Retinal detachment

In a retinal detachment, it is common to see flashes on the edge of the field of view and the field of view becomes smaller. If the retina becomes detached, you may have a visual impairment. Therefore, seek care if you think you have retinal detachment. The treatment you receive depends on how much of the retina has loosened.

You can get retinal detachment in one or both eyes. It does not have to happen simultaneously in both eyes. It is most common to get the disease in one eye.

What is retinal detachment?

The retina contains the visual cells. It is trapped in the retina, which supplies the retina with oxygen and nutrition. In the case of retinal detachment, the retina detaches from the retina and then does not get enough nutrition and oxygen. Then the sensory cells stop working and it affects your vision. 

Symptoms of retinal detachment

Retinal detachment often comes suddenly, but it usually does not hurt.

It is common to have any of the following symptoms in a retinal detachment:

  • You see lightning on the edge of the field of view.
  • You see small moving points, dashes or rings. They are called clouds.
  • You will see a grayish or dark shadow on the edge of the field of view.

Sometimes visual acuity may be impaired. It happens when the retina has loosened a lot and reached the yellow spot

When should I seek care?

The vast majority of those who have a cloudiness do not need to seek care because the problems usually go away by themselves after a few months.

If you see lightning on the edge of the field of vision, contact a health center or on-call reception . You can also contact an eye reception directly. If it’s night, you can wait until the on-call reception or medical center opens.

If it’s in a hurry

If you see a grayish or dark shadow on the edge of the field of vision, contact a health care center or an on-call reception immediately. If closed, seek care at an emergency room.

Investigation

Your eye is examined in several ways if your doctor suspects you have retinal detachment. A complete eye examination as the diagnosis can be made can only be done by an ophthalmologist.

Your visual acuity is examined

Your visual acuity may be impaired by retinal detachment. Therefore, the doctor tests your vision from a few meters away with the help of a syntax with letters of different sizes that you can look at. The doctor assesses your visual acuity based on how small letters you can see on the board.

The pressure in the eye is measured

If the retina comes loose, the pressure in the eye is usually lower.

The pressure measurement can be done with different instruments. Most often, the measurement is done with a pressure gauge in an eye microscope. It can also be done with a meter that looks like a pen that the doctor holds. The measurement works in the same way no matter what instrument the doctor uses.

To measure the pressure in the eye, you first get eye drops that numb the eye. The doctor puts the meter against your cornea. It doesn’t usually hurt, but it can feel uncomfortable.

Examination of the retina 

To examine the retina, you first get eye drops that dilate the pupils and then eye drops that numb the eye. Then a kind of hard contact lens with built-in mirrors is placed on the eye. They are called contact lenses.

It can feel uncomfortable when the contact glass is put on the eye. You may also be dazzled by the bright light from the eye microscope.

The survey takes about 30 minutes. When the survey is complete, you will be notified of the result immediately.

Handheld lens

You can also be examined with a so-called handheld lens. Then you first get eye drops that enlarge the pupils. Then the doctor can see your retina through the pupil using the lens. The eye does not need to be anesthetized in this type of examination, but the examination does not provide as detailed an image as an examination using contact lenses.

fundus Photographing

You can also get a special eye-catcher. Then a picture is taken through the pupil, with a camera. In the pictures, the doctor can see the entire retina and the eyes. The pupils do not need to be enlarged for this type of examination.

Ultrasound examination

Sometimes it can be difficult for the doctor to see the retina. It may be because you have bleeding in the glass body or that you are clouding in the eye. Then the doctor can use ultrasound to examine you. They then put a so-called ultrasound pen against the eyelid as you close your eyes and move it in different directions. The ultrasound pen transfers pictures to a monitor where the doctor can see if you have any changes in the eye.

The survey does not hurt. You will be notified of results immediately when the survey is complete.

Treatment of retinal detachment

The treatment of retinal detachment you receive depends on how much of the retina has loosened.

