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VITREOUS DETACHMENT - RETINAL DETACHMENT

How does Vitreous or Retinal Detachment occur ?

VITREOUS DETACHMENT Normally the vitreous gel is solid, but the gel may degenerate. Imperfections become larger as the gel structure weakens. When the outer surface is affected the fluid inside the gel breaks out and causes the outer surface of the gel to peel away from the retina.

RETINAL DETACHMENT A retina can detach if there is a hole in it. How can such a hole be caused? After vitreous detachment a hole or tear can appear in the retina. The pull of the vitreous on the retina can be strong enough to do this. Also, a weak or degenerated area of the retina can give way. A stretched retina is more likely to break or tear.

Why does Vitreous or Retinal Detachment occur ?

VITREOUS DETACHMENT Younger people's vitreous tends to be more solid. In later middle age, the gel has often weakened to a point where detachment is common. Short sighted people reach this point earlier in life. An injury to the eye or head can also cause a detached vitreous.

RETINAL DETACHMENT As with the vitreous, increasing age and short sight are associated with retinal detachment. A short sighted eye is too large, so the retina is stretched. Often it can degenerate, making it more likely to tear. Short sighted eyes have a particular chance of this happening after a cataract operation. Injuries can also cause a retinal detachment.

Treatment involved for Vitreous or Retinal Detachment

VITREOUS DETACHMENT Following a suspected vitreous detachment, the vitreous and retina are carefully examined through a widened pupil. The diagnosis can be confirmed and any signs of damage to the retina can be seen. Treatment is usually unnecessary.

RETINAL DETACHMENT If a retinal detachment is suspected or thought likely, the same procedure as above is followed. A hole or tear in the retina which is discovered after a vitreous detachment or after a routine examination may not be too serious. Fluid has not yet leaked under the retina. In that case, a laser (argon) treatment can seal around the hole like spot welding. If a true detached retina with fluid beneath it is seen, an operation is needed. If the special middle area of the retina (called the macula) is in immediate danger of becoming detached, the operation becomes more urgent. The idea of surgery is to make a dent on the outside of the eyeball by stitching a piece of plastic to it. The hole itself is frozen by an instrument placed on the surface of the eye during the operation. In this way, the frozen area of the retina heals on to the dent and the hole is sealed. Some patients are kept in special positions before and after surgery, to help the retina to settle back. Difficult or complicated detachments should be fixed by a surgeon specially trained in surgery of the vitreous. After surgery the eye is painful for a few days, and swollen. Following the use of drops for a few weeks and several visits to the clinic, patients are discharged. Sometimes the operation is not successful and needs repeating.

After treatment for Vitreous or Retinal Detachment

RETINAL DETACHMENT Vision should improve quickly. Often spectacle prescription is affected by surgery and needs checking. If the detachment has involved the macula at the middle of the retina, vision will be badly affected. It may gradually improve over many months. A problem sometimes found is double vision. This is due to interference with the eye muscle during surgery. It can be troublesome. If it doesn't settle down, a squint operation may be needed.

If Vitreous or Retinal Detachment is left untreated

VITREOUS DETACHMENT A simple vitreous detachment needs no treatment. The flashing light sensation lasts a week or two. The large floater in the centre of vision gradually drifts out of the line of sight. After several months, it should not be noticeable.

RETINAL DETACHMENT A retinal detachment, once started, increases in size. This may be slow or fast, ranging from a couple of days to several months before endangering vision. Eventually, the eye would become blind, developing a cataract and some inflammation as well. Very rarely, some detachments can stop spreading and seal themselves.