Retinal Detachment

What is retinal detachment?

The retina of the human eye converts light into electrical impulses, which are transmitted to the brain via the optic nerve. The retina makes up the innermost layer of the three layers that coat the wall of the eyeball. The middle layer is the choroid, which contains blood vessels that supply the retina with nutrients. The outermost layer is the sclera, which serves as a protective layer. 

The retina consists of several layers, each performing different functions. In retinal detachment, the retina separates from the underlying retinal pigment epithelium. Due to the weak connection between these two layers, this is where detachments most likely occur.

As the retinal pigment epithelium supplies the retina with nutrients, the connection between these layers is essential for vision. In retinal detachment, the sensory cells are no longer supplied and die within a short time. This can result in visual disturbances or even blindness.

With around 10 cases per 100,000 people each year, retinal detachment is fortunately a relatively rare disease. Nevertheless, its severity should not be underestimated. 

Retinal detachment is considered an ophthalmologic emergency, which must be treated immediately to prevent vision loss

What causes retinal detachment?

Various types of retinal detachment can be distinguished based on their underlying cause. The largest group encompasses the tear-related (rhegmatogenous) detachments. Tractional and exudative types are less common.

Tear-related retinal detachment

The detachment mostly occurs due to the formation of fine tears or holes in the retina. The openings allow fluid to enter from the vitreous body, leading to separation of the retina.

The most common cause of retinal detachment is degenerative processes, during which the vitreous body liquefies due to remodelling of collagen fibres, leading to posterior vitreous detachment. The retina can develop tears at the connection points where the vitreous body is attached, allowing fluid to enter the space between the retina and the retinal pigment epithelium.

Inflammatory processes in the eye can cause similar fluid accumulation in this space. This form of retinal detachment is very rare and occurs in individuals with severe systemic diseases, such as AIDS.

Tractional retinal detachment

In these cases, traction forces acting on the retina play a significant role. The retina can detach once these forces exceed a certain threshold. Tractional retinal detachment can be caused by various diseases. These include, among others, traumatic injuries to the retina, severe forms of diabetes mellitus, or previous retinal detachments. 

The healing process of these injuries causes scar formation. The new tissue is denser and shorter than the original tissue, pulling continuously on the retina and causing it to detach. Tractional retinal detachments generally develop very slowly over time.

Exudative retinal detachment

In exudative forms of retinal detachment, no tears, holes, or traction forces are present. Instead, the fluid exchange between the vitreous body, choroid, and retina is disturbed by various conditions. This results in excessive fluid accumulation in the space between the retina and retinal pigment epithelium.

This can be caused by various conditions, namely certain forms of macular degeneration, severe hypertension, or tumors of the retina or choroid. The treatment of exudative retinal detachment focuses on managing the underlying disease.

Risk factors for retinal detachment

Retinal detachment can occur in various medical conditions. Additionally, there are certain risk factors that increase the likelihood of developing retinal detachment.

As degenerative processes account for a majority of retinal detachment cases, age is a major risk factor. Moreover, high myopia (nearsightedness) and cataract predispose to the development of the disease. Similarly, surgical treatment of cataract (cataract surgery) is considered a risk factor.

A family predisposition can also increase the risk of developing retinal detachment. About 15-20% of patients who have experienced detachment in one eye, are at increased risk of developing it in the other eye as well. Therefore, patients should attend regular checkups for the unaffected eye.

Stress is increasingly discussed as a possible risk factor for retinal detachment. Chronically elevated cortisol levels are suspected to play a significant role. Cortisol is a stress hormone that increases blood pressure, among other things.

High blood pressure can damage the choroid and result in small tears in the retina. This condition is known as central serous retinopathy. Although the exact mechanisms are not yet fully understood, stress is thought to be of high relevance. Men aged 20 to 50 are predominantly affected. 

What symptoms can occur?

Retinal detachment is generally not painful. It manifests through visual disturbances. Affected individuals notice flashes of light and small black dots. These phenomena arise from an irritation of the retina. The most typical symptom for a retinal detachment is visual field loss. This is often perceived as a dark shadow or opacity which can move upwards and downwards, or leftwards and rightwards.

These opacities can also occur as harmless floaters due to the ageing process. They are also called mouches volantes. Unlike these transparent to greyish opacities, in retinal detachment, the opacities appear black and soot-like. Moreover, they appear very suddenly and are often accompanied by flashes of light. In these cases, patients are advised to consult an ophthalmologist as quickly as possible.

