Retinal detachment
What retinal detachment is, how it is treated, and what to expect after surgery.
What is retinal detachment?
The retina is the light-sensitive film at the back of the eye. Retinal detachment is a condition where the retina peels away from the inner wall of the eye. In most cases the retina detaches because a hole or a tear has formed in it, allowing fluid to pass underneath and lift the retina away.
Most retinal detachments occur as a natural ageing process, but certain people are at higher risk: those who are short-sighted, those who have had cataract surgery, and those who have suffered a severe direct blow to the eye. Some types can run in families, though this is rare.
What is the treatment?
Treatment involves surgery to seal holes in the retina and reattach it. The two main methods are vitrectomy and scleral buckle, sometimes used in combination.
Vitrectomy
A vitrectomy removes the vitreous gel (which caused the retinal tear) from inside the eye. The tear is then sealed using laser or a freezing probe. A gas or silicone oil bubble is inserted to support the retina while it heals. Gas absorbs over 2–8 weeks; silicone oil requires a small operation to remove it later. Vision will be very blurred initially due to the bubble.
Scleral buckle
Retinal holes can also be sealed by stitching a piece of silicone rubber or sponge to the outside of the eyeball. This creates a dent that pushes the outer wall up to the hole in the retina. The buckle is not visible and usually remains permanently.
Posturing
With a gas or oil bubble, you may be asked to posture — placing your head in a specific position to keep the bubble against the retina. This is often the hardest part of recovery but should be regarded as the second stage of the operation: 45 minutes in each hour during the day, with 15-minute breaks for gentle movement.
Anaesthesia
Retinal detachment surgery can be performed under local anaesthetic (you are awake but the eye is numbed with an injection) or general anaesthetic (fully asleep). The decision is made following discussion between you and your surgeon.
Benefits and risks
The most obvious benefit is preventing blindness in the affected eye. Even with successful surgery, vision may not return to normal.
The success rate is approximately 90% with a single operation — meaning 1 in 10 people need more than one operation, usually because of new tears forming or scar tissue contracting. If a gas or oil bubble is used, you will usually develop a cataract within 18 months, requiring a short operation to remove it. Haemorrhage and infection are very rare (less than 1 in 1,000) but can cause blindness.
After surgery
Retinal detachment surgery is rarely very painful. Simple painkillers such as paracetamol or ibuprofen usually manage any discomfort. The white of the eye will look red and the eyelid may be swollen. You may experience some watering and a gritty sensation in the first few weeks as any stitches dissolve. Vision will be very blurred initially but improves slowly — the final result may take several months, and you may need new glasses afterwards.
You will be given steroid drops to reduce inflammation, antibiotic drops to prevent infection, and sometimes drops to control pressure inside the eye.
You must not fly until the gas bubble has gone, and you must inform the anaesthetist if you later require a general anaesthetic while gas is in your eye.
Most people need at least two weeks off work, sometimes longer depending on the type of surgery and your occupation.
Asymptomatic retinal detachment
Sometimes a retinal detachment is discovered by chance before you have noticed any symptoms — usually because part of the very peripheral retina has detached without affecting central vision. This affects about 1 in 200 people, and in about 1 in 10 of those the detachment may progress to threaten central vision.
In this situation there are three options:
Observation
Especially if there are signs the detachment has been present a long time. If you develop new flashing lights, more floaters, or a shadow in your vision, seek urgent advice immediately.
Surgery
Stands a good chance of securing the retina (around 90% success) and removes the need for long-term monitoring if successful, but carries surgical risks.
Laser
Surrounds the area of detachment to reduce the risk of progression. About 4% of those treated with laser still go on to develop retinal detachment. Laser can occasionally contribute to the development of epiretinal membrane.
Adapted from the British and Eire Association of Vitreoretinal Surgeons (BEAVRS) website.