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Retinal tears and detachment


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Retinal tears and detachment

  1. 1. Am I at risk of Retinal Tears and Detachment? The common risks for retinal tears and detachment are: 1. Age > 50 years old 2. Family or personal history of retinal detachment 3. History of intraocular surgery 4. History of trauma 5. History of high myopia (> -6D) 6. Peripheral retinal degeneration • e.g. Lattice degeneration 7. Retinal disease • e.g. diabetes, hypertension 8. Retinal inflammation What are the treatments available? Treatment for Retinal Tear Laser therapy or cryotherapy is done to create a scar around a retinal hole and tear, to prevent it from enlarging and also prevent fluid from leaking in. This procedure can be done as an outpatient procedure (in the absence of retinal detachment), or as part of retinal reattachment surgery. Treatment of Retinal Detachment Treatment options all involve reattaching the detached retina to stabilize and prevent worsening of vision. However, treatment does not always result in pre-detachment vision and prognosis depends on whether the macula is involved, and the duration from detachment to treatment. Vitrectomy is a surgical procedure to remove the vitreous gel that caused traction on the retina. The surgeon inserts fine instruments into the eye to remove the gel, remove scar tissue, flatten detached retina and repair tears and holes in the retina. Scleral buckling involves placing a silicone sponge or plastic placed outside the globe at the site of the retinal detachment. The material is sewn to the eye and is usually left in place permanently to indent (“buckle”) the globe to bring it closer to the detached retina. The buckling effect on the globe relieves the traction (“pull”) on the retina. Please discuss with your surgeon the various surgical and treatment options available that are suitable for your condition. Retinal Detachment advice When should I return for an immediate assessment? 1. Any sudden onset of flashes and floaters, or increase in number of floaters. 2. Blocked vision in the periphery or centrally 3. Blurred vision. What precautions should I take? 1. Wear safety goggles if you engage in contact sports (e.g. squash, basketball, soccer) or high-risk occupations (e.g. engineer, construction) to reduce your risk of eye injury • Avoid contact sports that preclude use of safety goggles in the acute phase (e.g. martial arts, rugby) 2. Be aware of the symptoms that accompany retinal detachment and be sure to consult an ophthalmologist immediately 3. Always turn-up for your scheduled follow-up appointments with your ophthalmologist. Eagle Eye Centre @ Mount Alvernia Mount Alvernia Hospital 820 Thomson Road, #02-10/17, Medical Centre Blk B, Singapore 574623 Tel: 6456-1000 / 6-eagleye (6324-5393) Fax: 6456-1006 Eagle Eye Centre @ Mount Elizabeth Mount Elizabeth Medical Centre 3 Mount Elizabeth, #08-02, Singapore 228510 Tel: 6836-0001 Fax: 6836-0002 Eagle Eye Centre @ Parkway East Parkway East Medical Centre 319 Joo Chiat Place, #05-03, Singapore 427989 Tel: 6348-1000 Fax: 6348-1001 Eagle Eye Centre @ Mount Elizabeth Novena Mount Elizabeth Novena Specialist Centre 38 Irrawaddy Road, #08-22/23/24, Singapore 329563 Tel: 6570-1000 Fax: 6570-1001 (Picture courtesy of Email: Website: RETINAL TEARS & DETACHMENT
  2. 2. What is the Retina? What are the common forms of Retinal detachment? Healthy Retina The retina is the light sensitive membrane that lines the inner layer of the eyeball much like the film in a camera. Light from objects enter the eye and are focused onto the retina. The retina transmits visual signals to the brain via the optic nerve and that allows us to process the images. The central retina (called the ‘macula’) is responsible for clear central vision and colour vision, whilst the peripheral retina is responsible for peripheral navigational vision and night vision. What is a Retinal hole / tear? (Picture courtesy of Retinal detachment occurs when fluid enters through a retinal hole or tear and accumulates behind the retina, separating it from its underlying tissue. This is an emergency situation which requires immediate medical attention to preserve vision. The separation of the retina from its underlying tissue results in a lack of oxygen and nutrients to the light sensitive cells of the retina known as the photoreceptors. If left untreated, damage to the photoreceptors will result in permanent loss of vision. Bleeding may also occur if blood vessels are involved in the retinal tear. What are the signs and symptoms of retinal tears & detachment that I should be looking out for? Floaters This appears as spots or strands of black or semitransparent ‘debris’ in the vision that moves with eye movements. It is often described as a cobwebs or flies. This is more commonly seen under the sun, bright lights and against the sky or white background. Flashes This appears as brief lightning streaks usually in the periphery. It occurs due to vitreous pulling on the retina and may precede floaters. It is induced by eye movements and is best seen under dim illumination. Unlike floaters, the location of the flashes is unrelated to the location of the break. Blocked vision This is usually described as ‘a falling curtain or veil’ that obscures part of vision. The area of blocked vision corresponds to the location of the retinal detachment. Retinal Tear The eye is filled with a jelly-like substance known as the vitreous, which is in contact with the retina and responsible for the shape of our eyeball. With age, the vitreous gel liquefies and shrinks in size causing it to separate from the retina. This separation may pull on the retina causing a retinal tear. The danger of a retinal tear or hole lies in its risk of progression to a retinal detachment, which can cause blindness if left untreated. Retinal Detachment Occasionally retinal detachment can also occur in conditions such as poorly controlled diabetes with severe eye disease (proliferative diabetic retinopathy). In these cases, scar tissue forms on the retina due to abnormal growth of vessels. This scar tissue can contract pulling the retina away from the back of the eyeball (tractional retinal detachment). If the macula is involved, an emergency surgery is required to preserve vision. Blurred vision This occurs when the detachment progresses to involve the central vision (or ‘macula’). This may be associated with distorted vision in early stages. No symptoms Retinal breaks in the periphery often go unnoticed until a detachment occurs.