Movement of retina
from its usual location is called retinal
detachment. It usually signifies the
separation of the pigment layer from the
sensory layer. This cuts the retina off from
its blood supply and nutrition. The retina
will degenerate and lose its ability to
function if it stays detached long enough.
What is a retinal tear?
The retina may tear
at certain points due to pull by the
vitreous gel. A child’s vitreous has the
consistency of egg white… and is firmly
attached to the retina at certain points.
Usually with changes in hydration of the
vitreous, it separates from the underlying
retina. This separation usually is trouble
and symptom free… but may cause ters in the
retina at times. This allows fluid to seep
under and elevates the retina from the
choroid ( The pigment and vessel layer that
nourishes the retina)
What are the zones of the retina and
how are they important?
The most sensitive
area of the retina is the Macula. This is
primarily composed of cones and is
responsible for the fine visual work we put
our eyes to – reding, recognizing faces etc.
The peripheral retina is primarily composed
What are the types of retinal
There are three
major types of retinal detachment:
A break in the sensory layer can cause
the fluid to seep in and lifts the
retina off. This is more commonly seen
in eyes weakened by HIGH MYOPIA, EYE
INJURY or PREVIOUS EYE SURGERY
This is the kind of detachment that
develops when strands of vitreous or
scar tissue pull on the retina as
happens in DM
This kind of detachment results when any
inflammatory disease of the eye results
in collection of fluid under the retina
due to swelling or bleeding
Each of these would
need a different approach and comprehensive
care facility to treat the patient as a
whole and not an isolated episode of sight
How can you tell if you could be
having a retinal detachment?
There is usually
quite a typical presentation of an RD:
Who is at risk for
(More than -6 correction) LASIK surgery
to correct the ‘number’ may rid one of
glasses but it does so by altering the
shape and /or thickness of the cornea.
IT DOES NOT ALTER THE RISK OF RETINAL
DETACHMENT in a ‘corrected’ eye. Even
myopes who have had refractive surgery
MUST visit an ophthalmologist for a
quarterly eye exam to track the retina.
Near sighted subjects have a 1 in 20
chance of a RD as compared to 1 in
10,000 in the normal population.
This, too places the eye at high risk
for a detachment by traction or bleeding
or direct trauma?
contralateral eye This signifies a weak
surgery This may be as routine as
What can you do?
detachment is an OCULAR EMERGENCY. It is
critical to report early.
EXAM by an OPHTHALMOLOGIST is likely to
pick up early or predisposing changes in
the retina. The preventive steps can
then be taken and retinal detachment can
When at risk
avoid jerky activities like running/
timely treatment of seasonal allergies…
the force generated by a sneeze at the
nostrils is 600N/meter square
What you may have
PREVENTION IS THE BEST
Unless you undergo timely and appropriate
treatment including surgery by an expert,
you may suffer irreversible visual
This will affect your ability to perform
normal daily chores that you may be quite
used to before the visual disaster:
car pools or explore possibility of
special glasses meant for RD patients
and keep an extra pair in your work bag
Home safety :
Ensure that your home has no rugs that
you could trip over and is brightly lit
without and shade or shadow.
Enlist help : Do
inform your friends and relatives seek
help in any activity that you may find
difficult to perform
What are the tests you may
have to undergo?
of the eye
What are the treatment
retinal detachments need immediate
specialist consult atleast. All fresh RDs
MUST be treated surgically within 24-48
hours. All chronic and longstanding RDs must
be addressed within a week of diagnosis.
Exudative Rds usually resolve spontaneously
with appropriate menegement of the
Traction RDs require pars plana vitrectomy
and silicone oil tamponade.
Small tears or breaks may be managed by
LASER photocoagulation or cryopexy.
True RDs require surgical intervention. This
may be in the form of
The retinal tear is first repaired with
cryopexy, the fluid drained out and
thereafter, a soft sponge or hard silicone
band is used to indent the sclera at the
point of detachment or circumferentially in
case of major RDs. This is sutured to
reestablish adhesion between RPE and the
sensory retina and needs general anaesthesia.
A gas bubble is introduced intravitreally-
usually perfluoropropane( C3F8) under local
anaesthesia. Since gas rises, this is best
suited for superior detachments. Careful eye
and head positioning are of utmost
importance for a good “take”.
Silicone oil tamponade
This is similar to pneumatic retinopexy
escept that the tamponade material is the
What can you expect after
Strict head and
eye positioning will be required in the
immediate postoperative period and is
critical for the result.
that got you to the doctor in the first
place may not immediately disappear. As
the retina regains its perfusion and
heals, the curtain gradually fades and
the vision may clear significantly
depending upon the severity and the type
of RD and the timely intervention.
Time of surgical
intervention is of critical importance
and cannot be overemphasized. The nature
of all RDs is to progress to become
total within 6 months if left untreated.
all retinas may not reattach. If such is
the case, the eye is likely to continue
to deteriorate and ultimately become
|Author: Sanjay Dhawan, New Delhi, India
Last updated on 31 May 2011