Introduction:

Retinal detachment is defined as separation of the retina from the underlying tissue. This condition is considered one of the most serious conditions that can affect the eye. It is usually treatable with eye surgery but never the less can still cause residual loss of vision. Retinal detachment can occur when a tear in the retina allows fluid to pass through it and dissect the retina off the underlying tissue (Figure)

Anatomical Considerations:

What is the "Retina"? Where is it located in the eye? And what is the main function of it?

Retina is a highly sophisticated and sensitive neurological membrane. It lines most of the inside of the eye ball, it has blood vessels running through it and the fibers inside the retina create the optic nerve which connects the eye to the brain so we can understand and analyze what we see. A healthy Retina is very crucial for an eye to see. When light strikes the surface of the retina it stimulates it and produce a signal that get passed through the optic nerve to the brain. A common analogy to the retina in the eye is the film in a regular 35mm camera. In order to get a good picture you need a good unscratched film and in order to see well you need a healthy retina.

Risk Factors:

Who is at risk for retinal detachment?

Most retinal detachments occur sporadically without any predisposing factor. Some of the known predisposing factors include severe near-sightedness, eye trauma, strong family history of retinal detachment, and very advanced diabetes eye disease. Previous cataract surgery slightly increases the risk of getting a retinal detachment when compared with the average population.

Symptoms:

Retinal detachment always starts from the periphery and may or may not extend to back pole of the eye (called Macula) that we use in our central vision. Because of that, the most common symptom for retinal detachment is seeing what patients describe as "a curtain is covering one's sight from one of the corners". If a detachment extended through the central vision area, a severe loss of vision will result and the patient will be barely able to recognize his/ her fingers in front of his/ her face.

These symptoms may be proceeded with a seeing a shower of floating objects (not only two or three floaters) and/ or flashes of light as if someone beside you is taking continuos pictures.

What to do?

" Patients who experience a "curtain-like" loss of vision as described above should seek prompt medical attention. If you can not contact you Ophthalmologist or you have never seen one, it's a good idea to make a visit to the emergency room.

" Patients experiencing flashes of light and a storm of floating objects should also contact their Ophthalmologist at the earliest opportunity. If the vision considerably deteriorates and access to an eye caregiver is unavailable, a visit to the emergency room is also appropriate.

" Keep in mind that if you experience these symptoms during normal business hours, almost all ophthalmologists will agree to see you immediately without prior appointment and this is in fact the most efficient way of accessing care in such circumstances. An emergency room visit may add two to three hour of waiting and evaluations prior to making the appropriate referral

Treatment

Retinal detachment can be treated surgically with an operation that reapproximate the retina and the underlying tissue. It is an operation done under a surgical microscope in the operating room. The success rate for retinal detachment surgery is very good approaching 90%.

It is of utmost importance, however, to report to your ophthalmologist for immediate evaluation if a retinal detachment is suspected. If retinal detachment is not managed promptly, visual prognosis deteriorates due to the development of fibrous membranes on the surface of the retina which greatly complicates surgery. Keep in mind, however, that in certain cases these membranes develop anyway despite appropriate management.

If access to an eye care specialist is to be delayed for any reason, and the symptoms you are experiencing are suggestive of retinal detachment as described above, it is best to remain at bed rest until it is time to go to the ophthalmologist's office.