Retinal detachment


The Retinal detachment is a rare disease of the eye, in which the retina on the ocular fundus is detached. Affected persons perceive flashes of light and complain about various visual disturbances. Left untreated, retinal detachment can lead to blindness, so it is an ophthalmological emergency. Read all important information about retinal detachment here!

ICD codes for this disease: ICD codes are internationally valid medical diagnosis codes. They are found e.g. in medical reports or on incapacity certificates. H33

"If you see lightning, sooty rain, or a black shadow, this may be an indication of retinal detachment. See an ophthalmologist immediately."

Dr. med. Mira SeidelArticle overviewCut skin detachment
  • description
  • symptoms
  • Causes and risk factors
  • Examinations and diagnosis
  • treatment
  • Disease course and prognosis

Retinal detachment: description

In retinal detachment (retinal detachment, retinal detachment), the retina (retina) that lines the eyeball separates from the inside. Since the retina consists primarily of sensory cells that register, process and relay the visual information, the detachment usually affects the visual performance.

Retinal detachment untreated leads to blindness

Retinal detachment is a rare disease. Every year about one in 10,000 people are affected. Acute courses take place especially between the ages of 45 and 65 years. In addition, the retinal detachment occurs familial. The disease has a special significance in ophthalmology, because an untreated retinal detachment can lead to blindness in the affected eye.

How fast this happens depends on the extent of retinal detachment. Retinal detachment was a virtually untreatable disease as late as the 1920s. Fortunately, this has changed as a result of the rapid development of ophthalmology, so that today blindness can usually be prevented. Nevertheless, the earlier the retinal detachment is treated, the better the chances of recovery.

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Retinal detachment: symptoms

The disease is characterized by some classic symptoms: Retinal detachment is generally noticeable by a distorted vision. Characteristic are flashes of light (photopsias) in the affected eye. Patients see this especially in the dark. The effect is caused by tensile forces exerted on the retina by structures inside the eye (for example connective tissue strands). In addition, you may still encounter:

Black dots or flakes This "soot rainstorm" also called "flying mosquitoes" are black dots or flakes that seem to be moving. So you do not always stay in the same place visually. The reason for this are usually tears or bleeding in the retina.

Visual field loss (scotoma) The vision in certain areas is completely absent. Affected people often report that this is like a black shadow slowly spreads. The starting point of the increasing shadow is often also the place of incipient replacement. The fact that the shadow increases, indicates an increasing detachment of the retina. For example, if the shadow descends from top to bottom like a curtain, retinal detachment probably began at the bottom and continues upward. Such an increasing visual field loss is a absolute alarm signal for an acute retinal detachment. Signs like these should by no means be ignored as they require immediate action.

The symptoms may all be present, depending on the cause of the cause, or they may occur one at a time. For a long time, however, a retinal amotio can also completely symptom-free run. This is especially the case when the retinal detachment is small and located in the margins of the retina.

The severity of retinal detachment discomfort depends primarily on the location of the damage to the retina. If, for example, the area of ​​the retina on which most of the nerve cells are present ("place of sharpest vision" or macula) is affected, vision is particularly impaired.

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Retinal detachment: causes and risk factors

The retina is only about 0.1 to 0.5 mm thick and consists, in simplified terms, of two superposed different layers. On the one hand, the layer containing the nerve cells (Stratum nervosum). Underneath, towards the back of the eye, lies the second layer. This is due to their dark color as Stratum pigmentosum designated.

Normally, there is one between these two layers of the retina wafer-thin, liquid-filled gap, In this gap, there is a slight negative pressure, which "sucks" the two layers. Different reasons can cause the upper layer of the retina to detach from the lower one. This is called retinal detachment.

The separation of the two layers is problematic because the Stratum pigmentosum is responsible for the nutrition of the overlying stratum nervosum. When the connection between the layers is interrupted, the sensory cells die there after a short time and cause the typical retinal detachment symptoms.

Important for the stability of the retina: the vitreous body

Very often it comes because of diseases of the vitreous (Corpus vitreum) in the eye to a retinal detachment. This is a structure that fills the inside of the eye to almost two-thirds. The gelatinous substance of the vitreous body gives the eyeball its stable form. At the same time he presses the retina against the ocular fundus, thus preventing a detachment of the upper retinal layer from the lower. The vitreous thus plays a very important role in the stabilization of the retina.

The most common causes of retinal detachment

There are several causes for the entry of fluid into the cleft between the two retinal layers:

Rhegmatogen (due to cracks) By far common Form of retinal detachment, the so-called rhegmatogenous amotio, penetrates through a small tear in the retina fluid from the eyeball between the two retinal layers. As a result, the upper retinal layer rises and dies in the course. However, not every tear causes retinal detachment. It often happens that this remains completely symptomless.

Cracks in the retina often occur in the case of damage to the vitreous, for example in the so-called rear vitreous detachment, As a result of age-related fluid loss, the vitreous body collapses somewhat and tears a hole in the retina, where it adheres to its posterior surface. This is noticeable through impaired vision and blurred vision. Especially when looking around quickly, such a visual disturbance moves further than the actual eye movement that was made. This is because the movement of the liquid of the vitreous body is slower than the movement of the head. These may therefore be signs of retinal detachment. Another cause of retinal cracking is Blows to the eye (traumatic retinal tear).

Traktiv (due to traction) In the so-called traction-related retinal detachment, also called complicated retinal detachment, the upper retinal layer is literally pulled away by connective tissue strands inside the eye. It arises mainly in the context of diseases in which forms abnormal connective tissue in the interior of the eye. This connective tissue is firmly attached to the upper layer of the retina. Over time, the connective tissue strands shrink and pull on the upper retinal layer. This causes the detachment from the lower retinal layer. Examples of such diseases: diabetic retinopathy, retinal vein occlusions, retinopathy of prematurity, retinal necrosis or cataracts (after surgery).

Exudative (due to fluid) Under the lower retinal layer is the so-called choroid, This is a very vascular layer that supplies the overlying retina with blood. A exudative retinal detachment arises when, from the vessels of the choroid, fluid penetrates between the two layers of the retina and there leads to a detachment of the upper retinal layer. The main causes of fluid leakage from the vessels of the choroid are inflammation or tumors of the choroid.

Combination traction-rhegmatogen In the traction-induced rhegmatogenous retinal detachment Both retinal tear and connective tissue strands inside the eye are responsible for retinal detachment. The tear is usually caused by the train, which is often caused by an overgrowth of the connective tissue. This form is common in diabetics.

Risk factors for retinal detachment

Various risk factors increase the likelihood of retinal detachment. Which includes:

  • Surgeries on the eye (for example cataracts)
  • repeated inflammation of the eye
  • Accidental injuries
  • Myopia

In shortsighted eyes, the eyeball is too long, which is why the retina is already slightly stressed and thus easier tear. While in the normal-sighted population only about 0.2 percent of people are affected by retinal detachment, about seven percent of the short-sightedness suffer from it.

Other risk factors include eye diseases such as diabetic retinopathy, Coats's disease and retinopathy of prematurity. In these diseases, regular ophthalmological examinations should take place in order to detect a pathologically changed retina as soon as possible.

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Retinal detachment: examinations and diagnosis

The ophthalmologists are the specialists for retinal detachment. If necessary, a clinic with an ophthalmological department (Ophthalmology). This is especially true when the symptoms develop suddenly and quickly. Frequently, the symptoms described by the patient already indicate the presence of retinal detachment. The doctor could ask this question in conversation: