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RETINAL DETACHMENT 

Immediate attention is required!

Retinal detachment affects one in 10,000 people each year. This is a serious eye condition that can occur at any age, but usually tends to occur in middle-aged individuals or people of the third age. It is usually more common in myopic people or those who have previously had a retinal disorder. A strong blow to the eye can also cause retinal detachment. Less frequently, this disorder is related to hereditary diseases and may thus occur even in children. Treatment should not be delayed because it can lead to irreversible damage or loss of vision.

The retina is a thin, transparent membrane, formed by a series of layers with fibers and photosensitive cells; it is actually an extension of the brain. The retina is covering internally the eye cavity, in the same way as the wallpaper covers the walls of a room. The function of the retina is similar to that performed by a photographic film: the light passes through the cornea and the crystalline lens and is focused onto the retina. Light stimulates the cells of the retina that are responsible for "image capture" and transform the light stimulus into electrical stimulus that will travel through the optic pathway to the brain, where we will get the feeling of seeing.

 

CAUSES AND SYMPTOMS 

Most retinal detachments are caused by the presence of bleeding or tears in the tissue structure of the retina.

Inside the eye, the vitreous humor is firmly attached to the retina at some specific points. Traction of the vitreous humor can cause a tear or hole in the retina. Although some vitreous detachments occur naturally with aging and do not cause damage to the retina, an abnormal growth of the eye (sometimes as a result of myopia), inflammation, and ocular trauma secondary to accidents can cause vitreous detachment. In most cases, there may be a significant change in the structure of the vitreous prior to the retinal detachment. First, a tear in the retina starts, through which penetrates the vitreous fluid, facilitating the separation of the retina and the subsequent detachment. The area detached of the retina cannot function properly and causes blurred vision or blindness (partially or totally) of the visual field, depending on the extent of the detachment.

We should note that there are some detachments that are caused by other eye diseases, such as tumors, severe inflammation or complications of diabetes. These are called secondary retinal detachments and there are no tears or holes in the retina and the treatment of the condition that caused the detachment of retina is the only therapy that allows returning the retina to its normal position. 

Middle-aged individuals and elderly people can see floating black spots, commonly called "floaters", and flashes of light in their vision (less common in children or young people.) In most cases, these symptoms do not indicate any serious problems, but if there is a sudden and abrupt appearance of these spots and / or flashes of light, this could indicate a vitreous hemorrhage with retinal tear.  An eye exam by an ophthalmologist will be needed to examine the inside of the eye and determine if there is retinal detachment. The examination should be performed as soon as the first symptoms appear, because a recent retinal detachment can be treated by surgery before there is a more severe and irreversible situation.

Some retinal detachments can also be initiated without the presence of floaters or flashes of light. In these cases, patients may notice a wave or veil in their vision or the appearance of a shadow alongside of the visual field. The development of a retinal detachment will cause a blurring of central vision and create a significant loss of vision unless it is not treated quickly and effectively.

Occasionally, retinal detachment can happen suddenly and the patient may experience a total loss of vision in one eye. A similar sudden vision loss can also be caused by a vitreous hemorrhage associated with retinal tear or detachment.

 

TREATMENT

Preventive or prophylactic treatment is addressed to the control of all those injuries or tears that can lead to a retinal detachment. Among the possible treatments, we emphasize preventive cryotherapy and laser photocoagulation.

Photocoagulation consists of giving a series of laser impacts on all injuries that may predispose a retinal detachment. The laser seals the retina in those areas where it is weak, creating a strong bond between the retinal layers. It's a painless process and is carried out through the pupil. 

Cryotherapy is also intended to seal existing lesions.  The procedure will apply a cold probe in the external wall of the eyeball.

Yet, retinal detachment has already occurred and we must resort to a curative treatment. The scleral or classical surgery involves placing explants (materials adhered to the external wall of the eyeball) in order to produce an indentation of the eyeball wall inwards. In this way, the said wall reaches out the detached retina facilitating plugging of retinal tears and adhesion of the retina to the eye wall. Normally this procedure is often combined with laser.

Vitrectomy is another curative treatment, mainly indicated for those cases where the retina is detached as a result of vitreous traction.  The vitreous humor causing injury will be removed and replaced by injecting a similar fluid, then substances as air or expanding gases or silicone oils will be passed through in order to press the retina and adhere it properly. Prior to this procedure, injuries or tears shall have been treated with laser. 

Finally, we can also use gas injection but without removing the vitreous humor. In this case, a gas bubble will be infiltrated to push the affected retina and facilitate adherence. To complete the procedure, cryotherapy or laser will be used.

PREVENTION OF LOSS OF VISION.

Early detection of an injury to the back of the eye, that can cause retinal detachment, is the best protection against loss of vision. Notwithstanding no symptoms are observed, periodic examinations should be performed, especially in those individuals who are in a risk group (high myopia, family history, etc). It is important to remind people that a retinal detachment is a painless eye disorder but that requires immediate, urgent treatment.

 

 

 
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