Retinal detachment is a disorder of the eye in which the retina separates from its underlying supportive layer. Symptoms include an increase in floaters, flashes of light, and worsening vision. Without treatment, permanent vision loss can occur. Retinal detachment is commonly caused by breaks or tears in the retina that allow fluid from the eye to enter and separate the retina. Risk factors include nearsightedness, eye injuries or surgeries, and family history. Diagnosis involves examination of the eye and retina using instruments like an ophthalmoscope or ultrasound.

1. RETINAL DETACHMENTRETINAL DETACHMENT
PRSENTED BYPRSENTED BY
Om vermaOm verma

2. IntroductionIntroduction
 •• Retinal detachment is a disorder of the eyeRetinal detachment is a disorder of the eye
inin
 which the retina separates from the layerwhich the retina separates from the layer
 underneath. Symptoms include an increaseunderneath. Symptoms include an increase
in thein the
 number of floaters, flashes of light, andnumber of floaters, flashes of light, and
 worsening of the outer part of the visualworsening of the outer part of the visual
 field. This may be described as a curtainfield. This may be described as a curtain
over partover part
 of the field of vision. Without treatmentof the field of vision. Without treatment
 permanent loss of vision may occurpermanent loss of vision may occur..
 The vitreous humor is a transparent, gel-like material that fills the space within the eyeThe vitreous humor is a transparent, gel-like material that fills the space within the eye
between the lens and the retinabetween the lens and the retina

3.  The mechanism most commonly involves a break inThe mechanism most commonly involves a break in
thethe
 retina that then allows the fluid in the eye to getretina that then allows the fluid in the eye to get
 behind the retina. A break in the retina can occurbehind the retina. A break in the retina can occur
fromfrom
 a posterior vitreous detachment, injury to the eye, ora posterior vitreous detachment, injury to the eye, or
 inflammation of the eye. Other risk factors includeinflammation of the eye. Other risk factors include
 being short sighted and previous cataract surgery.being short sighted and previous cataract surgery.
 Retinal detachments also rarely occur due toRetinal detachments also rarely occur due to
achoroidalachoroidal
 tumor. Diagnosis is by either looking at the back oftumor. Diagnosis is by either looking at the back of
thethe
 eye with an ophthalmoscope or by ultrasoundeye with an ophthalmoscope or by ultrasound

4. DEFINITIONDEFINITION
Retinal detachment is a disorder of eye inRetinal detachment is a disorder of eye in
which the retina peels away from itswhich the retina peels away from its
underlying layer of support tissue . Intialunderlying layer of support tissue . Intial
detachment may be localized ,but withoutdetachment may be localized ,but without
rapid treatment the entire retina mayrapid treatment the entire retina may
detach, leading to vision loss anddetach, leading to vision loss and
blindness.blindness.

5. retinal detachmentretinal detachment is used to describe ais used to describe a
separation of the neurosensory retina fromseparation of the neurosensory retina from
retinal pigment epithelium (RPE).retinal pigment epithelium (RPE).
 A retinal detachment re-establishes theA retinal detachment re-establishes the
potential space that exists between thepotential space that exists between the
original layers of the embryonic optic cup.original layers of the embryonic optic cup.

6. RD is a separation of these two retinalRD is a separation of these two retinal
layeraslayeras

7. TypesTypes
 RHEGMATOGENOUS RETINALRHEGMATOGENOUS RETINAL
DETACHMENT –DETACHMENT –
 •• A rhegmatogenous retinal detachment occurs due to a break inA rhegmatogenous retinal detachment occurs due to a break in
the retina (called athe retina (called a retinal tear) that allows fluid to pass fromretinal tear) that allows fluid to pass from
thethe
vitreous space into the subretinal space between the sensoryvitreous space into the subretinal space between the sensory
retinaretina
and the retinal pigment epithelium. Retinal breaks are dividedand the retinal pigment epithelium. Retinal breaks are divided
intointo
three types – holes, tears and dialyses. Holes form due tothree types – holes, tears and dialyses. Holes form due to
retinalretinal
atrophy especially within an area of lattice degeneration. Tearsatrophy especially within an area of lattice degeneration. Tears
areare
due to vitreoretinal traction. Dialyses are very peripheral anddue to vitreoretinal traction. Dialyses are very peripheral and
circumferential, and may be either tractional or atrophic.circumferential, and may be either tractional or atrophic.
The atrophic form most often occurs as idiopathic dialysis of theThe atrophic form most often occurs as idiopathic dialysis of the

