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Detachment of the retina - immediate danger to eyesight
A retinal detachment in the eye (amotio retinae, ablatio retinae) is always an emergency by an ophthalmologist, regardless of the cause and form. If the retina detaches from its supply layer, the retinal pigment epithelium, there is a considerable loss of function due to insufficient supply to the affected areas. In severe cases, this can result in blindness. A quick diagnosis and treatment through a surgical intervention is crucial for the best possible preservation of the retina and thus the eyesight.
A brief overview
Retinal detachment is a medical emergency and quick examination and treatment is essential to prevent permanent vision damage or blindness. The following overview first summarizes the most important facts about the symptoms, the causes and the possible treatment methods. The following article contains detailed information on these and other aspects of amotio retinae.
How do you recognize retinal detachment?
- No pain is perceived and other symptoms can also be absent (initially), which often leads to a late diagnosis.
- Heralds are often symptoms of a retinal hole or tear, such as black, dancing spots ("flying mosquitoes") in front of the eyes or lightning when the eyes are closed.
- Signs of detachment of the retina are increasing black point clouds or sinking black points ("soot rain"), visual disturbances due to shadows, smoke or fog, veils in front of the eyes or blurred vision.
The most important triggers are divided into the following three groups:
- Rhegmatogenic retinal detachments are caused by tearing the retina beforehand and are the most common cause.
- Serous retinal detachments are caused by fluid accumulation under the retina, but are rather rare.
- Tractive retinal detachments are caused by scarring processes and the associated tensile forces on the retina, such as occur particularly in diabetic retinopathy.
In the event of retinal detachment, surgery is always required to put it back on. The following experienced procedures are carried out in a cause-specific manner:
- Sewing on a plastic seal (indentation of the eye wall),
- Attaching a plastic tape (cerclage),
- Removal of the vitreous (vitrectomy) and replacement with gas or silicone oil,
- Introducing a gas mixture inside the eye.
The retina is located on the inside of the eye or in the back of the eye. It is pressed through the vitreous to the choroid, where small blood vessels ensure the supply. These two structures lie only loosely next to each other, only in the area of the optic nerve and the external retinal circumference are adhesions between the retina and choroid. The macula lies in the center of the retina, exactly opposite the pupil. This so-called “yellow spot”, with the fovea placed in the middle, is the place of sharpest vision.
The retina is complex and consists of several layers. The layers facing the light protect the sensory cells that are located in the rear from over-excitation. The rearmost, light-away layers form on the one hand the photoreceptors (sensory cells in the form of rods and cones) and on the other hand the retinal pigment epithelium. The latter absorbs the residual light and separates the retina from the choroid.
The different layers guarantee a multitude of functions. The retina absorbs the incoming light, sorts the complex information and converts it into corresponding electrical impulses. These are passed on to the brain via the optic nerve. This means that the retina is significantly involved in effective visual perception and ultimately decisive for sharp and focused vision.
If the retina detaches, the affected areas are no longer adequately supplied with blood, oxygen and nutrients. This goes hand in hand with tissue stripping and loss of function. Eyesight can then be permanently impaired and complete blindness can occur. Subdivided according to the causes, there are various forms of retinal detachment. The retina can only partially or completely separate from the underlying tissue. Large or complete detachments are particularly dangerous, as is the inclusion of the macula as the center of the strongest eyesight.
About one in 10,000 people is affected by detachment of the retina, so this is a rather rare occurrence. In many cases, other retinal damage already exists that is not noticed or is noticed too late. If liquid from the adjacent vitreous body gets through the damaged areas between the retina and its surface, it detaches at different speeds.
Retinal detachment is usually painless because the retina has no pain fibers. Other typical symptoms may also (initially) be absent, which is why detachment is often only noticed late. This increases the risk of impaired eyesight.
The first symptoms that appear with smaller holes or tears usually cause black, dancing spots (“flying mosquitoes”) in front of the eyes or lightning is perceived when the eyes are closed. In addition to dots, lines and flashes of light, retinal detachment, on the other hand, usually perceives even more striking visual changes. Often, those affected report the following symptoms:
- falling black dots ("soot rain"),
- Smoke or fog phenomena through a massive increase in small black dots,
- Visual loss and narrowing of the field of vision due to dark, expanding shadows,
- Veil before the eyes,
- blurred vision (if the macula is affected).
There are many causes of retinal amotio. A basic division into three forms is based on the different triggers of a replacement.
Rhegmatogenic (tear-related) retinal detachment
The most common variant is caused by tearing the retina beforehand. Age-related shrinkage of the vitreous (vitreous detachment) and the resulting tensile forces are often decisive. It is not uncommon for small holes or cracks to appear at first. However, if these remain undetected and are not treated, liquid from the vitreous body can collect between the retina and the pigment epithelium. This ultimately causes gradual detachment. Especially people with eye problems, such as a strong myopia or a previous cataract, have an increased risk of developing this. The risk increases significantly from an older age of around 60 years.
Serous retinal detachment
With this rather rare form of retinal detachment, a fluid accumulation under the retina is the reason for its removal. This usually occurs in connection with inflammatory processes, which is why one speaks in this context of an exudative (inflammatory) retinal detachment. Various diseases can cause the fluid to leak, or it is a congenital eye disease (for example, Coats' disease).
