What causes the retina to detach from the eye?
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Isabella Kim
Studied at the University of Tokyo, Lives in Tokyo, Japan.
As an expert in the field of ophthalmology, I can provide a comprehensive explanation of the causes of retinal detachment. Retinal detachment is a serious condition where the retina separates from the underlying layer of tissue, known as the retinal pigment epithelium (RPE). This separation can lead to a loss of vision if not treated promptly. There are several mechanisms by which retinal detachment can occur, and I will discuss these in detail below.
1. Rhegmatogenous Retinal Detachment:
This is the most common type of retinal detachment, accounting for about 70-80% of cases. It occurs when a hole or tear in the retina allows fluid from the vitreous humor to pass through and accumulate under the retina. This fluid buildup creates a pulling force that gradually detaches the retina from the RPE. The formation of these holes or tears can be due to various reasons, including:
- Age-related changes: As we age, the vitreous gel can shrink and pull away from the retina, creating traction that may lead to tears.
- Posterior vitreous detachment (PVD): A sudden PVD can cause the retina to tear due to the sudden release of tractional forces.
- Trauma: Direct injury to the eye can cause the retina to tear or detach.
- Near-sightedness (Myopia): Individuals with high myopia have elongated eyeballs, which can increase the risk of retinal tears and detachment.
2. Tractional Retinal Detachment:
This type of detachment is less common and is caused by the contraction of fibrovascular or scar tissue that pulls on the retina. The contraction can be due to:
- Diabetic retinopathy: Neovascularization, or the growth of new blood vessels, can occur in severe cases of diabetic retinopathy. These new blood vessels are fragile and can lead to fibrosis and tractional detachment.
- Retinal vein occlusion: A blockage in the retinal veins can lead to the growth of abnormal blood vessels, which can cause traction on the retina.
- Inflammatory conditions: Certain inflammatory eye diseases can cause the formation of fibrovascular membranes that exert traction on the retina.
3. Exudative Retinal Detachment:
This is the least common type and is caused by the accumulation of fluid (not blood) between the retina and the RPE, without any hole, break, or tear in the retina. This can occur due to:
- Inflammation: Inflammatory conditions in the eye can lead to the leakage of fluid into the subretinal space.
- Vascular abnormalities: Conditions like central serous chorioretinopathy can cause fluid to accumulate under the retina due to issues with the blood vessels in the choroid layer.
- Tumor: In rare cases, a tumor can cause fluid to accumulate under the retina, leading to detachment.
Prevention and Treatment:
Preventive measures include regular eye check-ups, especially for individuals at high risk, such as those with a family history of retinal detachment or high myopia. Early detection of retinal tears or holes can prevent detachment through treatments like laser photocoagulation or cryotherapy.
Treatment for retinal detachment involves reattaching the retina to the RPE and can include:
- Pneumatic retinopexy: A gas bubble is injected into the eye to push the retina back into place.
- Scleral buckle: A silicone band is placed around the eye to provide external support and push the retina back onto the RPE.
- Vitrectomy: The vitreous gel is removed, and sometimes a gas bubble is inserted to help reattach the retina.
- Laser or cryotherapy: Used to create scar tissue that helps to reattach the retina.
Retinal detachment is a medical emergency and requires immediate attention. Prompt treatment can help restore vision, but the longer the retina is detached, the greater the risk of permanent vision loss.
1. Rhegmatogenous Retinal Detachment:
This is the most common type of retinal detachment, accounting for about 70-80% of cases. It occurs when a hole or tear in the retina allows fluid from the vitreous humor to pass through and accumulate under the retina. This fluid buildup creates a pulling force that gradually detaches the retina from the RPE. The formation of these holes or tears can be due to various reasons, including:
- Age-related changes: As we age, the vitreous gel can shrink and pull away from the retina, creating traction that may lead to tears.
- Posterior vitreous detachment (PVD): A sudden PVD can cause the retina to tear due to the sudden release of tractional forces.
- Trauma: Direct injury to the eye can cause the retina to tear or detach.
- Near-sightedness (Myopia): Individuals with high myopia have elongated eyeballs, which can increase the risk of retinal tears and detachment.
2. Tractional Retinal Detachment:
This type of detachment is less common and is caused by the contraction of fibrovascular or scar tissue that pulls on the retina. The contraction can be due to:
- Diabetic retinopathy: Neovascularization, or the growth of new blood vessels, can occur in severe cases of diabetic retinopathy. These new blood vessels are fragile and can lead to fibrosis and tractional detachment.
- Retinal vein occlusion: A blockage in the retinal veins can lead to the growth of abnormal blood vessels, which can cause traction on the retina.
- Inflammatory conditions: Certain inflammatory eye diseases can cause the formation of fibrovascular membranes that exert traction on the retina.
3. Exudative Retinal Detachment:
This is the least common type and is caused by the accumulation of fluid (not blood) between the retina and the RPE, without any hole, break, or tear in the retina. This can occur due to:
- Inflammation: Inflammatory conditions in the eye can lead to the leakage of fluid into the subretinal space.
- Vascular abnormalities: Conditions like central serous chorioretinopathy can cause fluid to accumulate under the retina due to issues with the blood vessels in the choroid layer.
- Tumor: In rare cases, a tumor can cause fluid to accumulate under the retina, leading to detachment.
Prevention and Treatment:
Preventive measures include regular eye check-ups, especially for individuals at high risk, such as those with a family history of retinal detachment or high myopia. Early detection of retinal tears or holes can prevent detachment through treatments like laser photocoagulation or cryotherapy.
Treatment for retinal detachment involves reattaching the retina to the RPE and can include:
- Pneumatic retinopexy: A gas bubble is injected into the eye to push the retina back into place.
- Scleral buckle: A silicone band is placed around the eye to provide external support and push the retina back onto the RPE.
- Vitrectomy: The vitreous gel is removed, and sometimes a gas bubble is inserted to help reattach the retina.
- Laser or cryotherapy: Used to create scar tissue that helps to reattach the retina.
Retinal detachment is a medical emergency and requires immediate attention. Prompt treatment can help restore vision, but the longer the retina is detached, the greater the risk of permanent vision loss.
Works at the International Air Transport Association, Lives in Montreal, Canada.
It happens when inflammation, vascular abnormalities, or injury cause fluid to build up under the retina. There is no hole, break, or tear. Tractional retinal detachment is when an injury, inflammation, or neovascularization causes the fibrovascular tissue to pull the sensory retina from the retinal pigment epithelium.Jan 23, 2018
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Oliver Kim
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It happens when inflammation, vascular abnormalities, or injury cause fluid to build up under the retina. There is no hole, break, or tear. Tractional retinal detachment is when an injury, inflammation, or neovascularization causes the fibrovascular tissue to pull the sensory retina from the retinal pigment epithelium.Jan 23, 2018
