A retinal detachment is considered an ocular emergency requiring prompt treatment to save your sight. Although a retinal detachment is painless, without attention from an ophthalmologist experienced in retinal surgery, the vision loss can be permanent and significant. Knowing the symptoms and signs of a retinal detachment can enable you to seek help quickly.
What is a Retinal Detachment?
The retina is the layer of sensory tissue lining the back of the eye. It’s the cells of the retina that receive the incoming light from the world around us, convert it to neural signals, and transmit these signals via the visual pathways to the necessary processing centres of the brain for vision.
For the retina to function properly (and for vision to work), it needs to be able to access the basic necessities – a blood and oxygen supply, plus a metabolic waste removal system. The retina must also, of course, be physically able to send along its neural signals via a connected network of cells. A retinal detachment occurs when the retina is separated from its underlying layers, removing its access to the support it needs to function. Many eye care practitioners will describe a retinal detachment as like wallpaper peeling away from the wall. This results in a loss of sight in the area of the detached retina. A retinal detachment may occur just in one area of the retina, or in severe cases, the entire retina may come away, resulting in complete blindness in that eye.
Eyecare professionals will often refer to a retinal detachment case as “macula on” or “macula off”. The macula is an anatomical part of the retina responsible for your central vision. The status of the macula – whether it is detached or still attached – can determine how urgently retinal surgery needs to be performed. As the central vision is still intact in a macula-on retinal detachment, ophthalmologists will recommend prompt treatment, typically within 24 hours, in order to preserve the vision. However, in a macula-off detachment, as the prognosis is immediately much poorer for recovering the central vision, immediate retinal surgery is less critical. Nonetheless, treatment for a macula-off detachment is still recommended within 7-10 days for the best possible visual recovery.
While some retinal detachments occur for no identifiable reason, a situation known as an idiopathic retinal detachment, there are some known factors that can increase your risk. These include:
- A history of trauma to the eye
- A history of a previous retinal detachment
- A family history of retinal detachment
- Any degree of myopia (short-sightedness), with the risk of retinal detachment increasing as the degree of myopia increases
- Older age
- Certain eye operations, such as cataract surgery
- Other eye conditions, such as a retinal hole or tear, diabetic retinopathy, or lattice degeneration
What are the Signs of a Retinal Detachment?
Signs of a retinal detachment include:
- The sudden appearance of small floating specks within the eye, known as floaters. Typically, this presents as a shower of many tiny dark drifting flecks or sometimes as cobwebs or drifting lines or squiggles in the eye. Floaters from a retinal detachment are due to fragments of retinal tissue or drops of blood from broken retinal capillaries floating inside the eye.
- The sense of flashing lights in the vision. This phenomenon is known as photopsia and is a result of the mechanical stimulation of the retina as it pulls away, giving the sensation of light perception.
- A sudden darkening or loss of vision in one area of the eye. Some will describe this sensation as like a dark curtain coming across the vision. This dark shadow occurs in the area of the detached retina as it loses its ability to detect light.
Another eye condition known as a posterior vitreous detachment can often present with signs similar to a retinal detachment. A posterior vitreous detachment is a normal age-related change to the vitreous gel inside the eye that can also cause floaters and photopsia. While most cases of flashing lights and floaters are likely to be a posterior vitreous detachment, as these may also be a sign of a retinal detachment it is important not to simply dismiss these symptoms but still get checked by an optometrist or ophthalmologist. A posterior vitreous detachment can increase the risk of a retinal detachment by causing a hole or a tear during the process of the vitreous gel liquefying.
A retinal detachment can be treated a few different ways, often depending on the location and size of the detachment. An ophthalmologist experienced in retinal surgery will counsel you on the most appropriate treatment, which may be:
- Pneumatic retinopexy: the injection of a silicon gas bubble into the eye, which pushes the detached retina back into position.
- Vitrectomy: surgical removal of the vitreous gel, so that it no longer pulls on the retina.
- Scleral buckle: a band of silicon is sutured to the outside of the eyeball, which indents the wall of the eye inwards to encourage the retinal to reattach.
As a retinal detachment can have devastating consequences on vision, it’s important never to ignore your symptoms.
Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.