Retinal Tear and Detachment

When the retina is pulled off the back wall of the eye, it stops functioning properly. The common symptoms people notice are new or worsening floaters in their vision, flashing lights, and a dark shadow or curtain that is either stationery or progressing towards the central vision.

You may have only one or all of these symptoms, and the severity of the symptoms can be related to the extent of the detachment.

The most common risk factor for a retinal tear is getting older. The vitreous gel that fills the inside of the eyeball ages and can pull on the retina where it’s strongly attached to the retina or where the retina is weaker. Other factors include trauma or injury to the eye, diabetes, being short-sighted (myopic) and previous eye surgery.

A careful, dilated, examination of the eye is required to check for retinal tears or detachment. This may include pushing of the outside of the eye (scleral depression) to bring the peripheral retina into view for examination.

Other testing available at the QEI Clinic and useful in diagnosing retinal tears and detachment include:

• Wide-field imaging – this allows documentation of the extent of retinal detachment
• Optical coherence tomography – to assess whether the macula (the central part of your retina) has been affected
• Ultrasound – if a clear view is not possible, then an in-clinic ultrasound may be needed

The main goal of treatment is to re-attach the retina, and to seal all tears or holes that caused the retinal detachment. The type of treatment needed is tailored by multiple factors, including each individual patient’s history and examination findings, their risk factors, family history, previous treatments and ability to tolerate the options.

• Laser surgery – Retinal tears that have not progressed to a detachment, or a small retinal detachment, can be treated with laser to ‘wall-off’ or ‘barricade’ the tear from the healthy.
• Vitrectomy – This is the commonest method to treat retinal detachments. It involves three incisions on the sclera, the white part of the eye. Fine instruments are then placed inside the eye to remove the vitreous gel, flatten the retina, and keep it in place using laser or cryopexy (freezing the retina). Following this, a gas or oil bubble may be placed in the eye.
• Scleral buckle with or without vitrectomy – In this procedure, a silicon band is placed around the eye ball to help support the retina from outside.
• Pneumatic retinopexy – in specific types of small retinal detachments, a gas bubble and laser in clinic can be used to either help repair the retina or temporary protect the retina until further surgery.

In some cases the repair can be a two-step surgery, to remove oil or perform cataract surgery. The risks, benefits and alternatives to each option are discussed in detail in clinic prior to any procedure.

How much vision you recover greatly depends on the extent of retinal tear and detachment present. Various factors are involved, including whether you have had cataract surgery or not, and whether your macula has been involved in the detachment or not. You may need a second step surgery in the future, for removing the oil, or earlier cataract surgery following retinal detachment repair to obtain the best possible vision. Most patients with a retinal detachment have some degree of permanent vision loss, either in their peripheral vision or in their central vision.