Retinal detachment

Retinal detachment is relatively rare. If not treated immediately, the affected eye can go blind. The most important information about causes, diagnosis and therapy can be found here

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The retina is located between the choroid and the vitreous humor

© W & B / Martina Ibelherr

Retinal detachment - briefly explained

When the retina becomes detached, the retina becomes detached from the underlying layer, which can lead to visual disturbances (loss of visual acuity or visual field defects) or even complete blindness in the affected eye.

The most common cause of retinal detachment are holes or tears in the retina due to a shrinking vitreous body (detachment of the vitreous body with tension on the retina). Myopia greater than three diopters, cataract surgery, previous eye injuries, blunt blows to the eye (sports injuries) or long-term diabetes mellitus (diabetes) are also risk factors.

Typical symptoms of retinal detachment include the perception of flashes of light, a swarm of black dots or a dark curtain or shadows in the field of vision. If these symptoms occur, an ophthalmologist should be consulted as soon as possible.

Detachment of the retina is diagnosed by examining the fundus of the eye. Holes or tears in the retina can usually be treated with a laser treatment. However, if the retina has already peeled off, the surgical treatment is carried out by a specialized eye surgeon.

What is retinal detachment?

Retinal detachment occurs when the retina is lifted from the underlying layer. This leads to an insufficient supply of the retina, which can ultimately lead to the death of the cells of the retina. Retinal detachment is therefore an emergency and should usually be treated as soon as possible.

Retinal detachment, called ablatio retinae in technical terms, is relatively rare. It affects about 1 in 10,000 people each year. The eye disease occurs more frequently in middle and older age, but can also affect young people, especially those with moderate to severe myopia or as a result of eye injuries (sports accidents).

Structure of the retina with rods and cones

© W & B / Szczesny

Background information - function of the retina

The retina is essential for the visual process and is located in the back of the eye. In addition to numerous blood vessels, the retina of the eye contains two different types of sensory cells (photoreceptors) that ensure vision: the cones and the rods. While the cones are responsible for colored vision during the day, the eye uses the rods to differentiate between light and dark, which is particularly important at dusk and at night. The external light stimuli hit the retina via the pupil and the eyeball. This directs the light stimuli to the optic nerve, via which the information in the brain is combined into the image that we perceive.

Causes: What causes retinal detachment?

Rhegmatogenic retinal detachment caused by cracks

The most common cause of a detached retina is a hole or tear in the retina. This form is called rhegmatogenic (tear-related) retinal detachment. Usually the retina tears because the vitreous humor shrinks in the course of life. The glass body lines the inside of the eyeball (see graphic at the beginning of the article). It consists of a gelatinous mass that contains a lot of water. If the vitreous body shrinks and it does not detach completely from the retina, this can lead to tractions on the retina. As a result, the retina can tear in these areas. Holes form in the retina through which fluid from the vitreous humor can pass under the retina. This accumulates between the retina and the underlying layer, causing the retina to become detached there.

There are various risk factors that can promote rhegmatogenic retinal detachment. In addition to age, this also includes moderate or severe myopia. People who have had to undergo surgery for a cataract or who have been hit in the eye (sports injuries such as martial arts or ball sports such as tennis) are also at higher risk.

Exudative retinal detachment

Another form is the so-called exudative retinal detachment. The retina loosens here because fluid escapes from the vessels of the choroid and accumulates between the retina and pigment epithelium. The cause of this is inflammation in the eye, and rarely a tumor - for example choroidal melanoma. This form of retinal detachment is very rare.

Tractive retinal detachment

The third form is called tractive retinal detachment. It occurs when vitreous tissue and / or layers of the retina scar. The area around the scar shortens and creates a pulling effect. The trigger is often diabetic retinopathy, i.e. damage to the retina that occurs as a result of longstanding diabetes mellitus. The retina can also become detached in this form as a late consequence of so-called retinopathy of premature babies.

Symptoms: what symptoms does retinal detachment cause?

The retina is supplied with nutrients via the choroid. If the retina becomes detached, it lacks the important substrates and functions only to a limited extent. This becomes noticeable with typical symptoms.

Flashes of light, soot rain, black mosquitos in front of your eyes

A tear in the retina often leads to flashes of light, whereby the vitreous humor also plays a role here, as it pulls on the retina. The flashes of light are perceived even with closed eyes. If small blood vessels are injured by the tear, this is indicated by black dots. They can appear and move in great numbers. Patients sometimes describe them as "soot flakes", "soot rain" or "a swarm of black mosquitoes". Flashes of light and soot flakes only occur when the retina is detached as a result of the crack.

Floaters

The phenomenon of "floaters", or flying mosquitoes, on the other hand, is usually harmless and is triggered by opacity of the vitreous body. Almost transparent streaks, dots or "mosquitos" form, which are particularly noticeable when reading or in front of a light background. Nevertheless: Anyone who notices "floaters" for the first time or notices that they are changing should always go to an ophthalmologist as a precaution. He can determine whether there is a retinal tear behind it.

