The retina is a membrane that lines the back of the eye. Retinal detachment is characterised by the detachment of this membrane, resulting in immediate partial loss of vision in the area of the detachment. This is a serious condition that must be treated quickly.

1. Definition of retinal detachment

The retina is a film that lines the back of the eye and receives the images perceived by the eye. It is, in a way, the equivalent of the photographic film in old cameras. When the images arrive on the retina, they are instantly sent to the brain. The brain analyses them and allows us to interpret them and act accordingly. The retina is made up of millions of nerve cells that are sensitive to the surrounding light. It is protected by a vitreous body, a kind of transparent gel that fills the entire eyeball. Retinal detachment refers to the separation of the neurosensory retina from the underlying pigment epithelium, the wall of the eye. The most common cause of this is a rupture of the retina. Sometimes it is a simple tear. More rarely, a hole may appear. This is called rhegmatogenous detachment, according to EM Consulte.

The retinal detachment is often preceded by a flash of light. This is the result of a localised tension that appears between the retina and the vitreous. Other patients also speak of "flying flies" in their field of vision. The latter is slight bleeding within the vitreous or is associated with a retinal tear. If the retinal detachment is confirmed, the patient will have a permanent black veil in the affected area of the eye. Gradually, this may worsen until it becomes a surgical emergency. In France, retinal detachment affects approximately one person per 10,000 per year, according to the Sorbonne-Saint-Michel ophthalmological centre. The peak incidence is generally around the age of 30 and 60. People in their thirties are more likely to suffer from retinogenic retinal detachment, while people in their sixties are more likely to suffer from rhegmatogenous retinal detachment.

2. Symptoms of retinal detachment

Retinal detachment is characterised by the appearance of certain symptoms in the field of vision, which was previously non-existent:

luminous points, more or less fixed and diffuse ;
the appearance of a single, fixed, slightly bluish flash of light, always located in the same place, and whether the eyes are closed or in darkness;
the impression of seeing small flying flies or very fine particles in the image being observed;
the presence of a pronounced shadow or black veil at the edges of the field of vision;
the vision that is more blurred and/or foggy than usual, suggesting a sudden and rapid loss of vision;
loss of vision in one eye.

The best way to observe the severity and extent of the symptoms is to compare the vision in both eyes. By closing both eyes successively one after the other, it is possible to better characterise and describe the disorders.

3. Causes of retinal detachment

There are three different types of retinal detachment according to the MSD Manual:

rhegmatogenous, i.e. related to a retinal tear;
tractional ;
serous.

The last two categories are not related to a retinal tear. They are therefore called non-rhegmatogenous detachments. Moreover, they are less frequent. Several risk factors are likely to lead to a retinal detachment

high myopia ;
a previous eye trauma;
retinal degeneration;
a history of cataract surgery;
family history of retinal detachment.

Retinal detachment can be caused by vitreoretinal traction. This can occur when a fibrous membrane forms in proliferative diabetic retinopathy or sickle cell disease. Serous detachment occurs when fluid accumulates in the subretinal space. Its causes can be multiple and include severe uveitis (i.e. inflammation of the iris, similar body or choroid of the eye), Vogt-Koyanagi-Harada disease, choroidal haemangiomas, and primary or metastatic choroidal tumours (i.e. cancers of the retina).

4. Retinal detachment: when to consult?

In order for the practitioner to make a more accurate diagnosis, it is strongly recommended to note the times when the first symptoms appeared. It is then important to schedule an emergency consultation with an ophthalmologist. When an individual experiences a decrease in vision in one eye or changes in the field of vision, it may mean that he or she is subject to a retinal detachment. To ensure better visual recovery and for the treatment to be effective, the retinal detachment must be operated on within 24 to 48 hours. Otherwise, it can progress to total detachment, resulting in permanent vision loss. When a person sees light spots or dust in the field of vision, it may be a sign that the fluid between the lens and the retina is being pulled. This may be a tear that precedes detachment. Here again, an ophthalmologist must be consulted. An appointment must be made very quickly. Because retinal detachment can have serious consequences, it should never be taken lightly. In this case, rapid treatment is essential to ensure that the treatment is effective.

5. Examinations and diagnosis of retinal detachment

When a patient presents with signs of retinal detachment, the ophthalmologist will see the patient in an emergency consultation. If this is not possible in the practice, the patient is referred to a hospital or care facility where there is an ophthalmic emergency. During the appointment, the ophthalmologist carries out several checks. He measures visual acuity and eye pressure. Then he performs a fundus examination. This allows him to observe the retina perfectly and reliably diagnose whether a detachment is really present. The fundus is the ideal way to look for any tears or to locate a detached area. Both eyes are systematically examined. In this way, the practitioner can identify any existing retinal tears or lesions predisposing to tears, even in the healthy eye. If the ophthalmologist finds that there is a favourable ground for the development of a retinal detachment, he or she can administer a preventive treatment with laser photocoagulation.

6. Treatments for retinal detachment

In the case of retinal detachment, the only possible treatment is surgery. The operation consists of reinstalling the detached retina. There are a number of techniques available for this. The medical procedure used depends on the location of the detachment, the number of tears, the age of the patient, his or her activities, and the age of the detachment. The practitioner can use several surgical methods:

by endo-ocular route: this is also called vitrectomy. With this procedure, the surgeon sucks out the excess vitreous gel to release the traction on the retina;
exo-ocular: the retina is brought closer to the tear by external compression of the eye, using silicone bands or sponges.

Tears that precede retinal detachment can be treated with cold or laser:

Laser treatment, also known as retinal photocoagulation: laser impacts are applied around the tears. Laser treatment, also known as retinal photocoagulation: laser impacts are applied all around the tears, fusing the different layers of the retina to prevent detachment.
Cold, or cryotherapy: a probe is placed in the eye at the site of the tear. This cools the eye to an extreme temperature, which also helps to fuse the different layers of the retina.

Gas can also be injected into the eye to hold the retina in place. The gas expands and remains in the eye for several days or up to a few weeks, giving the retina time to heal.

7. How can retinal detachment be prevented?

To prevent retinal detachment, it is essential to take care of your eyesight, starting with regular check-ups with your eye doctor. It should also be noted that some people have more risk factors for this condition. They are therefore all the more concerned with preventive consultations. These include people over 50, diabetics, people with high blood pressure or high myopia, anyone with a family history of retinal detachment, or cataract patients. The best way to prevent retinal detachment is to perform regular fundus examinations. This is currently the preferred examination for a closer look at the fragile areas of the eye, and for the detection of potential tears or small detachments. When lesions are observed, laser or cold treatment is an excellent preventive solution. These create an adhesive scar on the retina, which greatly reduces the risk of detachment. This is a preventive treatment carried out under local anaesthetic, using an anaesthetic eye drop. Finally, it should be noted that the eye fundus can also be used to detect other eye diseases such as glaucoma or AMD.

Sources :

EM consulte, Paris Centre COSS Ophtalmologie, Manuel MSD, Revue générale des uvéites Manuel MSD, Centre de prévention et de santé universitaire