The retina is critical to your eyesight since it sends messages to the brain via the optic nerve. When the retina gets separated from the back wall of the eye, it leads to a condition of retinal detachment. Retinal detachment leads to loss of function of the retina due to loss of blood supply and nutrition. It is imperative that a condition of retinal detachment be attended to immediately to avoid permanent loss of vision. Some patients may suffer a condition where there is a tear in a small area of the retina. Rhegmatogenous detachment of the retina occurs when there is a tear in the retina. On the other hand, tractional retinal detachment is caused due to scar tissue on the retina. When retinal detachment occurs due to an inflammatory disease or injury, it is a case of exudative retinal detachment.
Retinal detachment can be caused due to advanced diabetes or an inflammatory disease. Trauma can also cause the retina to get detached. Any leakage of vitreous liquid accumulating under the retina can cause the retina to get detached. This can happen due to aging. Persons who suffer weak areas in the retinal periphery or have undergone severe eye injury are at risk for retinal detachment. Signs of retinal detachment include sudden flashes of light in the affected eye and blurred vision. Many floating debris might appear in the vision.
The size and location of the retinal detachment decides the kind of treatment that would be most suitable. Small retinal tears are treated with cryopexy or retinal cryotherapy that involves freezing of the area around the tear. Laser surgery is used to fuse the retina to the underlying tissue. Laser surgery can be done sans incision and the patient suffers minimal discomfort. More complex cases would require vitrectomy and scleral buckling procedures to seal the detached retina. Surgery is not always a guarantee of restored vision as it's success hinges on how much of the retina is detached and for how long.
An ophthalmoscope is used to examine the retina and vitreous. Ophthalmoscopy aids visualization of the inside of the back of the eye including the retina, optic disc, choroid and blood vessels. It is often part of a routine eye examination. A direct ophthalmoscope is used for viewing the central retina. It is hand-held and powered with a light source. The instrument has to be adjusted constantly to focus on different structures within the eye. The light can be intense and disturbing. An indirect ophthalmoscope aids in examining the entire retina. This instrument is attached to the doctor's head and allows a clear view of the retina with a special lens. The patient may feel uncomfortable due to the intense light and pressure from the instrument.
Ophthalmoscopy is useful in detecting any changes in the retina due to diseases such as eye disease, diabetes, arteriosclerosis, high blood pressure or macular degeneration. Cataracts and other eye problems can be detected with an ophthalmoscope.
The patient's eyes are dilated so as to allow a good view of the insides of the eye. Some patients develop allergic reaction, vomiting, nausea and dizziness. This test is conducted in a darkened room where the patient is asked to look ahead at a distant spot. The eyes must be held steady without blinking. The ophthalmoscopy procedure may take just about 5 - 10 minutes.
Central Serous Retinopathy
Central serous retinopathy or CSR is associated with serous fluid accumulation below the retina in the macula at the back of the eye. The retina is an important structure of the eye, which facilitates the signal conversion of light to electrical impulses transcribed to the brain. This is because of its photosensitive nature. In CSR the retinal layer is slowly damaged and distorted because of fluid accumulation.
CSR is triggered by the onset of edematous fluid accumulation under the retinal layer. Studies indicate the involvement of the choroid tissue blood vessels, which are responsible largely for the fluid accumulation. The tissue injury and fluid accumulation affects the retinal epithelial tissue causing disturbance in vision. This avascular focal leakage caused in the retinal pigment epithelium triggers the distortion of the neuron-sensory retina. In some cases, this damage caused is self-limiting and recovery is possible. In case of adverse effects such as atrophy, neuron-sensory damage can cause permanent loss of vision.
Causes and Clinical manifestations
CSR is associated with central vision impairment as the zone of fluid accumulation is the choroid region followed by the retinal epithelium. Many studies indicate the effect of cortisol on the incidence of CSR. Cortisol is an adrenal hormone triggered in the event of stress. The hormone thus produced can cause blood vessel damage. Although the actual cause of CSR still remains controversial, it is believed that cortisol, epinephrine and external steroid applications can induce the condition.
CSR is usually noticed in the age groups of 20-50 and it has no ethnic specificity. This might be suggestive of the increasingly stressful lifestyle, which is a possible trigger for CSR. CSR is more common among men than women. Usually people who face severe stress - like pilots, police officers or soldiers may face this condition, which can be self limiting in some cases. The symptoms fade away after a few months. The complications associated with CSR include blurred vision, blind spot, distorted vision and hazy appearance of objects at a distance. Symptoms of Central serous retinopathy include patch in central vision, reduced color vision and changes in image size.
Diagnosis and Treatment
CSR is diagnosed based upon optometric tests. Some of the common tests include optical coherence tomography (OCT) which is used determine the amount of fluid under the retinal layer caused because of trauma, inflammation or infection. Fluorescein Angiography enables location of the exact point of fluid leakage. Indocyanine green angiography determines the vascular abnormalities associated with respective tissue. Since the CSR is related to leakage of fluids from vascular regions, photodynamic treatment is suggested to seal the respective regions by administering laser. In most cases of CSR, the symptoms and the condition disappear after 3 months with full restoration of vision. But it may recur at some time later in some cases. The only known complications of CSR therapy include grey spots and eye irritations.
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Bibliography / Reference
Collection of Pages - Last revised Date: January 28, 2020