The retina is the transparent, light-sensitive membrane that lines the inside of the eye. It is the "film in the camera" that allows us to see. Normally, the retina lies closely against a layer of cells known as the retinal pigment epithelium (RPE). If fluid collects between the retina and the RPE the retina will separate from the back of the eyewall, a condition known as a retinal detachment.

Retinal detachments are most commonly caused by retinal tears which allow fluid from the inside of the eyeball to pass under the retina causing it to detach. Once the retina begins to detach from a retinal tear, it usually progresses until the entire retina is out of place. Once the central retina (the macula) becomes detached, vision is usually severely affected.

Retinal detachments may also occur from scar tissue or abnormal blood vessels pulling on the retina (a tractional retinal detachment). Tractional retinal detachments are most commonly seen in individuals with diabetes (see diabetic retinopathy), or in those who have had scar tissue grow over the retina following a previous surgery for retinal detachment. Vitrectomy surgery can be used to remove scar tissue and abnormal blood vessels and repair tractional retinal detachments. Not all tractional retinal detachments require treatment.

Inflammatory conditions may also cause retinal detachment due to the excess production of fluid which accumulates under the retina (exudative retinal detachment). Anti-inflammatory treatment may be adequate to cause resolution of exudative retinal detachments.

Individuals with retinal detachments may experience a number of symptoms. Those with retinal tears frequently notice flashes and floaters in their vision followed by a shadow or curtain obscuring a portion of the peripheral vision as the retina detaches. Once the central retina detaches, the vision usually becomes significantly blurred. Because the retina has no pain fibers, most patients with retinal detachments experience no pain. Individuals with symptoms suggestive of a retinal detachment should be seen as soon as possible. The earlier a retinal detachment is diagnosed and treated, the better the visual prognosis.

Numerous different treatments are available to treat retinal detachments and with modern surgical techniques, nearly all retinal detachments can be repaired. Small peripheral detachments may occasionally be treated with laser demarcation. In this procedure, laser spots are used to wall-off the retinal detachment and thus reduce the chance of it enlarging. This technique is useful for only a small percentage of retinal detachments. Intraocular gas bubbles can be used to flatten some retinal detachments through a procedure known as pneumatic retinopexy. This procedure is usually done in a minor procedure room rather than an operating room. The most common surgery used to repair retinal detachments is scleral buckling. In this procedure, a piece of silicone rubber is sewn to the eyewall to indent the eyeball and relieve traction being exerted on any retinal tears. The scleral buckle is often placed around the eye much like a belt to achieve the desired result. This procedure is performed in an operating room and can be done either with local or general anesthesia. Finally, vitrectomy surgery is necessary to repair some forms of retinal detachment. During a vitrectomy, instruments are placed inside the eye and the vitreous gel is surgically removed. Any traction being exerted on the retina can be directly relieved. The eye is usually filled with gas at the end of this procedure and a scleral buckle is usually placed on the eye at the same time.

Dr. Goldman has extensive experience in the diagnosis and treatment of retinal detachments. If you or someone you know has a retinal detachment or other retinal problem, please call us to arrange a comprehensive evaluation at either of our convenient locations.

Click here to see a photograph of a retinal detachment.