Retinal Tears and Detachments

Transcription

1 Retinal Tears and Detachments

2 Understanding Retinal Problems When your eyes are working well, it s easy to take them for granted. But a tear or detachment of your eye s retina (the light-sensing lining of the eye) can cause troubling vision changes. It can even lead to permanent vision loss. Fortunately, most retinal problems can be treated. Symptoms of a Tear or Detachment Retinal tears and detachments are painless. You may not even realize something is wrong. More often, though, you notice sudden vision changes. These include: Floaters (dark spots) Flashes (bursts of light) Cobwebs in your vision Blurry vision A shadow or curtain across your vision A retinal tear may cause floaters and flashes to appear in your vision. 2 This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. 2003, 2015 The StayWell Company, LLC All rights reserved. Made in the USA.

3 Who Is at Risk? Anyone can have a tear or detachment. Factors that can make a tear or detachment more likely include: Nearsightedness Older age Previous eye surgery Trauma to the eye Thinning or weakness of the retina Diseases, such as diabetes Family history of retinal tears or detachments Table of Contents When the Eye Is Healthy When the Retina Is Damaged Your Eye Evaluation Retinal Tears and Holes Retinal Detachments Prompt treatment of a retinal problem can help you keep enjoying the things you love. What You Can Do If you have symptoms of a tear or detachment, see your eye doctor right away. He or she will assess your vision changes and help you decide on treatment. In some cases, emergency treatment may be needed to save your sight. By working with your doctor, you can do what s best for your eyes. Treating Tears and Detachments Additional Treatments

4 When the Eye Is Healthy The eye receives and processes light, allowing you to see. The retina plays an important role in this process. It is the part of the eye that turns light into nerve signals. These signals are then sent to the brain. There they become the images you see. Parts of the Eye The iris (colored part of the eye) controls the amount of light entering the eye through the pupil. The light is then focused by the lens and is projected through the vitreous (a clear, gel-like substance that fills the eye). The light travels to the retina at the back of the eye. The Retina Iris Pupil Lens Sclera (white of the eye) The retina has several parts: The sensory retina contains lightsensing cells (photoreceptors). The vitreous gel is attached to this layer. The retinal pigment epithelium (RPE) layer sits beneath the sensory retina. The macula is the center of the retina. It is responsible for sharp central vision (seeing straight ahead). The peripheral retina is the outer edge of the retina. It is responsible for side vision (seeing out of the corner of your eye). Macula Vitreous Retina Front view of a healthy retina. Macula Sensory retina (photoreceptors) RPE Sclera Peripheral retina 4

5 When the Retina Is Damaged If the retina is torn or detached, the eye can t send clear visual signals to the brain. Damage to the peripheral retina affects side vision. Damage to the macula affects central vision. If not treated, retinal problems can lead to permanent vision loss. Causes of Tears and Detachments Common causes of tears and detachments include: Changes in the vitreous. With age, the vitreous gel in the eye begins to liquefy and shrink. As it shrinks, the vitreous can pull on the retina and cause it to tear or detach. Lattice degeneration. Over time, areas of the retina may thin and weaken. This makes it easier for retinal tears to occur. Scar formation. Certain diseases or trauma to the eye can cause scar tissue to form between the vitreous and retina. This can pull on or wrinkle the retina. Types of Retinal Damage Damage to the retina may take these forms: Retinal tears are rips or breaks in the sensory retina. Retinal holes are the result of tears that pull a small piece of the sensory retina off the RPE layer. A hole can also form in a weak area of the retina. Retinal detachments occur when part of the sensory retina is lifted completely off the underlying RPE layer. Shrinking vitreous pulling on the retina Flap tear in retina A retinal tear allows fluid under the retina. This can lead to a detachment. Detached retina Retinal tear Lattice degeneration Fluid under retina 5

6 Your Eye Evaluation Your eye doctor will evaluate you to learn more about your vision problem. This includes taking a medical history. It also includes vision tests and an eye exam. Based on the results of the evaluation, your doctor will discuss the options you have for treatment. Your Medical History Your eye doctor will ask questions about your symptoms and any history of vision problems. Be sure to mention: Previous eye injury. Past treatment for eye problems. Health problems, such as diabetes. Family history of retinal problems. Whether you are currently taking any medications, supplements, or herbal remedies. Your Eye Exam An eye exam is used to check the health of your eye. First, eyedrops are used to dilate (widen) your pupils. Your doctor will then look inside the eye using different magnifying tools, or instruments. A slit lamp is used to look at the front parts of your eye. A magnifying lens is sometimes used along with the slit lamp. This helps your doctor look more closely at certain areas within the eye. A slit lamp exam lets the doctor examine your eye in detail. 6

