Rhegmatogenous Retinal Detachment

Rhegmatogenous retinal detachment is a serious eye emergency where a tear in the retina allows fluid to seep underneath, causing it to separate from the back of the eye. Without prompt treatment, this condition can lead to permanent vision loss.

Table of contents

• What Is Rhegmatogenous Retinal Detachment?
• How This Condition Develops
• Who Is at Risk?
• Warning Signs to Watch For
• Why Immediate Care Matters
• How Doctors Diagnose the Condition
• Treatment Options
• What to Expect After Surgery

What Is Rhegmatogenous Retinal Detachment?

Rhegmatogenous retinal detachment is the most common type of retinal detachment^[1]. The retina is a thin layer of tissue at the back of your eye that senses light and helps you see. It converts light into signals that your brain understands as images^[2].

In this condition, a small tear or break develops in the retina. The gel-like fluid in the center of your eye, called vitreous, can then get behind the retina through this tear. As the fluid builds up, it pushes the retina away from the back of your eye, causing it to detach^[1]. When the retina detaches, it separates from the blood vessels that provide it with oxygen and nutrients^[2].

This separation prevents the retina from working properly. The longer the retina stays detached, the greater your risk of permanent vision loss in the affected eye^[2].

• Retina
• Vitreous body
• Eye

How This Condition Develops

The most common cause of rhegmatogenous retinal detachment is degeneration of the vitreous body^[3]. The vitreous is made up almost entirely of water and is held together by collagen fibers that extend into the surface layers of the retina^[3].

As you get older, the vitreous in your eye may change in texture and may shrink. Sometimes, as it shrinks, the vitreous can pull on your retina and tear it^[1]. This natural aging process can start as early as the first few years of life^[3].

When the vitreous gel separates from the retina, it can cause a retinal tear by pulling on it with enough force. Once a tear forms, the liquefied vitreous can seep through the opening and accumulate under the retina, causing it to detach from the eye wall^[4].

Other causes include eye injuries and eye surgery. Retinal tears may occur along the edges of certain areas of retinal thinning, near scars, or in areas of apparently normal retina^[4].

Who Is at Risk?

Aging is the most common cause of rhegmatogenous retinal detachment. People in their sixth and seventh decades of life are most commonly affected^[3]. However, anyone can experience this condition.

Several factors can increase your risk^[1][5]:

• Nearsightedness (myopia), especially severe nearsightedness, is a major risk factor. Studies have identified myopia as one of the main risk factors for this condition^[3]
• Previous cataract surgery increases the risk^[3]
• Eye injuries or trauma to the eye
• Previous retinal detachment in one eye or a family history of retinal detachment
• Previous eye surgery

Certain eye conditions also raise your risk, including thin patches in the outer retina, called lattice degeneration^[4].

Warning Signs to Watch For

Retinal detachment is painless^[2]. Often, symptoms appear before the retina fully detaches or before the detachment gets worse^[2]. Some people with rhegmatogenous retinal detachment notice warning signs that reflect the vitreous gel separation and retinal tear^[4].

The main symptoms include^[2][3]:

• The sudden appearance of tiny specks or squiggly lines that seem to drift through your field of vision, called floaters. These are often described as black dots or cobwebs
• Flashes of light in one or both eyes, known as photopsias
• Blurred vision
• A dark curtain, shadow, or cloud that progresses across your side vision or through the middle of your field of vision
• Reduced side vision, also called peripheral vision

If only a small part of your retina has detached, you may not have any symptoms at all^[14]. However, as more of the retina detaches, symptoms become more noticeable. The rate at which the retinal detachment progresses can vary from days to weeks depending on factors such as your age and the size and number of retinal tears^[4].

Why Immediate Care Matters

Rhegmatogenous retinal detachment is a medical emergency^[2][3]. If you have symptoms of a detached retina, it is important to go to your eye doctor or the emergency room right away. Early treatment can help prevent permanent vision loss^[1].

All patients should be seen by an eye doctor, called an ophthalmologist, on the same day that symptoms arise^[3]. The symptoms of retinal detachment often come on quickly, and without treatment, blindness in the affected eye may result^[3].

