RETINAL DETACHMENT – Types and Causes, Risk Factors, Signs and Symptoms, Diagnostic Evaluation and Management
The retina is a light-sensitive membrane located at the back of the eye. When retina is detached from its pigmented epithelium is called retinal detachment. It is characterized by partial or total loss of vision.
TYPES AND CAUSES
- Rhegmatogenous retinal detachment: it is characterized by tear or hole in retina. This allows fluid from within the eye to slip through the opening and get behind the retina. The fluid separates the retina from the membrane that provides it with nourishment and oxygen. The pressure from the fluid can push the retina away from the retinal pigment epithelium, causing the retina to detach.
- Tractional retinal detachment: it occurs when scar tissue on the retina’s surface contracts and causes the retina to pull away from the back of the eye. This is a less common type of detachment that typically affects people with diabetes
- Exudative detachment: this type of detachment is caused by retinal diseases such as inflammatory disorder or Coats disease, which causes abnormal development in the blood vessels behind the retina.
RISK FACTORS
Risk factors for retinal detachment include:
- Posterior vitreous detachment (PVD): a common condition in aging individuals, in which the fluid in the retina breaks down, putting strain on the retinal fibers
- Extreme nearsightedness
- Family history of retinal detachment
- Trauma to the eye
- Being over 40 years old
- Prior history of retinal detachment
- Complications from cataract surgery
- Diabetes
SIGNS AND SYMPTOMS
There is no pain associated with retinal detachment, but there are usually symptoms before the retina becomes detached. Primary symptoms include:
- Blurred vision
- Partial vision loss
- Flashes of light when looking to the side
- Areas of darkness in field of vision
- Suddenly seeing many floaters (small bits of debris that appear as black flecks or strings floating before the eye).
DIAGNOSTIC EVALUATION
- Tonometry: to evaluate the eye pressure
- Gonioscopy: to inspect the drainage angle of eye
- Ophthalmolscopy: to evaluate the optic nerve
SURGICAL MANAGEMENT
- Photocoagulation: it is a laser burn around the tear site and the resulted scar will fixes the retina to the back of the eye.
- Cryopexy: it consists of application of freezing probe to the tear site and the resulting scarring will help hold the retina in place
- Retinopexy: in this doctor will put a gas bubble in eye to help the retina move back into place. Once the retina is back in place, with the help of laser the holes are sealed out
- Scleral buckling: in this the sclera is pulled near the retina by decreasing the diameter of sclera. A small piece of silicone maybe sutured on or around the eye in a fashion that indents the eyeball and brings the retinal break that caused the detachment again in contact with it. This allows the subretinal fluid to reabsorb and the retina to reattach. Sometimes an air or gas bubble is injected at the time of surgery to aid reattachment of the retina.
- Vitrectomy: by making tiny incisions into the eyeball, instruments are able to remove all the vitreous and subretinal fluid and reattach the retina. The retinal tear or tears that caused the detachment are then treated with laser to cause a permanent adhesive scar in this area and prevent a future detachment. A gas bubble, or less frequently and oil bubble, is instilled in the eye at the end of surgery to maintain the retina in contact with the eye wall as the laser scar matures
NURSING MANAGEMENT
Nursing Diagnosis
- Anxiety related to possible vision loss
- Disturbed sensory perception related to visual impairment
- Ineffective health maintenance related to knowledge deficit
- Risk for injury related to impaired vision
- Self-care deficit related to impaired vision
Interventions
- Prepare the patient for surgery
Instruct the patient to remain quiet in prescribed (dependent) position, to keep the detached area of the retina in dependent position
Patch both eyes
Wash the patient’s face with antibacterial solution
Instruct the patient not to touch the eyes to avoid contamination
Administer preoperative medication as ordered
- Take measures to prevent postoperative complications
Caution the patient to avoid bumping head
Encourage the patient no to cough or sneeze or to perform other strain-inducing activities that will increase intraocular pressure
- Encourage ambulation and independence as tolerated
- Administer medication for pain, nausea and vomiting as directed
- Provide quiet diversional activities, such as listening to a radio or audio books
- Teach proper technique in giving eye medications
- Advise patient to avoid rapid eye movements for several weeks as well as straining or bending the head below the waist
- Advise patient that driving is restricted until cleared by ophthalmologist
- Teach the patient to recognize and immediately report symptoms that indicate recurring detachment, such as floating spots, flashing lights and progressive shadows
- Advise patient to follow-up