Tractive retinal detachment
This variant is caused by scarring processes and the resulting, contracting connective tissue membranes that are firmly attached to the retina in some places. Shrinkage of these membranes causes tensile forces that pull the retina from its base. This is a particularly complicated form that is difficult to treat. The main cause is diabetic retinopathy. If you have diabetes for many years (diabetes mellitus), scarring on the vitreous and on the retina often occurs. Inheritance or complications from previous retinal surgery may also be related.
Furthermore, eye tumors (for example retinoblastoma or choroidal melanoma) or trauma due to an accident or injury can cause an amotio retinae. Other risk factors that may be considered include frequent flying, long screen work, and increased stress levels.
Since the extent of retinal detachment and the associated damage to the eye depend on the length of time between the onset of detachment and its treatment, early diagnosis significantly improves the vision prognosis. People at increased risk are therefore also recommended to have regular ophthalmological checks. Often, those affected only recognize the signs too late, and serious visual disturbances or even blindness are then possible consequences.
For this reason, an immediate examination of the eyes is necessary at the slightest sign. If preliminary stages such as retinal holes or tears are ruled out during an examination and the suspicion of retinal detachment is confirmed, it is always an ophthalmological emergency that requires a surgical intervention.
During the examination, as with other retinal damage, the pupil is first dilated with medication by eye drops so that the fundus can be seen. With the help of a light source, an eye mirror, a magnifying glass or a so-called contact glass, the retina and its changes can be precisely assessed in an enlarged view. If gray wrinkles become visible, this indicates retinal detachment. This type of examination is classic eye mirroring (ophthalmoscopy or fundus copy). A digital retinal exam can also be performed nowadays and offers several advantages over the conventional method. An ultrasound examination can also be used for the examination. For example, if there is bleeding that complicates the mirroring, an ultrasound is usually performed.
While laser or cold therapy is often sufficient for retinal holes or tears, detachment always requires surgery. The sooner an operation can be performed, the better the forecast for eyesight. However, it is not always possible to prevent vision loss.
As a rule, the surgical procedures are carried out by specialists and under general anesthesia. During the operation, the contact between the retina and the layer underneath is to be restored, which causes the causes to be eliminated accordingly. The following procedures are used to create the retina, either from the inside of the vitreous (vitrectomy) or from the outside:
- Denting of the retina by means of a plastic seal,
- Attaching a plastic band (cerclage) around the eyeball,
- Removal of the vitreous (vitrectomy) and fluid accumulation (cause: vitreous detachment), replacement with gas or silicone oil,
- Introducing a gas mixture inside the eye.
Sewing on a plastic seal or cerclage from the outside onto the dermis causes permanent indentation of the eye wall. This is the oldest method and is no longer used as often.
Vitrectomy is the more modern and gentle standard procedure in which the retina is applied from the inside. Fine instruments are inserted inside the eye to remove the vitreous. Subsequently, laser therapy (laser coagulation) or cold treatment (cryocoagulation) is usually carried out to form scars on the retina. This is intended to restore a stable connection between the retina and its base. These methods are otherwise used to repair minor damage. The retina is usually temporarily sealed by introducing a gas bubble. In complicated cases, silicone oil can also be used. Sometimes just introducing a certain gas mixture into the inside of the eyeball is enough to put the retina back on. However, this is then always combined with laser or cold therapy. The gas is absorbed after a certain time.
If other underlying diseases, such as a tumor, are responsible for the amotio retinae, the treatment of this cause is in the foreground.
In most cases (90 percent), an operation performed by experts leads to the desired success on the first intervention. Without treatment, those affected risk going blind.
Complications and late effects
Like other surgical procedures, retinal surgery involves certain risks. Retinal detachment cannot be prevented in all cases (permanently), which may make further interventions necessary. Bleeding, infections, inflammation or unwanted scarring or membranes on the retina can also occur. When using a plastic band or a seal, double images can appear after the procedure. Other possible impairments in vision include, for example, myopia or astigmatism. Cataracts or glaucoma (glaucoma) are also possible late effects.
Behavior after treatment
The eye is very sensitive after every surgical procedure. Even with successful treatment, a general closed period should be observed in the first few weeks. Physical stress, certain sports and in particular stimuli and efforts for the treated eye should be avoided as far as possible. An introduced gas prevents the eye from being exposed to major pressure changes, which would be the case, for example, when hiking in the mountains or diving. Usually, a certain head position must be adopted. Sometimes the eye remains sensitive and sensitive to the weather for a longer period of time.
Retinal detachment is a medical emergency and requires rapid medical attention.
In connection with signs of aging or diabetes mellitus, some preventive measures for a healthy eye are known from the field of naturopathy, which can also reduce the risk of retinal damage. In addition to adequate hydration (water), orthomolecular medicine (OM) in particular offers opportunities to maintain eye health for as long as possible. Certain additional nutritional supplements help preserve the eyes and the retina. Appropriate advice is advised before taking such products.
Current state of research
A relatively new and minimally invasive treatment method is the suprachoroidal hydrogel seal, which is used either in combination with vitrectomy or as the sole form of therapy in certain expert centers. Only a very small incision is necessary to close a retinal defect using a special, cross-linked hydrogel and to approach the retina of the choroid again. However, further examinations with long-term experience are recommended before this technique can replace the standard methods. Previous knowledge has already been published online by Georg Thieme Verlag (jvs, cs)
Hole in the retina - retinal holes
Corneal inflammation of the eyes (keratitis)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dr. rer. nat. Corinna Schultheis
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ICD codes for this disease: H33ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.