Retinal detachment: What are the causes and symptoms of the damaged retina?

Retinal detachment is one of the most serious and urgent conditions, or diseases of the eye, more precisely the retina. It leads to a reduction in visual acuity or, if treatment is delayed, to irreversible damage of sight or even blindness of the affected eye.

It is one of the relatively common causes of a disorder of this important sense. Early detection and treatment have a major impact on the success of the treatment.

Retinal detachment = the retina peels away, 
the technical term is amotio retinae. 

FAQ:

• What is retinal detahcment and why is there a hole in the retina?
• What are the symptoms of a damaged retina?
• What is the treatment? Is surgery the only solution?
• What is the postoperative recovery like?

First, a brief description of the retina

The retina is one of the most important parts of the eye. Thanks to the rods and cones, it has a sensory function. These light-sensitive cells capture light rays.

The captured image is then transmitted by the optic nerves to the brain, where it is further processed, which allows us to see.

Photoreceptor cells:

1. rod cells are photoreceptor cells
   • they process light of lower intensity
   • they do not recognize the colour
2. cone cells capture light of different wavelengths, i.e. colours
   • they recognize colours, intensity, colour saturation
   • they provide visual acuity
   • they are concentrated in the middle of a pit in the eye - the fovea centralis
   • there are about 6 million cone cells

The retina is a thin membrane approximately 0.1 to 0.25 mm thick. It is placed on the inside of the eyeball. For the most part, it is loosely deposited on the choroid.

The eye is filled with the vitreous body which has a gel-like consistency. It fills the space of the eyeball and presses the retina against the choroid.

The choroid is a layer that nourishes the eye, as it contains blood vessels.

It is made of nerves and support cells with fibres. It also contains the macula lutea, which is the place of sharpest vision, in the centre of which is a visible pit - the fovea.

Macula lutea - the macula

The retina is divided into two layers, pars optica and pars caeca:

1. pars optica - contains photoreceptor cells
   • the light-sensitive area - neuroretina
2. pars caeca - the blind area (caeca = blind)
   • also referred to as external pigmented area
   • located in a part of the ciliary body and the back of the iris

What is retinal detachment?

The term includes the process of peeling away of layers of the retina. As a result, there is a nourishment dysfunction. This leads to retinal damage.

The retina of the eye is retracted from its original and normal position.

More precisely, the definition states that retinal detachment is:
A separation of neuroretin, i.e. the sensory part, from retinal pigment epithelium.

The retinal pigment epithelium (part of the retina) is fixed to the choroid. After peeling away from each other, a space is created between the two layers. The result is fluid accumulation and impaired nourishment of the sensory part of the retina.

The accumulated fluid can be vitreous due to pressure changes (transudate - passing through a tear or a hole), or exudate, i.e. penetration of blood and its parts from the choroid and from the vessels.

Retinal detachment is, therefore, a serious and urgent condition. Early detection and timely treatment are important for maintaining vision.

A delay and neglect may mean a serious threat to the visual sense of the damaged eye, either by worsening sight, i.e. reduced visual acuity, or even blindness.

In the late stages of the disease, any changes are irreversible.

What is the cause?
There may be multiple causes, as different conditions may lead to retinal detachment.
What is more, various risk factors contribute to it.

Table: based on the causes, retinal detachment is divided into two forms

It is usually the primary form of the disease.

The detachment is due to a tear or hole in the retina. Intraocular fluid penetrates through the damaged retina. Its subsequent accumulation will cause the layers to rise and create a pathological (unhealthy/bad) space.

This whole process ultimately leads to a disruption of the blood supply and nutrient supply to the retina.  

One of the main causes is the aging of the body. As a result, there is a loss of vitreous fluid. This creates a disparity in shape and insufficient pressure on the retina. The vitreous may become smaller or less rigid.

Other examples are injury, inflammation and other eye diseases.

Risk factors leading to the disease:

• advanced age
• hereditary and genetic predisposition, increases the possibility of occurrence
• retinal detachment already present in one eye
• eye and head injury (speed sports, bumps, falls from a height, weightlifting, diving, parachute jump)
• inflammation of eye
• other diseases of the eye, such as glaucoma, tumor, occlusion of the retina
• extreme short-sightnedness
• High BMI and obesity
• high blood pressure - mainly malignant form and hypertensive crisis
• diabetes mellitus - diabetes and diabetic retinopathy
• eye surgery - intraocular procedures
• a person with a predisposition to bleeding
• eclampsia in pregnant women
• premature babies
• smoking

Retinal detachment symptoms do not include pain, so this disease is painless.

The main symptoms include:

• reduced visual acuity - blurred vision
• loss in the periphery of the field of view - impaired vision in the periphery, which can move closer to the center from the edge
• flashes of light, sparkle in one or both eyes - scintillating scotomas or floaters
• sudden appearance of floaters in the visual field
  • eye floaters are small dark spots or dots in the visual field that are particularly noticeable when looking at a blank or white background or surface
  • floaters swim around and drift into the field of vision
  • densely floating may appear as black dots that look like soot - a sign of bleeding into the vitreous
• shadows in a visual field, the impression of a curtain, curtains - partial to complete loss of vision may occur
  • the field of view may become darker or dimmer

Floaters, or mouches volantes, are common and do not indicate a serious problem. However, a sudden onset may be indicative of retinal detachment. Floater are best seen on a blank background, for example on a white wall and may appear as dark gray shadows, dots, or threads.

NB: 
In case of sudden issues, an eye examination by an ophthalmologist need to be done immediately.
This may save your vision.

If the macula is affected, the central visual acuity decreases significantly.

The separation of the entire retina will cause acute blindness. If not addressed immediately, the resulting damage will be irreversible, i.e. it cannot be reversed or undone.

The diagnosis is based on the medical history, i.e. what the affected individual describes.

This is followed by a special eye examination. The doctor will ask for more details about visual acuity and the occurrence of visual field loss, floaters, and whether the issues occurred suddenly.

The main examination methods are as follows:

• opthalmoscopy of the inside of the eye (using bright light and special lenses to enlarge the eye background image)
• ultrasound examination to determine if there is vitreous hemorrhage which makes it difficult to see the retina

This is followed by a treatment or surgery, depending on the form of retinal detachment.

The course of the disease depends on the form and, of course, on the underlying cause. Retinal detachment does not hurt, and its symptoms are well recognisable.

This is an advantage for early detection and timely professional intervention.

Acute forms are especially serious because they occur suddenly. The opposite is the degenerative type whose onset takes a longer time, as is the case with the aging of the organism.

Approximately 7% of cases take place bilaterally, i.e. in both eyes.

It should be noted that without treatment there is a risk of complete loss of vision in the damaged eye.