Detached Retinas & Blindness


The retina contains the macula and is the section of the eye on which light is shone from the cornea and pupil. When the retina is detached from the eye, the retina cannot send the light-picture to the brain and thus cannot make a clear image of the object observed. Because the retina is involved with both rod and cone cells, detached retinas affects both the acuity and the field of vision. 

How do retinas become detached?

A detached retina can occur spontaneously, through complications with diabetes, or due to trauma. Retinas can degenerate in stages or all at once. When the retina is damaged, it can tear or develop a small hole. If left untreated, these tears can expand and the retina can detach completely.

Detection & treatment of detached retina

If detected early, surgical methods to reattach the retina can be effective, however, without treatment within the first two or three days it can be irreversible leading to blindness in one or both eyes. So how can retinal damage be detected? There are several obvious signs to be aware of and an optometrist can identify the problem as well. As the retina moves away from the optic nerve the brain no longer gains the nerve signals so that neither acute (detailed) nor visual field (peripheral) vision can be detected.  This means both peripheral vision loss and fuzzy central vision called metamorphopsia are common at early stages of retinal detachment. Flashes of light can also occur, as can photopsiae or floating, sparkling specks across the eye. If you experience these symptoms, contact your optometrist immediately for a quick diagnosis.  As with retinitis pigmentosa, direct or indirect ophthalmoscopy and slit-lamp ophthalmoscopy are the most common ways to ascertain the retina’s damage.

Depending on the type of tear or detachment the retina has, there are various treatments which can repair it if caught in time. If there are small tears in the retina but no actual detachment, then laser photocoagulation can be used to close up the hole. Alternatively, a cold probe, cryopexy, can be employed to create scar tissue over the rip, thus preventing it from expanding. If the tear is too large, usually do to a condition called tractional retinal detachment, and then another method called vitrectomy may be employed. In this procedure, the liquid part of the eye, or vitreous, is removed and a saline solution is inserted. Often the retina detaches because liquid gets between the retinal wall and the back of they eyeball so removing the liquid can help it get back into place while the saline keeps the eye lubricated. 

If complete detachment of the retina occurs, then cryopexy will be used in conjunction with other methods to salvage vision. The most common procedure is scleral buckling.  First the initial tear is patched through cryopexy and the vitreous fluid is removed. Then, a silicone band is explanted around the eye and acts as a belt buckling the retina firmly in place. Although it is not visible, the band is sutured into place permanently. Cryopexy is also utilised in an alternative method, pneumatic retinopexy. In this procedure, the retina must be repositioned and a small gas bubble generally made up of perfluoropropane is inserted into the eye’s vitreous. Once inside the eye fluid, the bubble presses against the retina and pushes the rip together so that the tear can be fixed with cryopexy and the retina itself can be reattached and held in place using lasers. If silicone is utilised instead of perfluoropropane, then the procedure is known as silicone oil tamponade, but the procedure itself is unchanged. These surgeries tend to have a high success rate as long as the symptoms are caught quickly and treated before any there is any serious damage done to the macula. In some cases, a second surgery may be necessary if the retina detaches a second. No treatment will result in total blindness.

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