Be careful of hard physical activity before receiving treatment

Before receiving treatment for retinal detachment, do not perform any harsher physical activity as it may cause the retina to become more detached. At check-in after treatment, your doctor can tell you when you can start exercising again.

Laser treatment if there is a small hole in the retina

It is common for the retina to begin to loosen in conjunction with a vitreous detachment . When the vitreous becomes detached, a small hole may appear on the retina. The hole can cause more of the retina to come loose. It can be prevented if the hole is repaired with laser before more of the retina has come loose.

A laser treatment of retinal detachment takes about ten minutes and is done at an eye reception. The eye to be treated is stunned with eye drops. Then you have to sit with your head in the support of an eye microscope while the doctor guides short flashes of laser light into the eye through a contact glass.

It doesn’t usually hurt but you can feel it sticking in the eye.   

Retinal detachment has loosened

Most often, surgery is needed if the retina has begun to loosen more. There are several different types of operations.  

Advice for an operation

You usually get local anesthesia if you are going to undergo an operation. Some surgeries are more complicated, then you get anesthesia.

If you are going to get anesthesia, you should fast. This means that you must not eat anything for six hours before surgery. However, you are allowed to drink clear liquids up to two hours before.

It is good to eat and pee before the operation if you are going to have local anesthesia.  

Common operating methods

The most common operation of retinal detachment is to remove the vitreous. Then the doctor removes the parts of the vitreous that pull in the retina. Then you have to go through a laser treatment to get the retina back in place. Then the hole in the retina is also sealed and cloudings and bleeding disappear. Then the eye is filled with air or gas.

Treatment when the eye is filled with gas or air

If you have a simple form of retinal detachment it can sometimes be treated by injecting air or gas into the eye. The gas seals the hole in the retina so that the fluid under the retina is absorbed. The hole is then closed using a laser treatment or freeze treatment. The gas disappears by itself after about two to six weeks.

Treatment with silicone material

Another treatment method for retinal detachment is to seal the hole with silicone material, a so-called seal. It is stitched to the eye wall so that it is curved in and the hole in the retina is clogged. The doctor also often attaches a thin band of silicone around the eye that holds the retina in place. They can also seal the area around the retina with laser or a special freezing technique.

Sometimes several operations are needed

If it has been some time since the retina came loose, it can solidify and loosen. Then several surgeries may be needed to get the retina back against the wall. Most often, silicone oil is used to support the retina during surgery and afterwards when the eye heals. Once the retina has healed again, the oil can be removed. It is done with an operation.   

After the treatment

The operations usually take about an hour. You may remain at the reception for one to two days. It usually does not hurt after surgery.

You are usually allowed to sit or lie with your head in a special position for a few days after the operation if you have been treated with gas. Then the gas can settle over and clog the hole in the retina. In what position the head should be in depends on where on the retina the hole is located. This is especially true while you are on reception, but you should also try to keep your head in that position for the first few days when you get home.

You may need prescription painkillers, anti-inflammatory eye drops some time after surgery. The eye is usually red and moist one to two weeks after surgery. Usually you can stop taking the drops after that. 

Check after a week and then a few times the first half

You usually get checked in from a doctor after a week. If retinal detachment has disappeared, you can live as you did before you got the disease. Depending on how you feel, you may be able to start working again, if you have a job. You may also need to be on sick leave for a while.

The eye can feel stiff and at times it can hurt. These problems usually disappear after a few months. 

You may have to check with your doctor three to four times during the first six months after surgery.

Materials that have been stitched to the inner wall of the eye are not removed, but remain for the rest of their lives. This prevents the formation of new holes on the retina. 

You who have been operated with gas should not fly until the gas has disappeared. The pressure in the eye gets high during a flight and you can get very hurt. It usually takes two to six weeks until the gas is depleted. You see a round dark shadow down as long as there is gas left in the eye. 

If the disease comes back

The retina can come loose again. Then you usually get a different treatment than the first time. 

complications

Complications associated with the operation are uncommon. It is unusual but you may have a bleeding eye. The bleeding usually disappears by itself after a few weeks.

