Detached retina, and retinal tear.

The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.

In some cases there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment.

Symptoms include a sudden or gradual increase in the number of floaters and/or light flashes in the eye or the appearance of a curtain over the field of vision. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.

There are three different types of retinal detachment:

Rhegmatogenous [reg-ma-TAH-jenous] -- A tear or break in the retina causes it to separate from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina, and fill with fluid. These types of retinal detachments are the most common.

Tractional -- In this type of detachment, scar tissue on the retina's surface contracts and causes it to separate from the RPE. This type of detachment is less common.

Exudative -- Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina (subretina).

Although anyone can experience a retinal detachment, people with certain eye conditions are at increased risk. Some examples of these conditions include posterior vitreous detachment, lattice degeneration, x-linked retinoschisis, degenerative myopia, and uveitis. Injuries to the eye or head can also cause retinal detachment.

Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor's office. During laser surgery tiny burns are made around the hole to "weld" the retina back to into place. Cryopexy is a similar procedure that freezes the area around the hole.

Retinal detachments are treated with surgery that may require the patient to stay in the hospital. In some cases a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed to treat more severe cases. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous. Salt solution is then injected to into the eye to replace the vitreous.

Early treatment can usually improve the vision of most patients with retinal detachment. Some patients, however, will need more than one procedure to repair the damage.

The NEI supported The Silicone Study, a nationwide clinical trial that compared the use of silicone oil and long-acting intraocular gas for repairing retinal detachment complicated by proliferative vitreoretinopathy (PVR). Results indicate that silicone is slightly more effective than gas in reattaching retinas with no previous vitrectomy (surgical removal of the vitreous gel).

The following organization may be able to provide additional information on retinal detachment:

American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94109-7424
(415) 561-8500
http://www.eyenet.org
Publishes a patient brochure entitled Detached and Torn Retina.

For additional information, you may also wish to contact a local library.

Below is a sample of the citations available in MEDLINE, a comprehensive medical literature database coordinated by the National Library of Medicine (NLM). MEDLINE contains information on medical journal articles published from 1966 to the present. You can conduct your own free literature search by accessing MEDLINE through the Internet at http://medlineplus.nlm.nih.gov. You can also get assistance with a literature search at a local library.

To obtain copies of any of the articles listed below, contact a local community, university, or medical library. If the library you visit does not have a copy of a desired article, you may usually obtain it through an inter-library loan.

Please keep in mind that articles in the medical literature are usually written in technical language. We encourage you to share any articles you order with a health care professional who can help you understand them.

The repair of rhegmatogenous retinal detachments. American Academy of Ophthalmology. Ophthalmology 103(8):1313-24, August 1996.
Retinal detachments are the result of separation of the sensory retina from the retinal pigment epithelium (RPE), and they generally lead to severe visual loss if not successfully treated. There are four major types of retinal detachments: (1) rhegmatogenous, (2) traction, (3) exudative, and (4) combined mechanism. Rhegmatogenous retinal detachments occur in approximately 1 in 10,000 persons each year. In more than half of these eyes, the detachment occurs spontaneously, with no history of surgical or non-surgical trauma. Various treatments are used to repair most detachments, including retinal reattachment using cryopexy, diathermy, or laser in conjunction with indentation of the slera with a scleral buckle, or retinal reattachment surgery using pars plana vitrectomy or pneumatic retinopexy with or without a scleral buckle.

Vitrectomy for the management of recurrent retinal detachments. Holekamp NM, Grand MG. Current Opinion in Ophthalmology 8(3):44-9, June 1997.
Repair of rhegmatogenous retinal detachment is successful in approximately 90% of cases. Assuming all retinal breaks are identified and closed, the most common reason for eventual failure of surgery is the development of proliferative vitreoretinopathy, accounting for the failure of 7% to 10% of primary repairs and an increased proportion of secondary procedures. Recurrent retinal detachment complicated by proliferative vitreoretinopathy is now most frequently treated by pars plana vitrectomy with intraoperative peeling of membranes. This article reviews the latest developments in vitreous surgery to repair recurrent retinal detachments due to proliferative vitreoretinopathy, focusing on the most recent reports in the literature.

The National Eye Institute, part of the National Institutes of Health, is the Federal government's principal agency for conducting and supporting vision research. Inclusion of an item in this Information Resource Guide does not imply the endorsement by the National Eye Institute or the National Institutes of Health.