Module 8.2 - Retinal Detachment

Question 1

What is a retinal detachment?

Answer 1

The retina is a light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.

Question 2

What are the 3 types of retinal detachment?

Answer 2

1. Rhegmatogenous – A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retinal; most common.
2. Tractional – Scar tissue on the retina’s surface contracts and causes the retina to separate from the RPA; less common.
3. Exudative – frequently caused by retinal diseases, including inflammatory disorders (Diabetes mellitus, sickle cell anemia) and injury/trauma to the eye (cataract extraction). In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.

Question 3

What is the etiology/predisposing factors for retinal detachment?

Answer 3

A. More common in people > 40 years of age, affects men more than women and Caucasians more than African Americans.

B. Likely to occur in people who:

1. Are extremely nearsighted
2. Have had a retinal detachment in the other eye
3. Have a family history of retinal detachment
4. Have had cataract surgery
5. Have other eye diseases, such as uveitis, degenerative myopia, or lattice degeneration
6. Have had an eye injury

Question 4

What are the subjective/physical exam findings associated with retinal detachment?

Answer 4

• Sudden, or gradual increase, in painless, visual changes, floaters, blurred vision, light flashes
• As detachment becomes pervasive, a ‘curtain’ obscures part or all of the visual field
• Elevations of the retina related to tears
• Exudative, bullous elevation without tears

Question 5

How do you manage a detached retina?

Answer 5

A. Immediate referral to an ophthalmologist for evaluation and treatment, such as the following:

1. Cryotherapy/cryopexy – freezing the area around the hole, to help reattach the retina.
2. Diathermy – an application of alternating electrical current that creates heat and coagulates the tissue, causing scleral shrinkage with subsequent necrosis.
3. Scleral buckling – sewing a tiny synthetic band to the sclera over the affected area that indents the wall of the eye and relieves some of the force caused by the vitreous tugging on the retina.
4. Photocoagulation – using a laser to burn around the tear, creating scarring the welds the retina to the underlying tissue.
5. Pneumatic retinopexy – injection of a bubble or air or gas into the vitreous that floats against the retinal tear and seals it.
6. Vitrectomy- removal of vitreous along with any tissue that is tugging on the retina; air, gas, or liquid is then injected into the vitreous space to reattach the retina.

B. If the detachment is the result of trauma, patch the eye with a metal shield.