Retinal detachment: symptoms and causes

By Cristiano Antonino On Jan 28, 2023

Retinal detachment is one of the most frequent causes of sudden vision loss, the prognosis of which is worse when the part of the retina that detaches is the macula, i.e. the central part

It can affect people of any age, and is a condition that must be treated immediately, at the first symptoms.

What is retinal detachment?

Retinal detachment describes an emergency situation in which the retina moves away from its normal position.

Retinal detachment separates the retinal structures from the choroidal blood vessel layer, which provides oxygen and nourishment to the eye.

The longer the retinal detachment goes untreated, the greater the risk of permanent vision loss in the affected eye.

Retinal detachment: the symptoms

Retinal detachment is painless, but warning signs almost always appear before it occurs or is advanced, such as

sudden appearance of tiny specks that seem to move across the visual field;
flashes of light in one or both eyes (photopsia);
blurred vision;
gradually reduced lateral (peripheral) vision;
perception in the visual field of a scotoma, which is a tent-like shadow that gradually expands.

What are the causes of retinal detachment?

There are three different types of retinal detachment: rhegmatogenous, traditional and exudative.

Rhegmatogenous. Rhegmatogenous detachments, the most common, are caused by a hole or tear in the retina that allows fluid to pass through and collect below the retina. This fluid accumulates and causes the retina to pull away from the underlying tissues. The areas where the retina detaches lose blood supply and stop functioning, causing loss of vision. The most common cause of rhegmatogenous detachment is ageing. With age, the gelatinous material that fills the inside of the eye, known as the vitreous, can change consistency and shrink or become more liquid. Normally, the vitreous separates from the surface of the retina without complications, a common condition called posterior vitreous detachment (PVD). When the vitreous separates or detaches from the retina, it can pull on the retina with sufficient force to create a retinal tear. If left untreated, the liquid vitreous can pass through the tear into the space behind the retina, causing retinal detachment.

Traditional. This type of detachment can occur when scar tissue grows on the surface of the retina, causing the retina to move away from the back of the eye. Traction detachment is usually observed in people who have diabetes or other poorly controlled conditions.

Essudative. In this type of detachment, fluid accumulates under the retina, but there are no holes or tears in the retina. Exudative detachment can be caused by age-related macular degeneration, eye injuries, tumours or inflammatory disorders.

How to prevent retinal detachment

Prevention of retinal detachment is achieved by being aware of the warning symptoms (flashes of light, flying flies, black curtain) and undergoing an eye examination as a matter of absolute urgency if one or more of these appear.

The only effective form of prevention of functional damage is also the speed with which one is able to intervene in the event of a rupture.

Surgery or outpatient laser photocoagulation treatment of the retina can then be performed.

In certain cases, albeit rare, retinal laser treatments can also be performed in patients with peripheral retinal degeneration, conditions that can lead to retinal ruptures.

How to treat retinal detachment

Surgery can be performed under locoregional anaesthesia or general anaesthesia.

Surgery from the outside is possible, in which without entering inside the eye, cerclages or plumbings are applied to the sclera, facilitating the release of traction and the closure of retinal ruptures.

Then there is surgery from the inside, in which the vitreous, i.e. the gel contained inside the eye, is removed, and with the help of tamponades, the detached retina is repositioned and supported until it heals.

In some cases, a second surgery several months later is necessary to remove the tamponade.

Today it is possible to perform the operation using minimally invasive surgical techniques with accesses of about 0.5 mm in size.

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