7 Viewing the Retina Your eye doctor will use an indirect ophthalmoscope to view the retina. While looking through the scope, your doctor may gently place a small tool against your eye. This makes it easier to see tears in the peripheral retina. Ultrasound is another tool that may be used. It creates an image of the eye using sound waves. This helps your doctor locate a tear or detachment. Discussing Treatment After the exam, your doctor will talk with you about your eye problem and options for treatment. Because retinal problems can sometimes lead to permanent vision loss, your doctor may suggest starting treatment right away. An indirect ophthalmoscope and hand-held lens can help your doctor see signs of retinal damage. 7

8 Retinal Tears and Holes The retina is very thin and fragile. If something pulls on the retina, a tear or hole may form. Retinal tears can cause troubling vision changes. Left untreated, a tear can also lead to a retinal detachment. What You May See The shrinking vitreous pulls on the retina and causes it to tear. When a tear forms in the retina, you may notice: Floaters or spots. These are caused by tiny strands of fibers inside the vitreous. They can also result if blood enters the vitreous. Flashes or streaks of light. These occur when the vitreous pulls on the sensory retina. The pulling stimulates the retina and causes it to send nerve signals to the brain. Retinal Tears Certain areas of the vitreous are strongly attached to the retina. When the vitreous shrinks, it can pull on these areas and tear a flap of retinal tissue off the eye wall. The retina can continue to tear if the flap stays connected to the vitreous. The retina may also tear across a blood vessel. This can allow blood to enter the vitreous and cause additional vision problems. 8 Retinal tears may cause floaters and flashes of light.

9 What You May See Atrophic holes often form in weak or thin areas of the retina. When a hole forms in the retina, you may notice slight vision changes, such as floaters. Or you may not have any symptoms at all. This is because holes usually form in the area of the retina responsible for side vision. Retinal Holes Most retinal holes are very small. In some cases, they may not require treatment. Atrophic holes develop in weak or thin areas of the retina. These are the most common type of retinal hole. Operculated holes form when vitreous shrinkage tears off a small piece of the retina. Macular holes are a more serious form of retinal damage. If a hole forms in the macula, it can affect central vision. Retinal holes may cause mild vision changes, or no changes at all. 9

10 Retinal Detachments A detachment occurs when part of the retina separates from the eye wall. Any part of the retina that is detached won t be able to send visual signals to the brain. If not treated, a detachment will often lead to permanent loss of some or all the vision in that eye. Types of Detachments There are several types of detachments. The types can vary in size, location, and severity. If the macula is detached, or certain kinds of scarring are present, it may be difficult to restore best vision. Tear-Induced Detachment When the retina is torn, vitreous fluid can pass through this opening. The fluid may then pool beneath the sensory retina and lift it off the RPE layer. This is the most common type of detachment. Scar tissue Scar tissue can pull the retina off the eye wall. Fluid Fluid may enter through a tear in the retina and cause a detachment. Tractional Detachment Tractional detachment is caused by scar tissue growing between the vitreous and retina. Scar tissue may form due to trauma or conditions such as diabetes or sickle cell disease. As it forms, scar tissue may pull on the retina. This can peel the retina off the eye wall and cause a detachment. 10

11 Exudative Detachment Certain medical conditions may cause fluid to pool underneath the retina. Over time, the fluid can push on the sensory retina and separate it from the RPE layer, even when there is no hole. What You May See What you see depends on the location of the detachment. A peripheral detachment may cause a shadow or curtain to appear in your side vision. A macular detachment causes central vision loss. Treating Retinal Problems There are many different treatments for tears, holes, and detachments. Your eye doctor can discuss these treatments with you and help you decide which is best for your eye problem. Read on to learn more. Fluid Fluid pooling beneath the retina may cause a detachment. A peripheral detachment causes loss of side vision. 11

