What is Retinal Detachment?

The Retina

The retina is a thin layer of cells lining the inner back wall of the eye. It is the innermost layer of the eye's wall and contains light-sensitive cells called rods and cones, which detect shape, color, and patterns. The retina is supported internally by the jelly-like vitreous, which fills the eyeball behind the lens.

Externally, the retina is attached to the choroid, the middle layer of the eye, which is rich in blood vessels. Nerve fibre from the retina comes together to form the optic nerve, which transmits visual information to the brain.

What is Retinal Detachment?

Retinal detachment occurs when the retina separates from the surrounding tissue (the choroid), which supplies it with oxygen and nutrients. When detached, the retina cannot function properly, resulting in vision loss.

Causes of Retinal Detachment

The most common cause of retinal detachment is age-related shrinkage of the vitreous gel, which can lead to tears in weak areas of the retina. Once a tear or hole forms, fluid can collect beneath it, weakening the adhesion between the retina and the choroid, causing detachment. Eye injuries can also lead to retinal detachment, though this is less common.

Surgery for Retinal Detachment

Surgery for retinal detachment involves reattaching the retina to the back of the eye and sealing any tears or holes. A retinal specialist will determine the most suitable procedure based on the condition of the eye.

Operative Procedures

1. Pneumatic Retinopexy
This is the simplest method for repairing detachment, though it may not be suitable for all cases. The surgeon injects a gas bubble into the vitreous cavity and treats the tear(s) with laser or cryotherapy (freezing). The gas bubble presses the retina against the eye wall, while the laser or freezing seals it in place. Post-operative head positioning is crucial for success. The gas bubble dissolves naturally over several days or weeks.

2. Scleral Buckling
Cryotherapy is used to treat the retinal tear, fluid under the retina is drained, and a silicone band is sutured to the sclera (outer eye wall). This band creates an indent that pushes the eye wall back against the retina. The scleral buckle remains permanently unless complications arise.

3. Vitrectomy
During this procedure, the vitreous gel is removed, tears are treated with laser or cryotherapy, and the eye is filled with gas or silicone oil. Correct head positioning post-surgery is essential to allow the retina to reattach. Vision may remain blurry while the gas is absorbed and replaced by natural eye fluid. If silicone oil is used, further surgery is needed to remove it after a few months.

After Surgery for Retinal Detachment

Immediately After Surgery:

• The eye will be covered with a protective pad or shield.
• Hospitalization may be required overnight or longer in some cases.

During Recovery:

• Discomfort may last for several weeks, especially if a scleral buckle is used.
• Blurred vision is common and may take weeks to months (up to six months) to improve.
• Watering and a gritty sensation may occur, especially if stitches were used.
• Avoid rubbing or pressing the eye.
• An eye pad may be required at night for protection.
• Follow all medication instructions, including eye drops.
• Avoid vigorous activities for several weeks.
• Adhere strictly to head positioning instructions.

Important Precautions:

If gas was used in the eye, avoid air travel until the gas has fully reabsorbed—this may take up to four weeks.

Seek medical attention immediately if you experience severe pain.

Possible Complications of Retinal Detachment Surgery

While modern techniques have minimized risks, complications may include:

• Cataract formation (loss of clarity of the lens of the eye).
• Glaucoma (raised pressure in the eye).
• Infection.
• Haemorrhage (bleeding) into the vitreous cavity.
• Vision loss.
• Loss of the eye, although with modern surgical techniques this is a very unlikely outcome.

With appropriate treatment and care, most retinal detachment surgeries are successful in preserving or improving vision.