Black shadow or curtain

If the retina becomes detached in the upper area, a dark shadow can appear from bottom to top, which obscures the view. If the retina rises in the lower area, a kind of black curtain can form, which sinks from top to bottom. These dark areas can shift. If retinal detachment occurs at the point of sharpest vision (yellow spot, macula lutea), the patient can no longer see clearly. No image is formed on the retina in the black areas, the person affected has deficits within the image shown, which is also known as visual field loss. Black shadows or curtains can appear with all forms of retinal detachment. If the disease is not treated quickly, the affected eye becomes blind.

Important: If you have symptoms of retinal detachment, you should consult an ophthalmologist as soon as possible.Retinal detachment is an emergency and should be clarified immediately and, if necessary, operated on so that the eye does not become permanently blind.

Diagnosis: how is retinal detachment diagnosed?

Because the retina is at the back of the eye, the ophthalmologist cannot examine it with the naked eye. He inspects the retina through an ophthalmoscopy. To do this, the doctor first gives eye drops with an agent that dilates the pupil.

Then he looks through the dilated pupil with a magnifying glass - similar to a magnifying glass. With the help of a light source, he can now illuminate the fundus and recognize changes in the retina. If this has loosened, gray, raised wrinkles are often visible, for example. Cracks and holes also have characteristic structures.

If there is bleeding in the vitreous humor obscuring the retina, the ophthalmologist can use an ultrasound machine to detect changes in the retina.

Therapy: how is retinal detachment treated?

Laser treatment

Neither a tear in the retina nor a detachment can be brought under control with medication. If the ophthalmologist determines that the retina is torn but has not yet detached, he can laser the eye in question. The laser beam triggers an inflammatory reaction at the injured area, scarring the tissue and "sticking" the hole in the retina. This can often prevent retinal detachment.

surgery

However, if the retina has already loosened, laser treatment will no longer help. In this case, the patient should be operated on by a specialized eye surgeon as soon as possible. Which method is used depends, among other things, on the type of retinal detachment and how far it has progressed. The aim of such an operation is to reattach (fix) the detached retina and to remove the triggering factors, for example changes in the vitreous humor.

As surgical methods, indenting procedures (silicone seal or cerclage) with or without removal of the (subretinal) fluid lying under the retina through a puncture as well as the so-called pars plana vitrectomy with gas or silicone oil filling (tamponade) have established themselves. All procedures have specific advantages and disadvantages and only an experienced surgeon can select the most promising procedure for the particular patient. In general, the indenting procedures are more suitable for the simpler retinal detachments with one or a few holes, while the pars plana vitrectomy is more suitable for more complicated cases. The introduction (instillation) of silicone oil promises the highest chance of permanent retinal application, but has the disadvantage that the silicone oil has to be removed again in a further operation.

In around 90 percent of cases, the eye operation is successful the first time and the retina can be put on permanently. Sometimes, however, the retina detaches itself again after days or even after weeks and months and another procedure has to take place. Surgical treatment of retinal detachment is considered a very demanding operation. If possible, patients should therefore choose a center that specializes in this operation, has a lot of experience and can therefore use the various surgical procedures adapted to the situation. Even if every surgical procedure has its risks: Those who do not have it carried out run the risk of the affected eye going blind.

Our expert: Professor Dr. med. Dr. hc. Arthur Mueller

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Our advisory expert:

Professor Dr. med. Dr. hc. Arthur Mueller is a specialist in ophthalmology and director of the clinic for ophthalmology at the Augsburg Clinic. He is a member of numerous specialist societies. His professional focus is on microsurgical interventions on the posterior (retina, choroid, vitreous humor) and anterior segment of the eye (cataract, glaucoma, keratoplasty).

Swell:

  • Deutsches Ärzteblatt, Feltgen N., Walter P., "Crack-related retinal detachment - an ophthalmological emergency", Dtsch Arztebl Int 2014; 111 (1-2): 12-22; DOI: 10.3238 / arztebl.2014.0012. Online: https://www.aerzteblatt.de/archiv/152678/Rissbedingte-Netzhautabloesung-ein-ophthalmologischer-Notfall (accessed on September 26, 2019)
  • German Opthalmological Society (DOG), "Pre-stages of a rehgmatogenic retinal detachment in adults", guideline 22 a, status 11/2011. Online: https://www.dog.org/wp-content/uploads/2009/09/Leitlinie-Nr.-22-a-Vorstufen-einer-rhegmatogener-Netzhautablösung-bei-Erwachsenen-17.11.2011.pdf (accessed on September 26, 2019)
  • German Opthalmological Society (DOG), "Rhegmatogenic Retinal Detachment", guideline 22 b, status 11/2011. Online: https://www.dog.org/wp-content/uploads/2009/09/Leitlinie-Nr.-22b-Rhegmatogene-Netzhautablösung-17.11.2011.pdf (accessed on September 26, 2019)
  • German Opthalmological Society (DOG), "Vitreous cloudiness - Mouches-volantes", guideline 23, status 06/2017. Online: https://www.dog.org/wp-content/uploads/2009/09/Leitlinie-Nr.-23-Glaskkörperertrübungen-Mouches-volantes-21.06.2017.pdf (accessed on September 26, 2019)
  • University Hospital Jena, Clinic for Ophthalmology, Retinal Detachment. Online: https://www.uniklinikum-jena.de/augenklinik/Patienten+und+Zuweiser/Krankheitsbilder+und+OP_Verfahren/Netzhautablösung.html (accessed on September 26, 2019)

Important note: This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.

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