8.  Exudative, serous, or secondary retinal detachment –Exudative, serous, or secondary retinal detachment –
•• An exudative retinal detachment occurs due toAn exudative retinal detachment occurs due to
inflammation, injury or vascular abnormalities thatinflammation, injury or vascular abnormalities that
results in fluid accumulating unberneath ( below ) theresults in fluid accumulating unberneath ( below ) the
retina without the presence of a hole, tear, or break.retina without the presence of a hole, tear, or break.
Although rare, exudative detachment can be causedAlthough rare, exudative detachment can be caused
by theby the
growth of a tumor on the layers of tissue beneath thegrowth of a tumor on the layers of tissue beneath the
retina, namely the choroid. This cancer is called aretina, namely the choroid. This cancer is called a
choroidalchoroidal
melanoma.melanoma.

9. Tractional Retinal Detachment –Tractional Retinal Detachment –
•• A tractional retinal detachment occursA tractional retinal detachment occurs
whenwhen
fibrous or fibro vascular tissue, causedfibrous or fibro vascular tissue, caused
by anby an
injury, inflammation orinjury, inflammation or
neovascularization,neovascularization,
pulls the sensory retina from thepulls the sensory retina from the
retinalretinal
pigment epitheliumpigment epithelium

10. ETIOLOGYETIOLOGY
Severe myopia,Severe myopia,
•• Retinal tears,Retinal tears,
•• Trauma,Trauma,
•• Family history,Family history,
•• Complications from cataractComplications from cataract
surgery.surgery.
•• InjuryInjury
•• Advanced diabetesAdvanced diabetes

11. •• Activities that increase intra ocularActivities that increase intra ocular
pressurepressure
can cause retinal detachment:can cause retinal detachment:
•• High-impact sports or in high speedHigh-impact sports or in high speed
sports.sports.
•• Diving and skydivingDiving and skydiving
•• As bungee jumping or roller coasterAs bungee jumping or roller coaster
rides.rides.
•• Valsalva maneuverValsalva maneuver
•• WeightliftingWeightlifting

12. •• Aging — retinal detachment is moreAging — retinal detachment is more
common incommon in
people over age 50people over age 50
•• Previous retinal detachment in onePrevious retinal detachment in one
eyeeye
•• A family history of retinal detachmentA family history of retinal detachment
•• Extreme nearsightedness (myopia)Extreme nearsightedness (myopia)
•• Previous eye surgery, such asPrevious eye surgery, such as
cataract removalcataract removal
•• Previous severe eye injuryPrevious severe eye injury
•• Previous other eye disease orPrevious other eye disease or
inflammationinflammation

13. DMDM

15. SIGNS AND SYMPTOMSSIGNS AND SYMPTOMS
PHOTOPHOBIAPHOTOPHOBIA

16. Contd……………..Contd……………..
SUDDEN DRAMATICS INCREASE INSUDDEN DRAMATICS INCREASE IN
THE NUMBER OF FLOATERSTHE NUMBER OF FLOATERS
HEAVINESS IN THE EYEHEAVINESS IN THE EYE
STRAIGHT LINES THAT SUDDENLYSTRAIGHT LINES THAT SUDDENLY
APPEAR CURVEDAPPEAR CURVED
 CENTRAL VISION LOSSCENTRAL VISION LOSS

17.  A rhegmatogenous retinal detachment isA rhegmatogenous retinal detachment is
commonlycommonly
 preceded by a posterior vitreous detachmentpreceded by a posterior vitreous detachment
whichwhich
 gives rise to these symptoms:gives rise to these symptoms:
  flashes of light (photopsia) – very brief inflashes of light (photopsia) – very brief in
thethe
 extreme peripheral (outside of center) part ofextreme peripheral (outside of center) part of
visionvision
  a sudden dramatic increase in the numbera sudden dramatic increase in the number
 of floatersof floaters
  a ring of floaters or hairs just to thea ring of floaters or hairs just to the
temporal (skull)temporal (skull)
 side of the central visionside of the central vision

