Retinal Tears and Detachment

retina dekolmanı

What is the cause of retinal tears or holes?

The retina is in contact with the vitreous gel that covers the eye. A healthy eye vitreous gel homogenates, tightens, supports the retina and pushes it towards the outer layer tissues, such as underlying choroid and sclera. This viscous consistency of the vitreous gel’s homogeneous nature can deteriorate in some special cases. Diseases such as high myopia, eye trauma and intraocular inflammation facilitate the fluid confluence of the vitreous gel. The transition to liquid consistency causes the vitreous, which acts as a roof, to lose its supporting characteristic. It starts to separate from the surface where it sticks to the retina. In some cases, during retraction, the retina is withdrawn and tear occurs. Intrusion of this viscous vitreous from the torn area leads to retinal detachment.

 Why is retinal detachment an emergency and dangerous?

Retinal detachment is a disease that can progress to blindness. The tearing apart of the retina from the cohesive layer will result in the deterioration of the nutrition and the death of the cells. Progress of Retinal detachment causes loss of central vision.

Even if the retina is successfully set in its place, the loss of time makes lost cells impossible to renew. In such a case, it is impossible even in the most successful operation to obtain the same old image. Early diagnosis and early surgery is important.

 Conditions requiring a treatment for patients with retinal degeneration:

  • If there is retinal detachment in the other eye
  • If there is familiar retinal detachment
  • Coexistence of other diseases with risk of retinal detachment
  • If the retinal thinning area is torn
  • If eye surgeon is planned
  • Having a profession with a high risk of eye or head trauma

What is a retinal detachment?

Retinal detachment is an eye disorder that is seen at 1 in 10.000 persons in every year and seriously threatens vision. It may occur at any age, more often in middle age and above. If not treated urgently, it may cause partial or complete vision loss. Retinal detachment is the separation of the layer of pigment epithelium below the retinal nerve layer. Often due to ruptures or holes in the retina, it develops through leakage of fluid between the two layers. It is most commonly seen on patients with high myopia. The retina layer is stretched as the anterior-posterior diameter of the eye increases, and the stress area on it begins to thin and deteriorate. In some familial or degenerative diseases and infections, thinning and deterioration may occur around the retina. Meanwhile, for the same reasons, the vitreous gel begins to lose its homogeneity and deteriorate the gel consistency changes and is gradually separated from the retina. This separation is called vitreous detachment. In the meantime, shrunken and occasionally opaque vitreous tissue is seen as a fly or fog screen flying in front of the eye as it passes through the visual axis in the eye.

Reasons and symptoms for retinal detachment

Retinal detachment is the separation of the layer of pigment epithelium below the retinal nerve layer. Often due to ruptures or holes in the retina, it develops through leakage of fluid between the two layers. It is most commonly seen on patients with high myopia. The retina layer is stretched as the anterior-posterior diameter of the eye increases, and the stress area on it begins to thin and deteriorate. In some familial or degenerative diseases and infections, thinning and deterioration may occur around the retina.

In the presence of thinned, distorted areas around the retina, pullout of the retina may occur when the shrunken vitreous leaves the retina. These pullouts may rarely occur in people with a healthy retina. Retina pullouts are perceived by the patient as “light flashes, flash bursts”. These light flashes can sometimes be short-lived, and sometimes last for days. In some patients it may not be felt at all. Some patients may not feel it at all.

These pullouts in the retina layer as a result of the shrinkage of the vitreous can cause ruptures and perforations in the areas of the retinal wall, which is thinner and deformed. If a vein passes through the torn retinal layer, sometimes this vein may break off and cause some bleeding in the eye. This is perceived by the patient as “the tissue is falling.” If a tear or hole is formed in the retina, the fluid in the vitreous passes through these tears and separates the retinal nerve layer from the pigment layer that it adheres to. This event is called retinal detachment. The retinal area that separates from the underlying tissue does not have a visual function and the patient feels ‘blurred’, ‘black spot’ or ‘curtain’ sensation on the exact opposite side of that area. Retinal detachment can sometimes be limited to a region but is often progressive.

Central vision is lost when the macula (vision centre of the eye) is removed from the tissue beneath it. In long-term detachments, intraocular balances deteriorate and the eyeball begins to shrink. Sudden, severe or piercing blows that are noticeable may be the cause of the detachment. In diabetes and some degenerative diseases, retinal detachment of the vitreous can occur and tracheal detachments may develop. Rarely, some dislocations may develop without any tears in the eye, especially in the case of a tumour or a tension crisis in pregnancy.

Diagnosis of retinal detachment

In order to detect the thinly deteriorated areas around the retina, holes and tears in these areas, the pupils are widened by drops. The ophthalmologist examines the inside of the eye with an inspection microscope using various lenses. As a result, a tear or detachment is detected in the eye. If necessary, eye ultrasonography is applied if the retina cannot be seen due to cataract or bleeding.

What is the Treatment of Retinal Tear?

Early detection of retinal tears and detection and treatment of retinal detachment before its progress is extremely important. Symptoms of retinal tears are light flashes and flying objects. If these symptoms occur, a retinal check must be done as soon as possible.

If a retinal tear is detected during the examination and if it is suspected that the tear may cause retinal detachment, it must be treated. In the treatment, tear is covered by laser.

What is the treatment of retinal detachment?

If retinal detachment develops, surgical intervention is necessary. The surgical method can vary depending on the number of retinal tears that cause retinal detachment, the size, the location, and the length of retinal detachment.

External buckling method (scleral buckling method):

It is the oldest method used in detachment surgery. A piece of hard silicone is applied to the outer wall of the eyeball with matching it to the tear and the retinal tear is covered. If the retina is torn by this external intervention, retinal detachment fluid (fluid accumulating under the retina) is absorbed by the eye for a short time and recovery is completed.

Vitrectomy:

If there is a large number of tears that lead to retinal detachment, if the location is unusual, if a tear cannot be detected, if there are other accompanying diseases (such as eye bleeding) or if the time has passed, vitrectomy surgery may be needed. During a vitrectomy surgery, retinal detachment is treated through the eye. For this, small holes are made in the eye, the vitreous fluid is cleaned with a set of cutter and aspirator rods (probe) and light sources, liquid aspirated under the retina is aspirated, tears are closed and laser treatment is applied. At the end of the operation, it is necessary to give a tampon material to the eye to paste the applied laser treatment into the tear zone and to continue this effect. Depending on the situation, this buffer may be air, similar gases or silicone oil. After the operation, the patient must use protective eye drop for a period of time and lie in a certain head position.

Who should make a retinal examination from the perspective of retinal tear and detachment risks?

Persons who examine light flashes and sudden flying objects must be checked for retinal tears. Especially those who have high myopia, have had eye injuries, had undergone eye surgery such as cataract surgery, had a history of laser treatment or retinal surgery due to retinal tear in their family, laser treatment due to retinal tear in the other eye or had a history of retinal surgery must take such light flashes and sudden flying objects complaints seriously and must go for retinal examination as soon as possible.