View Video Animations about the Retina and Retinal Detachments

What are the treatments for retinal tears and detachments?

For certain retinal tears or holes found before a detachment has developed, or, rarely, if the detachment is new and very small, treatment may consist only oflaser or cryotherapy, and this will not require hospitalization. Once a retinal detachment has occurred, however, all holes and tears that have allowed fluid to collect under the retina must be sealed. If a detachment is extensive, its repair requires major eye surgery. Whether you are hospitalized or not, and what type of anesthesia will be used, will depend on how complicated the detachment is. One or a combination of procedures and appliances may be required. These are some common ones:

• Cryotherapy:
extremely cold probes applied to a small area outside of the eyeball overlying the retinal tears, to "freeze-burn" the tissue, seal the tears, and create an eventual scar that will "stick" the retina to that spot.
• Lasers:
high energy light beams that burn the tissue and help seal tears and holes. This is usually used as a supplement to surgery. Despite a general impression to the contrary, a laser can only rarely be used alone, without surgery, to treat a detachment.
• Silicone surgical explants:
rubberlike spongy material or flexible strips sewn to the outside (scleral) surface of the eye to compress ("buckle") the eyeball over tears and detached areas and help bolster the retina (hence the term "scleral buckle").
• Drainage:
surgically draining the fluid from under the detached retina, to allow the retina to settle back down into its normal position. (Sometimes the fluid is not drained, but left to absorb on its own.)
• Vitreous surgery:
removing opaque debris and membranes from the inside of the eye and from the retinal surface.
• Intraocular gas:
injection of bubbles of air or special gasses into the eye to push or hold the retina in place; sometimes liquid silicone is used.

What happens after surgery for a retinal tear or detachment?

Medications: You will need to use various types of eyedrops and/or ointments, possibly for several weeks.

Activities: Will be somewhat restricted, since it takes a few weeks for the retinal tears to become firmly "welded." Once recovery is complete, most patients can lead a completely normal life. If you plan to take part in a sport that exposes your eyes to injury, however, always wear polycarbonate protective goggles or a face mask. Direct blows to any eye can be harmful, but they are especially risky to one that was previously detached.

Regular examinations: There is some risk that the retina can detach again, and you are also at greater risk for a detachment to occur in the other eye, so it is important to have regular, annual examinations. (Regular examinations are also important if you have any condition that predisposes you to a retinal detachment, such as extreme myopia.) Preventive laser treatment or cryotherapy may be advised for tears found in either eye, though usually they are merely identified and watched.

What is the prognosis after surgery for a retinal tear or detachment?

With modern therapy, over 90% of detachments can be successfully treated and the retina reattached. However, the visual outcome is not always predictable. The best visual result (which can approach normal) will occur if treatment takes place before the critical, center part of the retina (the macula) has detached. If the macula has already detached when the repair is undertaken, the best vision you can expect is usually poor, about 20/200. Still, the side vision in that eye can be normal, so that eye will almost always be a useful one despite its lesser acuity. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails and all vision may eventually be lost.