Retinal detachment - Symptoms, Causes and Treatment
What is a retinal detachment and how do you recognize the symptoms?
What is a retinal detachment
A retinal detachment (ablation or retinal ablation) is a serious ophthalmic condition in which the retina - the thin, light-sensitive layer on the inside of the eye - detaches from the underlying structure. This can lead to permanent vision loss if timely intervention is not taken. Normally, the retina is firmly connected to the underlying choroid, which provides blood supply and nutrients. When the retina detaches, the supply of oxygen and nutrients is interrupted, interfering with the function of the light-sensitive cells. Without treatment, this can lead to permanent blindness in the affected eye. Retinal detachment is often caused by a tear or hole in the retina, usually due to a vitreous detachment. This causes fluid to get under the retina, causing it to detach. Other causes include trauma, severe myopia, previous eye surgery or hereditary factors.
Three types of retinal detachment
- 1. Rhegmatogenous retinal detachment - The most common form, caused by a tear in the retina.
- 2. Traction retinal detachment - Occurs due to scar tissue pulling on the retina, often in diabetic retinopathy.
- 3. Exudative retinal detachment - Is caused by fluid accumulation under the retina, without a tear, often due to inflammation or tumors.
Symptoms of a retinal detachment
The following symptoms are possible in a retinal detachment:
Floaters or "Mouches volantes": these are clouds in the vitreous that can be seen as spiders, dots, strings or spots
Flashes of light, as if a fluorescent lamp goes on and off
Loss of visual field: initially a black spot is visible in the corner of the eye and then expands
Reduction of vision: a retinal detachment can cause vision to disappear gradually or very quickly. First there is a large black spot at the edge of the visual field
When the center of the retina (macula or yellow spot) has also detached, sharp vision disappears.
Causes of retinal detachment
The different steps in a retinal detachment
First step: vitreous fluid detachment
Initially, the vitreous is attached to the retina and fills the entire posterior chamber of the eye. With age, the composition of the vitreous changes. It shrinks slightly and the jelly-like substance or vitreum becomes more fluid. As a result, the vitreum sac will suddenly separate from the retina, creating a space between the retina and the vitreous. We call this vitreous detachment. This space will fill with water. During this process, impurities also appear in the vitreous, which the patient perceives as black spots, "mouches volantes" or floaters. These floaters can be very disturbing. They are especially noticeable in bright light, when looking at the blue sky or when looking at a white wall.
Sometimes a vitreous detachment can cause bleeding or a retinal tear.
This vast majority of patients with vitreous detachment remain at this stage and will not develop a retinal tear or retinal detachment. However, a comprehensive examination of the retina is always needed to rule this out.
Second step: retinal tear
Vitreous detachment is a relatively normal phenomenon, but sometimes the posterior vitreous membrane is tighter than normal in certain places. As a result, during vitreous detachment, one or more tears develop in the retina; a retinal tear. These tears are dangerous and must always be treated by laser. An untreated tear can lead to a retinal detachment.
Third step: retinal detachment
When there is a retinal tear, water can come out of the posterior chamber of the eye through the small hole under the retina. A retina detachment or retinal detachment occurs. The detached part of the retina can no longer function properly because it is loose. The patient will begin to see a dark hazy spot, which usually begins at the edges of the visual field. Here, prompt treatment is always needed to save the eye.
The different degrees of retinal detachment
A peripheral retinal detachment detachment
When the detachment is still in its early stages, the patient will perceive a black spot on the side of his visual field. Since the center (macula) is not yet affected, the patient can still see reasonably well. He can still see far and read.
At this stage, treatment is urgent, depending on how long the detachment has been present because one will try to avoid the macula also becoming detached. Therefore, if the detachment progresses further, it will also detach the macula and vision will drop dramatically.
A retinal detachment with detached macula
Thus, in this type of detachment, vision will drop dramatically. The patient will no longer be able to read or see far. Vision will gradually turn black. At this stage, treatment has become less urgent because the macula is already ligated anyway.
An older retinal detachment
When the detachment has been present for several weeks, a scar reaction (PVR) will occur. This reaction is extremely pernicious to retinal healing. The PVR will destroy the retina instead of promoting healing. Old retinal detachments are therefore more difficult to treat.
Treatment of retinal detachment: vitrectomy
Vitrectomy is the most commonly performed surgery for retinal detachment.
What is a vitrectomy
A vitrectomy is a surgical procedure performed to treat conditions in the vitreous and retina of the eye. The vitreous, a clear gel-like substance that fills the inside of the eye, is partially or completely removed during the procedure. This space is then filled with a special liquid, gas or silicone oil, depending on the type of treatment.
Vitrectomy is used for a variety of eye problems, including retinal detachment, macular surgery (such as an epiretinal membrane or macular hole), severe vitreous hemorrhage or infection, and complications of diabetes of the retina. Removing the vitreous allows the ophthalmologist better access to the retina to repair it or perform other treatments.
The procedure is usually performed under local anesthesia and takes an average of 20 to 60 minutes, depending on the complexity of the problem. Some recovery time may be required after surgery, depending on the filler used and the type of procedure. Vitrectomy is a safe and effective procedure that often leads to significantly improved vision or preservation of vision.
With 15 retinal surgeries per week, we have the expertise necessary to get you to the best possible outcome.
Retinal surgeon: Dr. Bart Pion
Dr. Bart Pion, specialist in vitreoretinal surgery, is a leading retinal surgeon with years of experience in complex retinal surgery. He graduated magna cum laude from the Free University of Brussels in 2002, after which he specialized in retinal detachment, macular surgery and other advanced vitreoretinal procedures. Through continuous continuing education and participation in international conferences, he always stays abreast of the latest innovations in retinal surgery.
From 2010 to 2023, Dr. Pion was head of ophthalmic surgery at St. Peter's Hospital Brussels, where he spent 13 years performing the most complex eye surgeries and leading a team of more than 20 ophthalmic surgeons. During this time, he built a strong reputation in retinal surgery, cataract surgery and refractive treatments.
Here he performs vitrectomies, laser treatments and other innovative techniques to restore and protect his patients' vision. Focus Eye Clinic is the only extramural center in Belgium where retinal surgery is performed in an outpatient setting, offering patients fast and efficient treatment without hospitalization. His commitment to precision, innovation and the highest quality care makes him an authority in retinal surgery and vitreoretinal disorders.
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