: Due to vitreous detachment, the retina tears. In most cases, this detachment happens because the vitreous shrinks. Most often this is seen in middle-aged people (a normal aging process), but also in severely myopic people. Fluid seeps out of the vitreous through the tear, accumulates under the retina, and lifts it off. Recent surgery for a cataract can also significantly increase the risk for tear-related retinal detachment.
• Injury-induced retinal detachment: The vitreous body can be deformed by external mechanical impact, for example when you get a very hard object on the eye. Then the eyeball is bruised. As part of this eye injury, a hole or tear can develop, vitreous fluid can enter, and the retina can detach.
• Fluid-induced retinal detachment: Other retinal diseases are involved here, such as diabetic retinopathy (in diabetes mellitus), age-related macular degeneration (AMD), infections and inflammations. Proteins, fats and water enter the retina and are deposited there. In addition, adhesions form that exert traction forces on the retina. Eye tumors can also be the cause. The tumor displaces the retina or it detaches due to fluid secretion.

Symptoms: Retinal detachment manifests as visual disturbances

Retinal detachment is often heralded by early symptoms that precede the actual detachment. You should watch for these warning signs and see an eye specialist immediately:

• Flashes of light because tensile forces act on the retina and irritate the sensory cells – the flashes of light show even when the eyes are closed
• Bright flicker – usually unilateral and more pronounced in the dark than in the light
• Affected persons see many dark spots (“soot rain“) or floating particles that sink downwards; the reason is small bleedings if the tear runs through a blood vessel – the blood particles spread in the eye and appear as soot rain.

If the retina has already detached, other symptoms are added:

• Visual field loss: A wall or shadow pushes in front of that part of the visual field where the retina has detached. Some also see a veil or curtain.
• If the macula – the area of sharpest vision – is affected: blurred or distorted vision, reduced vision

Without treatment, the symptoms continue to increase and damage occurs that can no longer be reversed – in the worst case, blindness is imminent if doctors do not intervene in time. So see an eye doctor or ophthalmologist immediately.

Retinal detachment: diagnosis with us

Doctors need to diagnose “retinal detachment” as soon as possible in order to treat it quickly. First, they ask for the patient’s medical history in a conversation (anamnesis). For example, the following points are important:

• What symptoms do they have and since when?
• How pronounced are they and have they progressively worsened?
• Do you have any known diseases, such as diabetes mellitus or age-related macular degeneration?
• Do you suffer from an eye disease, such as nearsightedness?
• Have you suffered an eye injury, such as from a blow or object?
• Have you undergone eye surgery?
• Have you ever had a retinal detachment ?

This is followed by an eye examination using the following methods:

• Ophthalmoscopy (ophthalmoscopy or funduscopy) for examination of the eye and fundus of the eye
• Determination of visual acuity
• sometimes ultrasound examination (sonography) of the eye
• in case of injuries to the eye: computed tomography – an X-ray examination that provides detailed slice images.
• In some cases, a magnetic resonance imaging scan is also done.

Ophthalmologists must differentiate retinal detachment from other eye diseases that cause similar symptoms. Once the diagnosis of retinal detachment has been made, therapy must begin immediately.

Retinal detachment: prevention, early detection, prognosis

The cause of a retinal detachment can be mechanical impact on the eye, such as from flying objects or force on the eye (e.g., during certain sports). Therefore, always protect your eyes well with glasses when they are exposed to particular hazards at work and in everyday life. In this way, you can prevent retinal detachment to a certain extent.

In addition, diabetes increases the risk of retinal detachment, or more precisely, a complication of it, diabetic retinopathy. You can prevent this by ensuring that your blood glucose levels are permanently well controlled. Also, have your eyes checked regularly by an eye doctor. This also applies to people who are severely nearsighted, have had cataract surgery, or have had a previous retinal detachment.

Otherwise, the general advice is to always seek medical attention immediately if you experience symptoms such as flashes of light, dark spots, or visual field loss. In the early stages, retinal detachment can sometimes still be treated with a laser.

Retinal detachment course and prognosis

The course and prognosis for retinal detachment depend on how far the retina has detached and how much time has elapsed between the onset of detachment and treatment.

The prognosis is more favorable if the extent of retinal detachment is not yet so great and doctors or physicians treat the disease quickly. Then the vision is preserved in many cases. Without treatment, the retina becomes more and more detached, vision increasingly fades, and blindness may even be imminent. Reasons enough, therefore, to consult an ophthalmologist immediately at the first alarm signs.

Retinal detachment: treatment must start quickly

Doctors and physicians must treat the retinal detachment as soon as possible. Which therapy is used depends on whether the retinal detachment has just begun (early stage) or whether the retina has already detached.