Retinal detachment is the separation of the neurosensory retina from the pigment epithelium, which is the underlying tissue. It is caused by the accumulation of fluid between the two.
It occurs in 1 in 10,000 people. Although it can affect any age, it is more frequent between 40 and 70 years of age, as well as in myopic patients (40% of cases), those who have suffered trauma (10% of cases) and those with a family history of retinal detachment. In 10% of cases both eyes are affected.
Symptoms of retinal detachment
Typical symptoms are: flashing or light vision, blurred vision or visual field defects referred to as a gray or black curtain by the patient.
Myodesopsia or floaters are characterized by being transparent objects, of different shapes and mobile, that interpose themselves in the visual field. They are usually multiple and black, and may be caused by retinal pigment epithelium cells released into the vitreous cavity or by hemorrhage.
The photopsias or luminous flashes are usually repetitive and localized over the same sector of the visual field, and may indicate the presence of a vitreo-retinal traction. This may lead to suspect the presence of a retinal tear, although they do not always appear as a previous symptom.
Sometimes the patient notices directly the complete or partial loss of visual field, referring to it as a black curtain that descends and covers the vision. This symptom may suggest a retinal detachment.
If the area of detachment is very peripheral or small, symptoms may be practically nonexistent.
Any of these symptoms should alert us and is a reason for consultation with an ophthalmology professional. In the case of retinal tear, early treatment can prevent retinal detachment. If it has already occurred, the waiting time until surgery is an important risk factor for the patient’s visual prognosis.
Diagnosis of retinal detachment
The anamnesis provides us with valuable information, as well as a fairly approximate diagnostic orientation. Any of the symptoms described above should be referred immediately to an ophthalmologist for a complete eye examination. Visual acuity should be analyzed and the fundus should be explored, with complete pupillary dilation, by means of indirect ophthalmoscopy with or without scleral detection.
Clinic
Retinal detachment can be classified in three ways according to its mechanism of production: rhegmatogenous, tractional and exudative.
- Regmatogenous: caused by a retinal rupture or tear that frequently appears after a posterior vitreous detachment. This allows passage of liquefied vitreous into the subretinal space, resulting in separation of the neurosensory retina.
- Tractional: caused by tractions produced by membranes or neoformed tissue. These traction the retina and lift it up. The main cause is proliferative diabetic retinopathy.
- Exudative: in this case the retina has no continuity solutions or tractions, but there are vascular permeability problems due to ocular or systemic pathologies or tumors, which causes subretinal fluid accumulation. Unlike the previous types, the treatment is not usually surgical, but rather that of the underlying pathology.