Detached Retina - Part I

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Detached Retina: This is the first part in a two-part blog series on detached retina injury.  

The retina is a thin layer of light sensitive tissue on the back wall of the eye. The optical system of the eye focuses light on the retina much like light is focused on the film or sensor in a camera. The retina translates that focused image into neural impulses and sends them to the brain via the optic nerve. Occasionally, posterior vitreous detachment, injury or trauma to the eye or head may cause a small tear in the retina. The tear allows vitreous fluid to seep through it under the retina, and peel it away like a bubble in wallpaper.

Types:

Rhegmatogenous retinal detachment - A rhegmatogenous retinal detachment occurs due to a break in the retina (called a retinal tear) that allows fluid to pass from the vitreous space into the subretinal space between the sensory retina and the retinal pigment epithelium. Retinal breaks are divided into three types - holes, tears and dialyses. 

Exudative, serous, or secondary retinal detachment - An exudative retinal detachment occurs due to inflammation, injury or vascular abnormalities that results in fluid accumulating underneath the retina without the presence of a hole, tear, or break. 

Tractional retinal detachment - A tractional retinal detachment occurs when fibrous or fibrovascular tissue, caused by an injury, inflammation or neovascularization, pulls the sensory retina from the retinal pigment epithelium.

A minority of retinal detachments result from trauma, including blunt blows to the orbit, penetrating trauma, and concussions to the head. A retrospective Indian study of more than 500 cases of rhegmatogenous detachments found that 11% were due to trauma, and that gradual onset was the norm, with over 50% presenting more than one month after the inciting injury.[10]

Signs and symptoms:

A retinal detachment is uncommonly preceded by a posterior vitreous detachment which gives rise to these symptoms:

  • flashes of light (photopsia) - very brief in the extreme peripheral (outside of center) part of vision
  • a sudden dramatic increase in the number of floaters
  • a ring of floaters or hairs just to the temporal side of the central vision
  • a slight feeling of heaviness in the eye
  • Although most posterior vitreous detachments do not progress to retinal detachments, those that do produce the following symptoms:
  • a dense shadow that starts in the peripheral vision and slowly progresses towards the central vision
  • the impression that a veil or curtain was drawn over the field of vision
  • straight lines (scale, edge of the wall, road, etc.) that suddenly appear curved (positive Amsler grid test)
  • central visual loss

Risk factors and prevention:

Risk factors for retinal detachment include severe myopia, retinal tears, trauma, family history, as well as complications from cataract surgery.

Retinal detachment can be mitigated in some cases when the warning signs are caught early. The most effective means of prevention and risk reduction is through education of the initial signs, and encouragement for people to seek ophthalmic medical attention if they suffer from symptoms suggestive of a posterior vitreous detachment. Early examination allows detection of retinal tears which can be treated with laser or cryotherapy. This reduces the risk of retinal detachment in those who have tears from around 1:3 to 1:20. For this reason, the governing bodies in some sports require regular eye examination.

Trauma-related cases of retinal detachment can occur in high-impact sports (e.g. boxing, karate, kickboxing, American football) or in high speed sports (e.g. automobile racing, sledding). Although some doctors recommend avoiding activities that increase pressure in the eye, including diving and skydiving, there is little evidence to support this recommendation, especially in the general population. Nevertheless, ophthalmologists generally advise patients with high degrees of myopia to try to avoid exposure to activities that have the potential for trauma, increase pressure on or within the eye itself, or include rapid acceleration and deceleration.

Intraocular pressure spikes occur during any activity accompanied by the Valsalva maneuver, including weightlifting. An epidemiological study suggests that heavy manual lifting at work may be associated with increased risk of rhegmatogenous retinal detachment. In this study, obesity also appeared to increase the risk of retinal detachment.

If you or a loved one has been the victim of a serious eye injury, you may be entitled to compensation. Contact an experienced Detached Retina traumatic injury trial lawyer at The Maurer Law Firm, PLLC to schedule a free consultation to discuss your rights by filling out our free website "Tell Us About Your Case" review form, or phone us directly at 845- 896-5295.

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Posted by Ira M. Maurer, Esq. for The Maurer Law Firm, PLLC

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