The lens of the eye can become cloudy if you have had an operation when the glass body has been removed. Most often it goes over, otherwise you may need to do surgery on cataracts . This is often done several months after the first surgery.  

It is unusual, but you can see double after a treatment with silicone material. The double end usually disappears within six months. 

How does vision become after treatment?

How the vision becomes after a retinal detachment depends on how much of the retina loosened before surgery.

Most often, vision becomes as usual after surgery if you have a simple form of retinal detachment and receive treatment quickly. However, the first time after surgery, vision may be impaired.

It is common to become more nearsighted if you have received a silicone band around the eye. That’s because the band makes the eye appear narrower and a little longer.

The dark shadow in the field of view disappears after the operation. It may take longer to regain visual acuity, sometimes several months.

The sight on the eye of the yellow stain loosened

In the center of the retina is the yellow spot. There are an extra number of vision cells and this is where you look like the sharpest. Your vision will be much worse if that part of the retina has loosened. Sometimes, an operation can make you look beside the yellow spot. Then you look bad straight ahead and can’t read with the eye, but look in the outer parts of the field of view.

If the vision becomes very impaired, there is help

Most often you get used to looking worse on one eye after a few months and do well with the sight on the other eye.

You who have impaired vision even on the other eye can get help from a vision center. There you can get help with technical aids, home adaptation and vision training.   

On our pages about  assistive technology  you can read about how it is possible to get visual aids, and find out what aids are available where you live.

What happens in the body?

The eye is largely filled by the glass body which is a transparent jelly-like mass. The glass body is stuck in a thin membrane called the retina. There are the sight cells. The outside of the retina is attached to the retina which supplies the retina with a large part of the oxygen and nutrition it needs. A healthy glass body supports the retina and prevents it from detaching from the retina.

When the light hits the retina, the visual cells are converted into nerve impulses. Through the optic nerve, the nerve impulses are directed to the brain’s visual center and there is an image of what the eye sees.

In the center of the retina is the yellow spot. It allows you to see small details and colors. The rest of the retina allows you to see in the dark and gives you a wide field of view. 

A glass body discharge can sometimes cause retinal detachment

As we age, the texture of the glass body changes. It becomes less jelly-like, more watery and less elastic. This can cause the glass body to detach from the retina. It is called  glass body releasing . It is very common.

As the glass body is loosening, you can see flashes on the edge of the field of view. This is because the glass body pulls into the retina. If you see large moving soot flakes or get hazy vision, a small bleeding may occur in any of the blood vessels in the retina.

It is unusual, but there may be fragile areas of the retina that can break when the vitreous becomes detached. Then there will be one or more holes in the retina. Since the vitreous body no longer supports the retina, fluid can penetrate through the hole so that the retina detaches from the retina. Then the retina does not get the oxygen and nutrition it needs and works worse. You can perceive a grayish or dark shadow on the edge of the field of view. The shadow grows and grows larger the more the retina becomes detached. 

It is important that you get treatment quickly if you have retinal detachment. You may get worse eyesight or become blind on the eye if the retina hole is not repaired within a few weeks. 

The risk of retinal detachment increases if you are 65 or older

The risk of retinal detachment increases if you have a close relative who has the disease or if you are 65 years or older.

The retina can also come loose on people who are younger. Then it is usually because more people in the family have had the disease or because the eye is very near-sighted. This is because the eye is longer with strong myopia. This causes the retina to become stretched and brittle. Then there are lighter holes on the retina for example a glass body discharge. 

There is an increased risk that the retina of your other eye will also come off if you have had a retinal detachment. Therefore, it is important to be attentive and seek care quickly if you get symptoms of retinal detachment again.

It is uncommon but retinal detachment can also occur in conjunction with other diseases. It can be, for example, after changes in the eye caused by diabetes, called  diabetes retinopathy , or after a cataract surgery.

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