Retinal detachment

The retinal detachment is the separation of the pigment epithelium other retinal layers level virtual space.

The eye has three layers, of which the innermost is the retina, which in turn is made up of ten others. Of these, there are two (the outermost retinal pigment epithelium and the innermost neural retina) that are separated by a virtual space.

The main function of the retina is to transform light into a nerve impulse. For this it has photoreceptor cells: cones (thanks to which we perceive color) and rods (distinguish between light and dark), responsible for transmitting the information they receive about brightness and color to the brain.

In the central area of ​​the retina are the macula (area of ​​maximum vision) and the papilla (portion of the optic nerve located in the eye).

The vitreous is a transparent, gelatinous gel that occupies 80% of the volume of the eye. It is the most abundant internal component of the eye. He has the lens in front of him and the retina behind him. They perform the functions of supporting the structures inside the eye and visual.

Causes of retinal detachment

There are three groups of causes and mechanisms by which retinal detachment occurs:

• By tear or break: it is the most frequent. It begins with a hole, which is usually located in the most anterior half of the retina, through which vitreous gel passes into the space behind the pigment epithelium and accumulates, detaching the retina. The cause of the initial retinal hole can be a degeneration of the retina or an alteration of the vitreous, such as posterior detachment (due to aging or trauma). Situations that increase the risk of suffering a retinal tear are: myopia , old age, trauma and aphakia.
• By traction: in cases of vitreous hemorrhages (such as in severe retinal involvement due to diabetes ), condensation of the gel and the formation of fibrous bands that adhere to the retina may appear. As these bands contract, they pull on the retina, detaching it.
• Secondary to inflammation or degeneration of the retina or its outermost layer (choroid), as occurs in advanced retinal involvement due to arterial hypertension . It is the least frequent form.

What symptoms appear?

A total or partial loss of vision, which usually begins in the outermost part of the visual field and, as the detached area extends, vision towards the center decreases. Vision loss is greatest if the macula is affected.

Sometimes, before vision loss, lights and flashes can be seen.

Diagnosis of retinal detachment

The suspicion is clinical, due to visual loss, but the diagnosis is made through an eye fundus, which consists of looking inside the eye using an instrument that contains a light source, a perforated mirror and several lenses. Through it you can observe the variations that the retina experiences if there is detachment (bags in the secondary, tears or fibrous bands).

The exploration may be made difficult by the existence of cataracts.

Treatment

Treatment should begin as soon as possible, because the prognosis, among others, depends on the speed of its onset.

The treatment aims to close the separation produced, which is achieved by two main techniques: cryocoagulation or laser photocoagulation.
In this way, inflammation is caused and the detached retina is glued.

Sometimes, the retina is very separated from the other outermost layers of the eye, so before starting the closure they must be approached by surgery with external silicone implants or by injecting gas into the interior of the eye.

How can I avoid it?

It is only possible to prevent retinal detachment in subjects at risk of suffering it due to certain diseases that favor it (myopia, aphakia, diabetics with severe retinal involvement, hypertensive patients with retinal involvement).

For prevention, in addition to other reasons, an eye fundus is performed periodically, and in patients with retinal degeneration, photocoagulation is performed.

When should I see a doctor?

If I am among the patients with diseases that can cause or favor retinal detachment, I must strictly comply with the check-ups and tests that my doctor indicates to me.

If I do not have diseases that can cause a retinal detachment, whenever I suffer, more or less abruptly, a loss of vision, especially if it is in only one eye, and especially if before this happens I have had a blow to the head, however small it may seem.