Retinal detachment in the eye

Detachment of the retina - immediate danger to the eyesight

Retinal detachment in the eye (retinal detachment, retinal detachment) is always an ophthalmological emergency, regardless of cause and severity. If the retina (retina) loosens from its supply layer, the retinal pigment epithelium, considerable loss of function occurs due to undersupply of the affected areas. In severe cases, this can lead to blindness. A quick diagnosis and treatment by surgery is crucial for the best possible preservation of the retina and therefore the eyesight.

contents

• Detachment of the retina - immediate danger to the eyesight
• A short overview
• definition
• symptoms
• causes
• diagnosis
• treatment
• Naturopathic treatment
• Current state of research

A short overview

Retinal detachment is a medical emergency and rapid examination and treatment is critical to prevent permanent vision damage or blindness. The following overview 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 an amotio retinae.

A retinal detachment is a major threat to the eyesight. (Image: Patrick Daxenbichler / fotolia.com)

How to recognize a retinal detachment?

• No pain is perceived and other symptoms may (initially) be absent, often leading to a late diagnosis.
• Harbingers are often symptoms of a retinal hole or tear, such as black "dancing" spots ("flying mosquitoes") in front of the eyes or lightning with the eyes closed.
• Signs of an ongoing detachment of the retina are increasingly occurring black point clouds or drooping black dots ("sooty rain"), visual disturbances by shadows, smoke or fog, fog in front of the eyes or blurred vision.

Possible causes

Among the many triggers, the most important are divided into the following three groups:

• Rhegmatogenic retinal detachment caused by a previous tearing of the retina and are the most common cause.
• Serous retinal detachments are caused by fluid retention under the retina, but are rather rare.
• Tractive retinal detachments are caused by scarring processes and associated retinal pulling forces, such as those associated with diabetic retinopathy.

Possible signs of detachment of the retina are various visual impairments, including blurred vision. (Image: schankz / fotolia.com)

therapy

Retinal detachment must always be followed by an operative procedure in order to restore it. The following skilled procedures are carried out on a cause-specific basis:

• Sewing on a plastic seal (indentation of the wall of the eye),
• Attaching a plastic band (cerclage),
• Removal of the vitreous (vitrectomy) and replacement with gas or silicone oil,
• Introduction of a gas mixture into the interior of the eye.

definition

The retina is located on the inside of the eye or in the back of the eye. It is pushed through the vitreous body to the choroid, where small blood vessels ensure supply. These two structures are only loosely connected to each other, only in the area of ​​the optic nerve and the outer Netzhaugeirkumferenz are adhesions between the retina and choroid. In the center of the retina, just opposite the pupil, lies the macula. This so-called "Yellow Spot" is, with the centrally placed fovea, the place of the sharpest vision.

The retina is complex and consists of several layers. The layers facing the light protect the sensory cells, which are supported by the neurons, from being over-stimulated. The farthest, light-averted 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 ensure a variety of functions. The retina absorbs the incoming light, sorts the complex information and converts it into corresponding electrical impulses. These are transmitted to the brain via the optic nerve. Thus, the retina is significantly involved in an effective visual perception and ultimately crucial for a sharp and focused vision.

The complex structure and the different layers of the retina provide a variety of functions for a sharp and focused vision. (Image: sakurra / fotolia.com)

If it comes to a retinal detachment, the affected areas are no longer adequately supplied with blood, oxygen and nutrients. This is accompanied by a striving tissue and a loss of function. The vision can then be permanently impaired and can lead to complete blindness. Divided by the causes, various forms of retinal detachment occur. The retina can only partially or completely separate from the underlying tissue. Especially dangerous are large or complete detachments, as well as an inclusion of the macula as the center of the strongest eyesight.

About one in 10,000 people is affected by a detachment of the retina, so this is rather a rare phenomenon. In many cases, there are already other retinal damage, which are not noticed or too late. If liquid from the adjacent vitreous body passes through the damaged areas between the retina and its base, it dissolves at different rates.

symptoms

Retinal detachment is usually painless, as the retina has no pain fibers. Other typical symptoms may be absent (at first), which is why detachment is often noticed late. This increases the risk of impairment of the eyesight.

First complaints that occur with smaller holes or cracks, cause mostly black, dancing around points ("flying mosquitoes") in front of the eyes or there are lightnings with closed eyes perceived. In addition to points, lines and flashes, on the other hand, in a retinal detachment usually even more noticeable visual changes are perceived. Frequently, sufferers report the following phenomena:

• drooping black dots ("soot rain"),
• Smoke or fog by a massive increase of small black dots,
• Loss of vision and constriction of the field of view through dark, expanding shadows,
• Veil in front of his eyes,
• blurred vision (if the macula is affected).

Frequently, age-related shrinkage of the vitreous body and concomitant tensile forces on the retina cause their detachment. (Image: Henrie / fotolia.com)

causes

The causes of retinal amotio are manifold. A basic division into three forms is based on the different triggers of a replacement.

Rhegmatogenous (ruptured) retinal detachment

The most common variant is caused by a previous tearing of the retina. Often an age-related shrinkage of the glass body (vitreous removal) and the resulting tensile forces are crucial. Not infrequently, this only causes small holes or cracks. However, if these remain undetected and are not treated, fluid may subsequently accumulate from the vitreous body between the retina and the pigment epithelium. This ultimately causes the gradual replacement. Especially people with eye problems, such as severe myopia or a previous cataract, have an increased risk of developing it. Even from an older age of about 60 years, the risk increases significantly.

Serous retinal detachment

In this rather rare form of retinal detachment, a build-up of fluid under the retina is the reason for their withdrawal. This usually occurs in connection with inflammatory processes, which is why one speaks in this context of an exudative (inflammatory) retinal detachment. Various diseases may cause fluid leakage, or it may be a congenital eye disease (for example, Coats's disease).

Tractive retinal detachment

This variant is caused by scarring processes and constricting connective tissue membranes, which in some places are firmly attached to the retina. Shrinking these membranes causes tensile forces that literally pull the retina away from its surface. This is a particularly complicated and difficult to treat form. The trigger is especially the diabetic retinopathy. Long-standing diabetes (diabetes mellitus) often causes scarring of the vitreous and retina. However, heredity or complications of previous retinal surgery may also be related.

A particularly complicated form is the tractional retinal detachment, often triggered by diabetes mellitus. (Image: koolsabuy / fotolia.com)

In addition, eye tumors (for example, retinoblastoma or choroidal melanoma) or trauma due to an accident or injury may result in retinal amotio. Other risk factors that may be considered are frequent flying, long screen work and increased stress levels.

diagnosis

Because the extent of retinal detachment and the associated damage to the eye depend on the time between incipient detachment and its treatment, early diagnosis significantly improves the prognosis for vision. People at risk are therefore also advised to undergo regular ophthalmological checks. Often sufferers recognize the signs too late and serious vision problems or even blindness are then possible consequences.

For this reason, an immediate examination of the eyes is necessary even at the slightest sign. Eliminating precursors such as retinal holes or tears in an exam and confirming the suspicion of retinal detachment is always an ophthalmological emergency requiring surgical intervention.

During the examination, as in the case of other retinal damage, the pupil is first dilated with medication by eye drops in order to be able to see the fundus of the eye. 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 accurately assessed in an enlarged view. If gray lines become visible, this indicates a retinal detachment. This type of examination is a classic ophthalmoscopy (ophthalmoscopy or funduscopy). A digital retinal exam can also be performed today and offers some advantages over the traditional method. An ultrasound examination can also be used for the examination. For example, if there are bleeding that complicate the ophthalmoscopy, usually an ultrasound is performed.

A detachment of the retina always requires a surgical procedure to prevent possible visual damage. (Image: 2707195204 / fotolia.com)

treatment

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 prognosis for the eyesight. However, it does not always succeed in preventing vision loss.

As a rule, the surgical procedures are performed by specialists and under general anesthesia. During the operation, contact between the retina and the underlying layer should be restored, which will correct the causes accordingly. For this application of the retina, the following methods are used, either from the inside of the vitreous (vitrectomy) or from the outside:

• Indentation of the retina by means of a plastic seal,
• Attach a plastic band (cerclage) around the eyeball,
• Removal of the vitreous (vitrectomy) and fluid retention (cause: vitreous detachment), replacement by gas or silicone oil,
• Introduction of a gas mixture into the interior of the eye.

Sewing a plastic seal or a cerclage on the outside of the dermis causes a persistent indentation of the wall of the eye. This is the oldest method and is not used so often.

Vitrectomy is the more modern and gentler standard procedure in which the retina is placed from the inside. Fine instruments are inserted into the interior of the eye to remove the vitreous humor. Subsequently, a laser therapy (laser coagulation) or a cold treatment (cryocoagulation) is usually performed to scar on the retina. This is to restore a stable connection between the retina and its base. These methods are otherwise used to remedy minor damage. Mostly, the retina is still temporarily sealed by the introduction of a gas bubble. In complicated cases, silicone oil can also be used for this purpose. Sometimes it is sufficient to introduce a certain mixture of gases into the inner part of the eyeball to restore the retina. However, this is 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 retinal detachment, the treatment of this cause is in the foreground.

In most cases (90 percent), an operation performed by an expert at the first intervention will produce the desired result. Without treatment, those at risk risk becoming blind.

Remains retinal detachment without treatment, there is a risk of blindness. (Picture: photocrew / fotolia.com)

Complications and late effects

Retinal surgery, like other surgical procedures, carries certain risks. Retinal detachment can not be prevented (permanently) in all cases, which may require further intervention. It can also bleeding, infection, inflammation or unwanted scarring, or membranes on the retina occur. When using a plastic tape or a seal, double images may occur after the procedure. Other possible impairments to vision include, for example, myopia or astigmatism. Also a cataract or glaucoma (Glaucoma) count to possible late effects.

Behavior after treatment

After every surgical procedure the eye is very sensitive. Even with a successful treatment, a general closed season 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 prohibits exposing the eye to greater pressure changes, which would be the case, for example, when hiking or diving. Also, usually a certain head posture must be taken. Sometimes a certain sensitivity and weather sensitivity of the eye persists for a longer period of time.

Naturopathic treatment

Retinal detachment is a medical emergency and requires prompt medical attention.

In the context of aging or diabetes mellitus, some preventative measures are known for a healthy eye in the field of naturopathy, which can also reduce the risk of retinal damage. In addition to adequate hydration (water), especially the orthomolecular medicine (OM) offers opportunities to maintain the eye health as long as possible. Certain supplemental nutrient supplements support the preservation of the eyes as well as the retina. Appropriate advice is advised before taking such products.

Often specialists are needed to treat a detachment of the retina. (Image: Vasyl / fotolia.com)

Current state of research

A relatively new and minimally invasive treatment procedure is the suprachoroidal hydrogel seal, which is used either in combination with vitrectomy or as the sole form of therapy in certain centers of expertise. Only a very small incision is necessary to close a retinal defect by means of a special, cross-linked hydrogel and to bring the retina closer to the choroid. However, further studies with long-term experience are recommended before this technique can replace the standard methods. Previous knowledge has already been published online via Georg Thieme Verlag (jvs, cs, updated on 10.09.2018)

also read:
Hole in the retina - retinal holes
Corneal inflammation of the eyes (keratitis)
Conjunctivitis (conjunctivitis)
Eyes (symptoms)