The earlier you are seen by an ophthalmologist, the greater the chance that the center of the retina (called the macula) is still attached, which means your central vision can be preserved^[3]. Retinal detachments often cause some degree of permanent visual field or central visual loss, even after successful surgery. However, final visual outcomes are best if the detachment is detected and treated before it involves the macula^[4].

How Doctors Diagnose the Condition

A comprehensive eye examination is essential to diagnose retinal detachment^[4]. Your healthcare professional may use the following tests^[6]:

A retinal exam is the main diagnostic tool. Your healthcare professional may use an instrument with a bright light and special lenses to check the back of your eye, including the retina. This type of device provides a detailed view of your whole eye and lets your healthcare professional see any retinal holes, tears, or detachments^[6].

Through a dilated pupil, the ophthalmologist will see one or more tears in the retina with varying amounts of underlying fluid. There may also be some degree of bleeding in the vitreous, which is common when the retina tears^[4].

If bleeding has happened in your eye and makes it hard to see the retina, your healthcare professional may use ultrasound imaging. This test uses sound waves to create images of the inside of your eye^[6].

Your healthcare professional will likely check both eyes even if you have symptoms in just one. If a retinal tear is not found during the first visit, your healthcare professional may ask you to return within a few weeks to confirm that your eye has not developed a delayed retinal tear^[6].

Treatment Options

Once a retinal detachment develops, surgery is almost always necessary to reattach the retina^[4][6]. The two main goals of surgery are to seal all retinal breaks and to relieve all traction (pulling) on the retina^[4].

If a retinal break or tear is detected before the retina has detached, laser treatment or freezing therapy (called cryotherapy) to the retinal tear is often successful in sealing the tear and preventing a retinal detachment^[4].

There are three basic surgical procedures used to treat rhegmatogenous retinal detachment^[4]:

Pneumatic retinopexy is an office-based procedure. It involves injecting a temporary gas bubble into the eye to flatten (reattach) the retinal tear and surrounding detachment. The gas injection is coupled with either cryotherapy or laser treatment to permanently seal the causative retinal tear. After the procedure, patients must maintain a certain head position for about one week to ensure the gas bubble properly closes the retinal tear^[4].

Scleral buckle procedure is performed in the operating room. It consists of suturing a soft piece of silicone on the eye wall in such a way as to indent and close the retinal tear. It is also coupled with cryotherapy or laser treatment. A gas bubble is also sometimes used during the procedure^[4].

Vitrectomy is another approach and is also performed in the operating room. As the name implies, it involves surgical removal of the vitreous gel from the eye and replacing it with a gas bubble, silicone oil, or saline solution to hold the retina in place^[4]. This procedure is commonly used for more complicated retinal detachments^[4].

The choice of procedure depends on certain features of the detachment, such as the number and location of retinal tears, among other factors^[4]. Your ophthalmologist will discuss the risks and benefits of your treatment options with you^[6].

What to Expect After Surgery

Anatomical success rates (meaning the retina stays attached) are in the range of 85% to 90%^[3]. Research comparing different surgical approaches shows that success rates can vary. One study found that single surgery anatomical success was higher with scleral buckle and the combination of vitrectomy with scleral buckle compared to vitrectomy alone^[10].

After surgery, proper care is required to ensure a complete recovery and prevent complications^[13]. Rest is essential during the early recovery phase. You should avoid intense activity, heavy lifting, and bending over, since these can raise eye pressure^[13].

Depending on the type of operation, your retina specialist may recommend that you maintain a certain head position to keep a gas bubble in place. This positioning can vary, but it usually requires keeping your head down^[13].

You will need to use prescribed eye drops to reduce inflammation, prevent infection, and maintain eye pressure. Follow your retina specialist’s instructions closely^[13]. Regular follow-up visits are critical to track your progress and address any difficulties early on^[13].

Persistent fluid under the retina after surgery can occur, with rates varying significantly depending on the procedure. This fluid can remain for an extended period, with reports of up to 30 months following scleral buckle surgery^[8]. Serial imaging tests are crucial for monitoring. If the fluid worsens, it could indicate new breaks or inadequate treatment^[8].

In patients who undergo vitrectomy, lens clouding (cataract formation) occurs in more than 70% of cases^[3]. One-year visual improvement is markedly better in eyes that achieve successful reattachment with a single surgery^[10].