Retinal Detachment: What It Is, Types, and How It Manifests

The retina is a thin light-sensitive membrane deep within the eye on which the image is formed. Retinal detachment is a condition in which the membrane separates from the underlying tissues. Below — about the types of detachment and its signs.

What retinal detachment is

The retina lines the eyeball from the inside at the back. Rays of light entering the eye are focused by the cornea and lens into an image precisely on it. Its most sensitive layer is the cones and rods, the nerve cells that perceive light.

During detachment, this layer separates from the pigment epithelium — the layer lying beneath it; in a healthy eye they are in close contact. During detachment, fluid accumulates between them and the connection is disrupted. There is usually no pain in the eye.

Types of retinal detachment

There are several types, and they differ by cause, not by the person's sensations.

• Rhegmatogenous detachment — the most common type: it occurs due to a tear or hole in the retina through which intraocular fluid seeps beneath it.
• Tractional detachment — the altered vitreous body pulls the retina with it, and there may be no tear.
• Detachment due to fluid accumulation under the retina without a tear — a rarer type, it may be associated with tumors and other eye diseases.

A distinction is made between partial detachment, when a separate area has separated, and total. If the detachment has involved the macula — the zone responsible for clear vision — central vision is severely affected.

Causes and risk factors of retinal detachment

The main cause of rhegmatogenous detachment is posterior vitreous detachment, that is, a change in the gelatinous contents of the eye, which more often occurs with age. The vitreous body becomes cloudy, and compacted fibers connected to the retina appear in it, which, when the eye moves, pull it along and can tear it.

Tears also occur with thinning of the retina, and large ones — with eye injuries. The risk is higher in people with myopia, in those who have undergone eye surgery, in those who have sustained an eye injury, and in those whose relatives have experienced detachment. The tractional form occurs in uncontrolled diabetes, after retinal surgery, and with prolonged inflammation. It is recommended to visit an ophthalmologist once a year, and more often if there are risk factors.

How it manifests and how retinal detachment is detected

Floating opacities appear — dots and lines before the eye — as well as flashes of light, which are described as sparks or lightning. A dark curtain or shadow may appear, advancing over the field of vision, and blurred vision. If the center is affected, letters and objects are distorted, and parts of the image drop out. There is usually no pain in the eye.

The doctor examines the fundus. If necessary, visual acuity testing, peripheral vision examination, measurement of intraocular pressure (normal — 16–25 mm Hg, with detachment it is sometimes lower), electrophysiological examination, and ultrasound examination of the eye are prescribed. Slit-lamp examination and fluorescein angiography — imaging of the retinal vessels with a dye — may be needed.

Why detachment is dangerous and when to see a doctor urgently

During detachment, nerve cells — cones and rods — die. The longer the detachment exists, the more of them die and the worse vision recovers even after a successful operation. Advanced detachment threatens persistent inflammation, cataract, and complete loss of vision. There is no medical treatment for detachment: timely surgery helps preserve vision.

Help should be sought within the first 24 hours after the appearance of new flashes of light and floating opacities. Detachment can recur, so if the previous sensations return, it is necessary to go to the doctor again.

Retinal detachment by itself is not a reason to call an ambulance; 103/112 — if vision has suddenly and sharply dropped or a dark curtain has covered the entire field of vision. In other cases, with new flashes of light and floating opacities, it is necessary to see an ophthalmologist within 24 hours.

The material is for reference: it does not replace a doctor's consultation and cannot take into account the characteristics of your particular eye.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer