Patient information: Retinal Detachment
What is the retina? The
retina lines the inside of the back of the eye. It
functions a bit like the film in the back of a camera, in that it
absorbs light to form an image of the outside world.
The most important part of the retina is the macula - this is the part
of the retina that the light is focussed on. It gives
the central vision that is important for fine visual tasks such as
reading and driving.
What is a retinal detachment?
A retinal detachment occurs when a break in the retinal allows
fluid to pass under the retina, so that the retina peels away from
the back of the eye. It is a serious eye emergency and
without treatment it can cause blindness in the affected eye. If you
are diagnosed with a retinal detachment it is important that you
see an eye doctor (ophthalmologist) immediately. You may then be
referred to an ophthalmologist who is also trained as a retinal surgeon, such as myself.
Most people develop a retinal detachment spontaneously, that is,
it is not caused by anything they have done. It is more common in
people who are shortsighted (myopic).
What are the symptoms of retinal detachment? People
often notice spots floating in their vision (floaters), or flashing
lights, in the period leading up to a retinal detachment. As
the retina detaches it causes an enlarging blind spot that may
progress to involve the macula. When this occurs the central
vision is much reduced (called a macular-off
detachment). Some small retinal detachments that haven't affected
the macula (macular-on detachments) may go unnoticed and be picked up
during a routine eye examination by an optician.
In summary, the key symptoms are flashing lights,
floaters, bits missing from the vision, or 'curtains' coming over
Do I need surgery? Most
patients with retinal detachments are advised to undergo surgery
as retinal detachments seldom go away, and many progress to cause
severe or total loss of vision in the affected eye. Very occassionally,
longstanding detachments are kept under regular review or treated with
What does surgery involve? Patients
usually require one of two types of operation: either cryobuckle
surgery or vitrectomy. Cryobuckle surgery involves putting a
silicone splint (explant/buckle) onto the outside of the eye to push
outside layers of the eye back into contact with the detached retina.
The buckle is not normally visible as it is hidden under the skin
of the eye (conjunctiva), and the eyelids. The retinal break is
then sealed with a laser or freezing probe
(cryoprobe). Victrectomy involves operating inside the eye and
removing the clear gel (vitreous) that fills the cavity of the eye.
The retina is pushed back into position with a bubble of gas, and
the hole is sealed with a laser or cryoprobe. The gas
bubble absorbs with time but whilst it is in the eye the patient
is usually asked to keep their head in a particular position, to float
the retina into the correct position. Surgery can be undertaken
under a local anaesthetic (the patient is awake but with an injection
to numb the eye), or general anaesthetic (asleep), and takes from about
30 minutes up to 2 hours, although most operations take about an hour.
It may also be recommended that you have laser or cryoprobe
any weak areas in the other, unaffected eye, to reduce the risk of
What are the benefits of retinal detachment surgery? This
depends on the type of retinal detachment. If the macula is still
attached, the aim is to prevent severe, central, vision loss. If
the macula has already become detached then surgery aims to improve
vision, but it seldom improves back to normal.
What are the risks of retinal detachment surgery? All
eye operations carry the risk of visual loss and this is true of
retinal detachment surgery, however, severe surgical complications such
as haemorrhage or infection are thankfully very rare (about 1 in 500
patients are affected). The most common problem is that the
retinal detachment persists, or recurs, and further surgery is required
to re-attach the retina. This is not uncommon, with 10-20% of patients
requiring more than one operation to attach the retina. Even if
patients may require more than one operation the good
news is that most retinas (more than 95%) can be attached. In
addition, those patients who require vitrectomy will usually go on to
develop cataract and this usually requires surgery at some time.
Those who have cryobuckle surgery may get double vision, but
this usually settles.
Are there any particular precautions after surgery? A nurse
will go through the general instructions for someone who has
just had an operation such as keeping the eye clean, use of eyedrops,
and follow up appointments. For those that had a vitrectomy
there are additional instructions. Firstly they must not go up to high
altitude as the gas in the eye will expand and this puts the eye
pressure up. Hence they cannot fly, or go up high mountains
gas absorbs, and this can take 1-2 months depending on what type
of gas is
used. Secondly, if they need a general anaesthetic
they must inform the
anaesthetist that they have gas in the eye, to avoid certain
Any further questions? Retinal
detachment is a serious diagnosis that often comes as a shock. In
addition, surgery is often performed relatively urgently so you may
feel there is not much time to consider the options. For this
reason it is important to ask questions and either myself of one of my
staff will be happy to discuss things with you. If you drive you
should check with us whether it is safe to continue. The Royal
College of Ophthalmologists also produces a helpful information
leaflet that is worth reading (click here to view).