18. •• Bright flashes of light, especiallyBright flashes of light, especially
in peripheral visionin peripheral vision
•• Blurred visionBlurred vision
•• Floaters in the eyeFloaters in the eye
•• Shadow or blindness in a part of theShadow or blindness in a part of the
visualvisual
field of one eyefield of one eye

19. DiagnosisDiagnosis
•• Retinal detachment can be examinedRetinal detachment can be examined
by:by:
 Ultrasound.Ultrasound.
 Fluorescein AngiographyFluorescein Angiography
 TonometryTonometry
 OphthalmoscopyOphthalmoscopy
 Refraction TestRefraction Test
 Color Vision TestColor Vision Test
 Visual AcuityVisual Acuity
 Slit-lamp ExaminationSlit-lamp Examination

20. Retinal examination.Retinal examination. The doctor may use The doctor may use
an instrument with a bright light and a specialan instrument with a bright light and a special
lens (ophthalmoscope) to examine the back oflens (ophthalmoscope) to examine the back of
your eye, including the retina. Theyour eye, including the retina. The
ophthalmoscope provides a highly detailedophthalmoscope provides a highly detailed
view, allowing the doctor to see any retinalview, allowing the doctor to see any retinal
holes, tears or detachments.holes, tears or detachments.
Ultrasound imaging.Ultrasound imaging. Your doctor may use Your doctor may use
this test if bleeding has occurred in the eye,this test if bleeding has occurred in the eye,
making it difficult to see your retina.making it difficult to see your retina.

21. FLUORESCEIN ANGIOGRAPHYFLUORESCEIN ANGIOGRAPHY
Medical Medical DefinitionDefinition of of FluoresceinFluorescein
angiographyangiography. . FluoresceinFluorescein
angiographyangiography: A test to examine blood: A test to examine blood
vessels in the retina, choroid, and iris ofvessels in the retina, choroid, and iris of
the eye. A special dye is injected into athe eye. A special dye is injected into a
vein in the arm and pictures are taken asvein in the arm and pictures are taken as
the dye passes through the blood vesselsthe dye passes through the blood vessels
in the eye.in the eye.

22. TonometryTonometry is the procedure eye care is the procedure eye care
professionals perform to determine theprofessionals perform to determine the
intraocular pressure (IOP), the fluidintraocular pressure (IOP), the fluid
pressure inside the eye. It is an importantpressure inside the eye. It is an important
test test

23. Visual acuityVisual acuity (VA) commonly refers to (VA) commonly refers to
the clarity the clarity of visionof vision..Visual acuityVisual acuity is is
dependent on optical and neural factors,dependent on optical and neural factors,
i.e., (i) the sharpness of the retinal focusi.e., (i) the sharpness of the retinal focus
within the eye, (ii) the health andwithin the eye, (ii) the health and
functioning of the retina, and (iii) thefunctioning of the retina, and (iii) the
sensitivity of the interpretative faculty ofsensitivity of the interpretative faculty of
the brain.the brain.

24.  A A refractionrefraction is an eye is an eye examexam that that
measures a person's prescription formeasures a person's prescription for
eyeglasses ... Thiseyeglasses ... Thistesttest is performed by an is performed by an
ophthalmologist or optometrist.ophthalmologist or optometrist.

25. SLIT-LAMP EXAMINATIONSLIT-LAMP EXAMINATION
The slit-lamp examination looks atThe slit-lamp examination looks at
structures that are at the front of the eye.structures that are at the front of the eye.
The slit-lamp is a low-power microscopeThe slit-lamp is a low-power microscope
combined with a high-intensity light sourcecombined with a high-intensity light source
that can be focused as a thin beam. Thethat can be focused as a thin beam. The
health care provider will examine yourhealth care provider will examine your
eyes, especially the eyelids, cornea,eyes, especially the eyelids, cornea,
conjunctiva, sclera, and irisconjunctiva, sclera, and iris

