Hello and welcome to Case of the Day. I’m Dr. Croley and today we’re gonna discuss a patient who came in complaining of floaters and flashes in their vision, and ended up having a retinal detachment. So we’re gonna discuss retinal detachments today.
So what happens with a retinal detachment? So your retina is the inside lining inside the back of the eye and this is like the film of a camera, that’s what you see with. The back of the eye, in front of the retina, is filled up with a substance called the vitreous humor or vitreous body. This is a Jello sort of like substance that is attached to the retina, more strongly out to the peripheral part here to the side and then also attached here to the posterior part. Overtime, this Jello or vitreous tends to sort of liquify and start to move around. And also, a tear can happen, a retinal tear can happen from an injury ‘cause of force hitting the eye can cause the jelly to move around or vitreous to move around.
So what happens is this vitreous starts to move and shrink and it pulls loose from the retina. So when it pulls loose, that’s when you see these floaters that can be like cobwebs, veils, curtains, bugs, nets, things floating in your vision. That’s when you start to see those. You see those attachments floating around your vision. And as this is tugging or pulling, or you move your eye and the vitreous bounces and hits you, right then you have flashes. Usually these flashes are not very bright so you may not see them as much in the daytime, but you see them during the night.
So that’s what goes on with a vitreous detachment; the vitreous pulls loose and most of the time, 90 something percent of the time, when this vitreous pulls loose, you have floaters, flashes, and that’s all that happens. But on a rare occasion, when this pulls loose, it tears a hole in the retina. So what that allows is that because there’s a hole there, now fluid inside your eye can seep underneath through that hole, underneath your retina, and then the fluid pushes the retina off of its attachment to the choroid, the next layer down and that is a retinal detachment.
So people who get retinal detachments, the detachment spreads, it can detach the whole retina, and the vision is extremely bad. In the beginning if it’s only detached in an area, you may notice some dark area to the side, in the beginning.
So there’s basically, what we sort of consider two types of retinal detachments as far as all the outcome after repairing the retinal detachment. That is, the detachment is localized; it does not involve the macula. So if it does not involve the macula, then almost always, that person’s gonna want that retina fixed cause we want to maintain good vision because the macula has stayed in its proper location. That type of retinal detachment needs to be repaired immediately because you wanna keep that macula from detaching.
The other type is where the macula has been detached. So now, the macula has been detached from its underlying choroid and nutritional blood supply to some extent. So even though the retina can be fixed, that macula may have been damaged, may not be as healthy as we would like. Therefore, the vision return after having a retinal detachment with the macula that has been detached is not as good.
So it’s important if someone who has flashes and floaters that they get their retina looked at to make sure they don’t have a tear. If they do, you wanna fix that tear before the retina detaches, that way you can maintain your vision. And if you do get a retinal detachment, you wanna catch up early so your macula stays in place.
There’s different ways to fix a retinal detachment, and we’ll briefly cover that. So one method is if the tear is up above, the top half of the eye, and is not too large, then what can be done is that area will have a freezing application applied for around where the tear is, from the outside, external part of the eye so that way it will seal that tear back up, the scar that tear back closed and then a gas bubble of gas is inserted into the eye. Then that bubble then pushes the retina back up to its proper location and seals everything back down and that can even be done in the office.
If there’s too many tears, or too large, or the tear is below, then you have to actually go into surgery and have the retina fixed and many times, that would include putting a band, like a rubber band that goes around the eye to squeeze this in so it releases the traction inside the eye. That area where the tears are is frozen, as well. Then sometimes, a retractomy is done, where all the vitreous is removed to remove any further traction on the retina. So that has to be done in a surgery center or a hospital, as far as the procedure goes. So those are the two basic ways in which a retinal detachment would be fixed.
In summary, if you have flashes or floaters, you need to go see your eye doctor right away to make sure that your retina is okay. If you do have a retinal detachment, the good news is, with today’s technology, most of the time they can be fixed. It’s important to do this as soon as possible if your macula is still intact because it will preserve the quality of your vision.
So if you have any questions about a retinal detachment, or any other eye questions, we’d be happy to try to answer those. You can contact us through the website. If not, may God grant you healthy eyes and great vision.