Detached retina

What is a detached retina?

The retina is a thin layer of light‑sensitive tissue that lines the back of your eye. When light enters through your pupil, your retina converts it into electrical signals. These signals are then sent to your brain, which processes them to create the images you see. 
 
Sometimes, the retina can get pulled away from its normal position. When this happens, it gets cut off from its blood supply, which means it won't be able to work. 
 
In 2018, there were 7,140 hospitalisations for retinal detachments in Australia, according to AIHW data.

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Types of detached retina

There are three kinds of retinal detachment, and you can have more than one type at a time. They have different causes, but the symptoms are the same. All three types of retinal detachment are medical emergencies, and can cause sight loss if not treated.

1. A hole or tear in the retina

The most common cause of retinal detachment. Fluid can leak through the tear and lift the retina away from the back of the eye, cutting off its blood supply. This is called rhegmatogenous retinal detachment.

2. Retinal scars

Certain health conditions can damage the retina so it forms scars. Over time, these scars can pucker or bunch up, pulling the retina up and away from the back of the eye. The medical name for this is tractional retinal detachment.

3. Fluid leaks from behind the eye

Rarely, leaking blood vessels can push the retina away from the eye wall. This is called exudative retinal detachment.

Retinal detachment diagnosis

If you have symptoms of retinal detachment, it's critical to get medical treatment fast. The sooner it's diagnosed, the better your chances of protecting your sight. Head to the ED to get your eyes checked if you have any warning signs of retinal detachment (such as a sudden increase in floaters, flashes or a 'curtain' in your vision).

Detached retina treatment

If you have a detached retina, you will need to go for urgent eye surgery. This is the only treatment for retinal detachment. 

There are a few different methods that the eye surgeon can use. They'll decide based on the type of retinal detachment, which part of the retina has become detached and the underlying cause. 

In most cases, you'll be awake when you have the surgery. You'll be given a local anaesthetic, which means you won't feel any pain (though you might be aware of some movement or pressure). You'll be able to speak with the surgeon if needed.

Detached retina recovery and outlook

Retinal detachment surgery is often very successful. Many people go back to having a similar level of sight to what they had before. But, like any surgery, it comes with risks ‑ and your vision may not be quite as good as it was. 
 
The effectiveness of detached retina surgery depends on how much of the retina had pulled away, for how long, and if the macula (the central part of your retina) was affected. Your post‑surgery recovery can also have a big impact ‑ especially if you need to do posturing (see below). Sometimes, people need to have detached retina surgery a few times to fully treat the problem.

Vitrectomy

This is the most commonly used treatment for retinal detachment in Australia. The surgeon will extract some of the fluid from inside your eye and replace it with a small bubble of gas (or sometimes a type of oil). The gas bubble presses gently against the retina, helping it move back into place against the inside wall of the eye so it can reattach. 

After a few weeks the gas will be absorbed by your body, and you will produce new vitreous fluid to replace what the surgeon removed. 

After surgery, you may need to follow a detached retina recovery routine called 'posturing' for a couple of weeks. This involves keeping your head in specific positions ‑ like lying on your side, face down or sitting upright ‑ so the gas bubble stays in the right spot. This can be quite uncomfortable and inconvenient. But remember that it’s temporary and plays a key role in helping your eye heal properly. 

If you’ve had a vitrectomy, you must avoid changes in air pressure, since this can cause the gas bubble to expand or shift, which can be dangerous. This means you should not fly or do things like scuba diving until your doctor gives you the go‑ahead.

Pneumatic retinopexy

This is a less common kind of retinal detachment surgery. As with a vitrectomy, a small amount of gas is put into your eye. But no vitreous fluid gets removed The bubble then presses the retina back in place, and cryotherapy or laser is applied around the hole or tear. The gas is reabsorbed over time and is replaced by fluid as the eye heals. 

Again, if you've had gas put in your eyes, you must not fly or scuba dive until your doctor says it's OK to do so.

Scleral buckle

The sclera is the white outer layer of your eye. In scleral buckle surgery, a tiny band (often made of silicone) is placed around your eyeball. This squeezes it slightly, so the inside of your eye moves inwards. That in turn helps the retina reattach. The buckle will be left in place permanently, but it won't be visible.

Cryotherapy or laser surgery

If your retinal detachment is caused by a hole or tear in the retina, the surgeon might use a laser or cryotherapy (a freezing technique) to seal up the edges of the tear or hole. This prevents more vitreous fluid from seeping out.

Preventing retinal detachment

A detached retina is usually caused by things that are out of your control (such as getting older), so you might not be able to prevent it. 
 
However, you can reduce the chances of it happening with some simple precautions. Regular eye tests can detect early signs ‑ and are especially important if you're very short sighted or recently had an eye injury. Wearing protective eyewear when doing sports or DIY can help. If you have diabetes, managing this can also reduce the risks of diabetic retinopathy.

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