Retinal Detachment Resource Guide

On this page:

• Other Names
• What is retinal detachment?
• What are the symptoms of retinal detachment?
• What are the different types of retinal detachment?
• Who is at risk for retinal detachment?
• How is retinal detachment treated?
• National Eye Institute-Supported Research
• Other Resources
• Medical Literature

The information provided in this Resource Guide was developed by the National Eye Institute (NEI) to help patients and their families in searching for general information about retinal detachment. An eye care professional who has examined the patient's eyes and is familiar with his or her medical history is the best person to answer specific questions.

Other Names

Detached retina, and retinal tear.

What is retinal detachment?

The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.

In some cases there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment.

What are the symptoms of retinal detachment?

Symptoms include a sudden or gradual increase in either the number of floaters, which are little "cobwebs" or specks that float about in your field of vision, and/or light flashes in the eye. Another symptom is the appearance of a curtain over the field of vision. A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see an eye care professional immediately.

What are the different types of retinal detachment?

There are three different types of retinal detachment:

Rhegmatogenous [reg-ma-TAH-jenous] -- A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina. These types of retinal detachments are the most common.

Tractional -- In this type of detachment, scar tissue on the retina's surface contracts and causes the retina to separate from the RPE. This type of detachment is less common.

Exudative -- Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.

Who is at risk for retinal detachment?

A retinal detachment can occur at any age, but it is more common in people over age 40. It affects men more than women, and Whites more than African Americans.

A retinal detachment is also more likely to occur in people who:

• Are extremely nearsighted
• Have had a retinal detachment in the other eye
• Have a family history of retinal detachment
• Have had cataract surgery
• Have other eye diseases or disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degeneration
• Have had an eye injury

How is retinal detachment treated?

Small holes and tears are treated with laser surgery or a freeze treatment called cryopexy. These procedures are usually performed in the doctor's office. During laser surgery tiny burns are made around the hole to "weld" the retina back into place. Cryopexy freezes the area around the hole and helps reattach the retina.

Retinal detachments are treated with surgery that may require the patient to stay in the hospital. In some cases a scleral buckle, a tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. If necessary, a vitrectomy may also be performed. During a vitrectomy, the doctor makes a tiny incision in the sclera (white of the eye). Next, a small instrument is placed into the eye to remove the vitreous, a gel-like substance that fills the center of the eye and helps the eye maintain a round shape. Gas is often injected to into the eye to replace the vitreous and reattach the retina; the gas pushes the retina back against the wall of the eye. During the healing process, the eye makes fluid that gradually replaces the gas and fills the eye. With all of these procedures, either laser or cryopexy is used to "weld" the retina back in place.

With modern therapy, over 90 percent of those with a retinal detachment can be successfully treated, although sometimes a second treatment is needed. However, the visual outcome is not always predictable. The final visual result may not be known for up to several months following surgery. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and vision may eventually be lost. Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches. That is why it is important to contact an eye care professional immediately if you see a sudden or gradual increase in the number of floaters and/or light flashes, or a dark curtain over the field of vision.

National Eye Institute-Supported Research

The NEI supported The Silicone Study, a nationwide clinical trial that compared the use of silicone oil with long-acting intraocular gas for repairing a retinal detachment caused by proliferative vitreoretinopathy (PVR). With PVR, cells grow on the surface of the retina causing it to detach. This is a serious complication that sometimes follows retinal detachment surgery and is difficult to treat. The results indicate that both treatments are effective and give the surgeons more options for treating these difficult cases. More information on The Silicone Study is available at http://www.nei.nih.gov/neitrials/static/study39.asp.

Other Resources

The following organizations may be able to provide additional information on retinal detachment:

National Eye Institute (NEI)
31 Center Drive MSC 2510
Bethesda, MD 20892-2510
(301) 496-5248
http://www.nei.nih.gov
Conducts and supports research on eye diseases and vision disorders. Offers free publications for the general public and patients.

National Marfan Foundation
22 Manhasset Avenue
Port Washington, NY 11050
1-800-862-7326
(516) 883-8712
http://www.marfan.org
Disseminates information about Marfan syndrome, a genetic disorder of the connective tissues in which dislocated lenses, cataract, and retinal detachment are ocular symptoms. Provides a communication network for patients and their family members. Supports and encourages research. Publishes The Marfan Syndrome, a comprehensive booklet on the disease, and A Guide for Eye Care Professionals.

For additional information, you may also wish to contact a local library.

Medical Literature

Below is a sample of the citations and abstracts of articles available on MEDLINE/PubMed, a comprehensive medical literature database coordinated by the National Library of Medicine. MEDLINE contains information on medical journal articles published from 1966 to the present. You can conduct your own free literature search by accessing MEDLINE through the Internet at http://medlineplus.nlm.nih.gov. You can also get assistance with a literature search at a local library.

To obtain copies of any of the articles listed below, contact a local community, university, or medical library. If the library you visit does not have a copy of a desired article, you may usually obtain it through an inter-library loan.

Please keep in mind that articles in the medical literature are usually written in technical language. We encourage you to share these articles with a health care professional who can help you understand them.

Pathology and pathogenesis of retinal detachment. Ghazi NG, Green WR. Eye 16(4): 411-21, July 2002.
Retinal detachment, separation of the neurosensory retina from the underlying retinal pigment epithelium, is a sight threatening condition that is considered one of the few ocular emergencies. The literature is enormously rich in studies that focused on different aspects of this disease process. Yet certain aspects remain largely unanswered. The authors briefly review major aspects of retinal detachment and discuss various important contributions in this field, focusing mainly on the pathogenesis of and predisposing factors to retinal detachment, and on the pathologic changes that occur following its development and following various surgical procedures currently used in its management.

Laser therapy for rhegmatogenous retinal detachment. Greenberg PB, Baumal CR. Current Opinions in Ophthalmology 12(3): 171-4, June 2001.
Traditional techniques for managing uncomplicated macula-sparing rhegmatogenous retinal detachments include scleral buckling and pneumatic retinopexy. Demarcation laser photocoagulation is associated with less morbidity than these techniques and may be equally as effective in stabilizing selected macula-sparing retinal detachments.

Visual recovery after retinal detachment. Ross WH, Stockl FA. Current Opinions in Ophthalmology 11(3): 191-4, June 2000.
Visual recovery after successful surgery for the macula-off rhegmatogenous retinal detachment continues to be an important topic for ophthalmologists. Recent studies have shown that despite the intuitive notion regarding outcomes in macula-off detachment, there is no improvement in final visual acuity despite more expedient repair within the first week. Macula-off detachments can therefore be treated with less urgency and can wait for the next scheduled available operating room time. Surgeons involved in retinal detachment surgery should be aware that visual function based on acuity testing may continue to improve in the long term, most notably in those with the following patient characteristics: younger age, no or mild myopia (less than -5.00 D), and shorter duration of macular detachment (30 days or less).

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