Is it easy to loosen your retina

Retinal detachment

Retinal detachment(Ablatio retinae, Amotio retinae): Detachment of the light-sensitive photoreceptor layer of the retina from the underlying pigment epithelium. Retinal detachment leads to visual field defects and, if left untreated, progresses to blindness of the eye. Therefore detached retinal parts are lasered as early as possible, i. H. "stuck on" again by punctiform inflammatory processes.

  • Early symptoms: seeing flashes of light, light flickering (mostly one-sided and more clearly in the dark than in light), many dark spots ("soot rain"), cobwebs
  • If there is already detachment: appearance of a wall or a shadow in the part of the visual field corresponding to the detached retinal area
  • If the yellow spot (macula) is affected: blurred, distorted and difficult vision
  • No pain, at best a headache when seeing becomes more difficult.

In the case of severe retinal detachments, the application of seals or bands made of silicone (cerclage) has proven itself. As a first step, the figure shows the creation of a cerclage parallel to the eyebrows on the left and another in the direction of the vertex on the right. By the way: Cerclagen made of silicone can remain in the eye for life.
Gerda Raichle, Ulm

When to the doctor

The next day if

  • the early symptoms mentioned above occur.

Immediately if

  • You see black shadows, a wall or a curtain, or your visual acuity is suddenly significantly worse (go to the nearest eye clinic on the weekend or at night).

The illness

Disease emergence

Anatomically, the retina consists of two layers: the light-sensitive photoreceptor layer and the pigment epithelium. The pigment epithelium is firmly fused with the underlying choroid, but with the light-sensitive photoreceptor layer only in the area of ​​the optic nerve exit and on the ciliary body. In the remaining areas, the close contact between the two layers is ensured by the intraocular pressure. If the receptor layer and pigment epithelium separate from each other, the sensory cells of the receptor layer are no longer adequately supplied with oxygen and nutrients and die. If left untreated, the detachment continues until the entire retina is affected: blindness threatens. As soon as the macula, the point of sharpest vision, is affected, visual performance drops sharply.

Classification according to cause

Retinal detachment caused by cracks (rhegmatogenic ablation): With severe myopia or after a contusion of the eyeball, the smallest cracks appear, through which vitreous fluid penetrates and pushes itself between the two layers like a wedge. Cracks are the most common cause of retinal detachment.

Retinal detachment caused by tension (Traction ablation): Due to pathological changes in the vitreous structure, e.g. B. in the context of a retinopathy or a previous detachment of the retina, the formation of adhesions and scar strands, which pull on the retina through shrinkage and thus lead to the detachment of the retina.

Fluid-induced retinal detachment (Exudative ablation): In some cancers (malignant melanoma, leukemia), choroidal or retinal inflammation and high blood pressure, fluid from damaged vessels gets between the retinal layers, causing retinal detachment.

Risk factors

Risk factors for retinal detachment are:

  • Severe myopia (especially from -10 D)
  • Previous cataract operation
  • Previous eye injuries
  • Retinal detachment in the other eye that has already passed
  • Family inclination
  • Inflammatory processes or tumors
  • Retinopathy.

Diagnostic assurance

The ophthalmologist makes the diagnosis by reflecting the fundus of the eye with the pupils wide open. The retina appears edematously swollen and whitish instead of transparent. Typical features are depending on the cause

  • Retinal holes outlined in red when the tear was detached
  • Gray strands and blister-like detachment of the retina during tension-related detachment
  • Bleeding, fat deposits or a tumor during exudative detachment.

Differential diagnoses

Glaucoma (glaucoma), retinal vein occlusion, retinal artery occlusion, vitreous hemorrhage.

treatment

As recently as 50 years ago, retinal detachment led to blindness of the eye or at least to severe impairment of visual performance. The further development of surgical techniques and the use of modern lasers have significantly improved the treatment results.

Operative treatment

Almost every retinal detachment has to be treated surgically.

  • Smaller ones Retinal holes and tears, which resulted in only the smallest detachment of the retina, lasers The doctor in an outpatient procedure: The laser beams cause a burn around the retinal defect, which leads to inflammation and scarring. This causes the retina to stick to the pigment epithelium at the lasered areas (laser coagulation) and can no longer detach itself.
  • Larger retinal holes and tears or more advanced detachments of the retina must be treated surgically in an eye clinic. A re-apposition of the pigment epithelium on the detached retina is brought about by indenting the eye, i.e. from the outside in. The ophthalmologist sews a silicone seal or a silicone tape (cerclage) onto the dermis from the outside, which presses the detached areas onto one another. He then freezes the affected areas of the retina from the outside with a cold rod (cryoprobe) or coagulates ("burns") them from the inside with laser beams.
  • If these measures are not sufficient, a Vitrectomy carried out and the reassembly brought about from the inside out. In a vitrectomy, the doctor inserts very fine instruments into the eyeball and removes parts of the vitreous or the entire vitreous. He then fills the eyeball with a gas that is difficult to absorb or a silicone oil in order to reattach the retina to the pigment epithelium.

Complications

In rare cases, laser treatment can lead to epiretinal fibroplasia. This creates a thin membrane that causes wrinkles to form in the retina. The result is poor eyesight and distorted images.

Complications with eye surgery are more common than with laser treatment and depend on how far the retinal detachment has progressed. Typical complications are the development of a cloudy lens (cataract) or glaucoma (green star), the procedure itself carries the risk of an infection of the inside of the eye (endophthalmitis). Sometimes the retina loosens after the procedure and a second operation must be performed.

forecast

If retinal detachment is not treated, it will lead to blindness. Retinal detachment is an emergency: the sooner it is recognized and treated, the better the chance of vision restoration.

If the visual center, i.e. the macula, has been detached, the surgical re-installation of the retina can no longer fully restore visual performance. The central sensory cells located there are irreparably damaged by even only temporary supply disruptions.

Your pharmacy recommends

What to watch out for after the operation

Follow all the rules of conduct of your ophthalmologist consistently in order to ensure optimal conditions for the healing process. In the first few weeks, the retina tolerates z. B. no vibrations and sudden pressure loads: Avoid stooping and carrying heavy loads. If you have been treated with a gas, you must not fly or climb mountains, as the changed air pressure affects the gas. As a rule, reading is also forbidden for the first 4 weeks.

After retinal surgery, head postures are usually given: e.g. prone position when sleeping or lying or lowering the head when standing up. There are positioning aids in pharmacies and health food stores to ease the unfamiliar posture, and red light or massages help with neck pain.

Sports such as squash, bungee jumping, parachuting, boxing or diving have to be avoided for life because of the short-term pressure loads.

Prevention

If there are risk factors (see above) for retinal detachment, an annual check-up by an ophthalmologist is recommended - every 3 months if the first retinal damage is already visible or if retinal detachment has already expired.

Authors

Dr. rer. nat. Katharina Munk, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:31


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.