26. TREATMENTTREATMENT
 Laser surgery (photocoagulation).Laser surgery (photocoagulation). The The
surgeon directs a laser beam into the eye throughsurgeon directs a laser beam into the eye through
the pupil. The laser makes burns around the retinalthe pupil. The laser makes burns around the retinal
tear, creating scarring that usually "welds" the retinatear, creating scarring that usually "welds" the retina
to underlying tissue.to underlying tissue.
 Freezing (cryopexy).Freezing (cryopexy). After giving you a local After giving you a local
anesthetic to numb your eye, the surgeon applies aanesthetic to numb your eye, the surgeon applies a
freezing probe to the outer surface of the eyefreezing probe to the outer surface of the eye
directly over the tear. The freezing causes a scardirectly over the tear. The freezing causes a scar
that helps secure the retina to the eye wall.that helps secure the retina to the eye wall.

27.  Scleral Buckle SurgeryScleral Buckle Surgery
 •• Scleral buckle surgery is an established treatment inScleral buckle surgery is an established treatment in
which thewhich the
 eye surgeon sews one or more silicone bands to theeye surgeon sews one or more silicone bands to the
sclera. Thesclera. The
 bands push the wall of the eye inward against thebands push the wall of the eye inward against the
retinal hole,retinal hole,
 closing the break or reducing fluid flow through it andclosing the break or reducing fluid flow through it and
reducingreducing
 the effect of vitreous traction thereby allowing thethe effect of vitreous traction thereby allowing the
retina to reattach.retina to reattach.
 •• CryotherapyCryotherapy (freezing) is applied around retinal(freezing) is applied around retinal
breaks prior tobreaks prior to
 placing the buckle. Often subretinal fluid is drainedplacing the buckle. Often subretinal fluid is drained
as part ofas part of
 the buckling procedure. The buckle remains in situ.the buckling procedure. The buckle remains in situ.

28.   Pneumatic RetinopexyPneumatic Retinopexy
 •• This operation is generally performed in theThis operation is generally performed in the
doctor's officedoctor's office
 under local anesthesia. It is another method ofunder local anesthesia. It is another method of
repairing arepairing a
 retinal detachment in which a gas bubble isretinal detachment in which a gas bubble is
injected into theinjected into the
 eye after which laser or freezing treatment iseye after which laser or freezing treatment is
applied to theapplied to the
 retinal hole. The patient's head is then positionedretinal hole. The patient's head is then positioned
so that theso that the
 bubble rests against the retinal hole. Patientsbubble rests against the retinal hole. Patients
may have tomay have to
 keep their heads tilted for several days to keepkeep their heads tilted for several days to keep
the gas bubblethe gas bubble
 in contact with the retinal hole.in contact with the retinal hole.

29.   VitrectomyVitrectomy
 •• Vitrectomy is an increasingly used treatment for retinalVitrectomy is an increasingly used treatment for retinal
detachment.detachment.
 It involves the removal of the vitreous gel and is usuallyIt involves the removal of the vitreous gel and is usually
combinedcombined
 with filling the eye with either a gas bubble or silicone oilwith filling the eye with either a gas bubble or silicone oil
(PDMS).(PDMS).
 An advantage of using gas in this operation is that thereAn advantage of using gas in this operation is that there
is no myopicis no myopic
 shift after the operation and gas is absorbed within a fewshift after the operation and gas is absorbed within a few
weeks.weeks.
 PDMS, if used, needs to be removed after a period of 2–8PDMS, if used, needs to be removed after a period of 2–8
monthsmonths
 depending on surgeon's preference. A disadvantage isdepending on surgeon's preference. A disadvantage is
that athat a
 vitrectomy always leads to more rapid progression of avitrectomy always leads to more rapid progression of a
cataract incataract in
 the operated eye.the operated eye.

30. COMPLICATIONCOMPLICATION
 DISCOMFORTDISCOMFORT
 WATERY,REDNESS,WATERY,REDNESS,
SWELLINGSWELLING
 ITCHINGITCHING
 BLUERED VISIONBLUERED VISION

31.  DIPLOPIADIPLOPIA
 GLAUCOMAGLAUCOMA
 BLEEDINGBLEEDING