12 Treating Tears and Detachments Some treatments for tears and detachments can be done in your eye doctor s office. Depending on the type of damage, your doctor may use one or more procedures. Afterward, be sure to follow all your doctor s instructions for recovery. Laser Therapy Laser therapy is a common treatment for retinal tears. First, the eye may be numbed. A laser beam is then directed into the eye. Heat from the laser creates a series of small scars. These seal the area around the tear. A freezing probe seals a tear by freezing tissue together. The laser makes small scars that form a barrier around the tear. Cryotherapy After Laser or Cryotherapy Treatment After treatment, your eye may be red or irritated. But you can often resume most activities within a short time. In some cases, you ll be asked to avoid strenuous exercise for a week or more. While you re healing, take any prescribed medication, and avoid rubbing your eye. Be sure to keep follow-up appointments with your doctor. Cryotherapy is another method for treating tears. The eye is first numbed. A freezing probe is then placed on the outside of the eye next to the tear. This bonds the tissue together. 12

13 Pneumatic Retinopexy After a tear is repaired with laser or cryotherapy, a detached retina may be repaired by filling the eye with a gas bubble. As the gas expands, it pushes the retina back into place. This treatment can be used only for certain kinds of detachments. Keep your head stable after treatment. This prevents the gas bubble from shifting within the eye. When to Call Your Doctor After any of these treatments, call your doctor if you have: Worsening vision. Severe pain. Swelling or redness that does not go away. Gas bubble Nausea or vomiting. Discharge from the eye. A gas bubble pushes the retina back into place. After Pneumatic Retinopexy A patch may be placed over your eye. You will need to keep your head in a stable position for at least several days. Follow your doctor s instructions for proper head placement. As you heal, the gas bubble will slowly be absorbed by your body. Avoid air travel, large changes in elevation, and scuba diving until your doctor says it s safe. 13

14 Additional Treatments For certain types of retinal damage, treatment is done at a hospital or surgery center. Follow your doctor s instructions to prepare for surgery. Be assured that your eye is not removed from its socket during the operation. Scleral Buckling A scleral buckle is a soft band made of silicone. After a tear is treated with laser or cryotherapy, the band is put around part or all of the eye. It is tightened to press the eye wall against the retina. Afterward, the buckle remains in place. But it won t be visible. Buckle A scleral buckle pushes the eye wall against the retina. Risks and Complications Scar formation within the eye Bleeding Re-detachment of the retina Glaucoma (elevated pressure in the eye) Vitrectomy A vitrectomy removes most of the vitreous from the eye. This is done to stop the vitreous from pulling on the retina. The vitreous is replaced with a clear fluid, gas, or silicone oil. Over time, fluid or gas is absorbed by your body. If silicone oil is used, it is usually removed a few months after the procedure. Infection Loss of vision Injury to other parts of the eye Cataract Double vision Surgical tools are used to remove the vitreous. 14

15 Preparing for Surgery To prepare for surgery, follow your doctor s instructions. Also be sure to: Tell your doctor if you are taking any medications such as aspirin, ibuprofen, or blood thinners. Arrange in advance for an adult family member or friend to give you a ride home. Follow instructions for eating or drinking before surgery. Your Surgical Experience Just before surgery, you ll be given eyedrops to dilate and numb the eye. Your surgeon uses a microscope to magnify and light the eye while performing the surgery. After surgery, a patch will be placed over your treated eye. In most cases, you will go home after a short rest in the recovery area. In certain cases, an overnight stay in the hospital is needed. Your surgeon will tell you how to position your head during recovery. When to Call Your Doctor After surgery, call your doctor if you have: Worsening vision. Severe pain. Discharge from the eye. Swelling or redness that does not go away. Nausea or vomiting. Your Recovery Your eye may be red, swollen, and itchy for a few days. You may be given eyedrops or other medications to use while the eye heals. Follow all your doctor s instructions, which may include: Do not rub your eye. Wear an eye shield while you sleep. Do not bend over. Keep your head above waist level. Limit exercise. Keep your follow-up appointments. These help your doctor monitor your healing. It will take time (months, in some cases) to gain your best vision. 15

16 Looking Ahead After treatment for your tear or detachment, your eye doctor may prescribe new glasses or contacts. Keep taking care of your eyes. Have regular eye exams and tell your doctor if you have any vision changes. Consultant: Mark R. Wieland, MD, Ophthalmology With contributions by: Steven Bodine, MD, Ophthalmology Patrick Caskey, MD, Ophthalmology Emily Hsui, OD, Optometry Walter H. Stern, MD, Ophthalmology