How is retinal detachment diagnosed?

Patients who report the above-mentioned symptoms should immediately undergo a thorough ophthalmologic examination. Both retinas should be examined carefully. This examination requires dilated pupils, which can be achieved by applying special eye drops beforehand.

The retina is best examined using ophthalmoscopy. Indirect ophthalmoscopy is particularly suitable as it allows for the examination of the peripheral zones of the retina. The examiner obtains a magnified, inverted image of the retina with the aid of an ophthalmoscope.

The retina is then assessed for its structure, color, and integrity. Any holes, tears or other abnormalities should be carefully documented before planning the appropriate treatment approach.

How is retinal detachment treated?

Retinal detachment is a medical emergency. If a patient notices these symptoms, they should seek immediate medical attention from an ophthalmologist. The latter will examine the affected eye to confirm the diagnosis.

Tears and small injuries to the retina can be treated using laser therapy. This induces scar formation around the site of injury, preventing further detachment.

If retinal detachment is already present, surgical treatment becomes necessary. The extent of surgery depends on the severity and duration of the condition.

If the symptoms are recognized early and treatment is initiated promptly, the detachment can be fixed in most cases. However, affected individuals might still experience persistent visual impairment.

How does retinal detachment surgery work?

Different surgical techniques are used depending on the extent of the retinal detachment.

If small holes or tears are the cause of the retinal detachment, the eyeball can be surgically indented. A small sponge implant is sutured onto the sclera at the injured area, allowing the retina to reattach to the retinal pigment epithelium. Additionally, cold therapy is used to promote scar formation and prevent further detachment. The accumulated fluid in the space between the retina and its layers can be drained during the surgery.

If larger tears are present or if the retinal detachment has existed for a longer period of time, a different surgical approach is required. The most common treatment is replacement of the vitreous body. During a so-called vitrectomy, the vitreous body is removed and replaced with gas, a saline solution, or oil. This way the retina and the retinal pigment epithelium are pressed back together from the inside.

The defect is also sealed with a laser during this procedure, and a temporary tamponade may be inserted if necessary. This involves creating a gas bubble, which presses against the defect until the gas is absorbed by the body. In some rare cases silicone oil is used. However, the main disadvantage is that the oil cannot be absorbed by the body and therefore has to be surgically removed during a subsequent procedure.

In recent years, vitrectomy has become a standard procedure for retinal detachment due to continuous advancements in technique and its minimally invasive nature. Nevertheless, the choice of surgical technique must be made with careful consideration of the individual case.

What does postoperative care involve?

The aftercare of any type of retinal detachment includes regular check-ups of both eyes by an ophthalmologist. Moreover, physical rest for several weeks is recommended, and rapid eye movements should be avoided. This includes activities such as reading.

Special precautions must be taken if the vitreous body was replaced with gas. In these cases, patients must maintain a specific body position for several days to ensure that the gas bubble remains in the correct position.

Patients typically do not have any significant restrictions after about two to three weeks postoperatively.

What are the prognosis and chances of recovery after a retinal detachment?

The prognosis after retinal detachment is generally better the smaller the extent of the detachment and the sooner treatment is initiated. Uncomplicated retinal detachments can be successfully treated in about 90% of cases. When promptly treated, visual acuity can be preserved. However, in some cases, it may take additional time for visual acuity to return to normal if the sensory cells of the retina need to regenerate.

Complicated retinal detachments have a generally poorer prognosis and may result in permanent visual impairment. If an underlying disease is causing the detachment, the prognosis depends on said disease.

Can retinal detachment be prevented?

As the most common cause of a retinal detachment is degeneration of the vitreous body, which is a natural ageing process, there are no effective preventative measures. However, it is recommended to seek immediate medical attention if any of the above-mentioned symptoms appear, so that treatment can be promptly initiated.

If some underlying conditions promote the development of retinal detachment, they should be treated optimally. For example, high blood pressure should be well controlled. Moreover, regular check-ups with an ophthalmologist are recommended.

What physicians and clinics specialize in retinal detachment?

Anyone in need of medical attention naturally wishes for the best possible medical care. Therefore, patients often ask themselves: where can I find the best retinal specialists in Germany? This question cannot be answered objectively as no reputable physician would claim to be the best. Instead, patients should solely rely on a physician's experience.

We will help you find an expert for your condition. All listed physicians and clinics have been carefully reviewed for their outstanding specialization in the treatment of retinal detachment and are awaiting your treatment request.