retinal detachment, a separation of the retina from the retinal pigment epithelium in the back of the eye. It usually results from a hole or tear in the retina that allows the vitreous humor to leak between the choroid and the retina. Severe trauma to the eye, such as a contusion or penetrating wound, may be the proximate cause, but in the great majority of cases retinal detachment is the result of internal changes in the vitreous chamber associated with aging or, less frequently, inflammation of the interior of the eye. ▪ OBSERVATIONS: In most cases, retinal detachment develops slowly. The first symptom is often the sudden appearance of a large number of floating spots loosely suspended in front of the affected eye. The person may not seek help because the number of spots tends to decrease during the days and weeks after the detachment. The person may also notice a curious sensation of flashing lights as the eye is moved. Because the retina does not contain sensory nerves that relay sensations of pain, the condition is painless. Detachment usually begins at the thin peripheral edge of the retina and extends gradually beneath the thicker, more central areas. The person perceives a shadow that begins laterally and grows in size, slowly encroaching on central vision. As long as the center of the retina is unaffected, the vision, when the person is looking straight ahead, is normal. When the center becomes affected, the eyesight is distorted, wavy, and indistinct. If the process of detachment is not halted, total blindness of the eye ultimately results. The condition does not spontaneously resolve itself. ▪ INTERVENTIONS: Surgery is usually required to repair the hole and prevent leakage of vitreous humor that separates the retina from its source of nourishment, the choroid. If the condition is discovered early when the hole is small and the volume of vitreous humor lost is not large, the retinal hole may be closed by causing a scar to form on the choroid and to adhere to the retina around the hole. The scar may be produced by heat, laser energy, or cold. The scar is held against the retina by local pressure achieved by a variety of surgical techniques. ▪ PATIENT CARE CONSIDERATIONS: Retinal detachment requires treatment. The degree of restoration of sight depends on the extent and duration of separation. Unless replaced, a detached retina slowly dies after several years of detachment. Blindness resulting from retinal detachment is irreversible.
