RETINA DETACHMENT
RETINA DETACHMENT
Retinal detachment describes an emergency situation in which a critical layer of tissue (the retina) at the back of the eye pulls away from the layer of blood vessels that provides it with oxygen and nourishment.
The retina sends visual images to the brain through the optic nerve. When detachment occurs, vision is blurred. A detached retina is a serious problem that can cause blindness unless it is treated.
The retina normally lies smoothly and firmly against the inside back wall of the eyeball and functions much like the film in the back of a camera. Millions of light-sensitive retinal cells receive optical images, instantly "develop" them, and send them on to the brain to be seen. If any part of the retina is lifted or pulled from its normal position, it is considered detached and will cause some vision loss.
Symptoms
Retinal detachment itself is painless. But warning signs almost always appear before it occurs or has advanced, such as:
➡️The sudden appearance of many floaters
➡️ tiny specks that seem to drift through the field of vision
➡️Flashes of light in one or both eyes (photopsia)
➡️Blurred vision
Gradually reduced side (peripheral) vision
➡️A curtain-like shadow over the visual field
Causes
There are three different types of retinal detachment:
A. Rhegmatogenous
B. Tractional
C. Exudative
A. Rhegmatogenous These types of retinal detachments are the most common. Rhegmatogenous detachments are caused by a hole or tear in the retina that allows fluid to pass through and collect undern
eath the retina, pulling the retina away from underlying tissues. The areas where the retina detaches lose their blood supply and stop working, causing loss of vision.
The most common cause of rhegmatogenous detachment is aging. As aging occurs, the gel-like material that fills the inside of the eye, known as the vitreous , may change in consistency and shrink or become more liquid. Normally, the vitreous separates from the surface of the retina without any complications a common condition called posterior vitreous detachment (PVD). One complication of this separation is a tear.
As the vitreous separates or peels off the retina, it may tug on the retina with enough force to create a retinal tear. Left untreated, the liquid vitreous can pass through the tear into the space behind the retina, causing the retina to become detached.
B. Tractional: This type of detachment can occur when scar tissue grows on the retina's surface, causing the retina to pull away from the back of the eye. Tractional detachment is typically seen in people who have poorly controlled diabetes or other conditions.
C. Exudative: In this type of detachment, fluid accumulates beneath the retina, but there are no holes or tears in the retina. Exudative detachment can be caused by age-related macular degeneration, injury to the eye, tumors or inflammatory disorders.
Risk factors
The following factors increase the risk of retinal detachment:
➡️Aging: retinal detachment is more common in people over age 50
➡️Previous retinal detachment in one eye
➡️Family history of retinal detachment
➡️Extreme nearsightedness (myopia)
➡️Previous eye surgery, such as cataract removal
➡️Previous severe eye injury
➡️Previous other eye disease or disorder, including retinoschisis, uveitis or thinning of the peripheral retina (lattice degeneration)
Assessment and Diagnostic Findings
After visual acuity is determined, the patient must have a dilated fundus examination using an indirect ophthalmoscope and a Goldmann three-mirror examination. This examination is detailed and prolonged, and it can be very uncomfortable for the patient. Many patients describe this as looking directly into the sun. All retinal breaks, all fibrous bands that may be causing traction on the retina, and all degenerative changes must be identified. A detailed retinal drawing is made by the ophthalmologist.
MEDICAL MANAGEMENT
Surgery will be necessary to find all the retinal breaks and seal them and to relieve present and future vitreoretinal traction, or pulling. Without surgery, there is a high risk of total vision loss.
Options for surgery include:
➡️Laser surgery, or photocoagulation: A laser beam is directed through a contact lens or ophthalmoscope. The laser burns around the retinal tear, resulting in scarring tissue that then fuses the tissue back together.
➡️Cryotherapy: Cryosurgery, cryopexy, or freezing, involves applying extreme cold to destroy abnormal or diseased tissue. The procedure produces a delicate scar that helps connect the retina to the wall of the eye.
➡️Scleral buckling: In the area where the retina has detached, very thin bands of silicone rubber or sponge are sewn onto the sclera, the outside white of the eye. The tissue around the area may be frozen or lasers may be used to scar the tissue.
➡️Vitrectomy: The vitreous gel is removed from the eye and a gas bubble or silicon oil bubble is used to hold the retina in place. The wound is stitched. Silicon oil needs to be removed 2 to 8 months after the procedure.
➡️ Pneumatic retinopexy: This can be used if the detachment is uncomplicated. The surgeon freezes the tear area, using cryopexy, before injecting a bubble into the vitreous cavity of the eye. This pushes the retina back against the tear and the detached area, preventing further flow of fluid behind the retina. After some days, the pressure eventually makes the retina reattach itself to the wall of the back of the eye.
Nursing Management
For the most part, nursing interventions consist of educating the patient and providing supportive care.
PROMOTING COMFORT
If gas tamponade is used to flatten the retina, the patient may have to be specially positioned to make the gas bubble float into the best position. Some patients must lie face down or on their side for days. Patients and family members should be made aware of these special needs beforehand, so that the patient can be made as comfortable as possible.
TEACHING ABOUT COMPLICATIONS
In many cases, vitreoretinal procedures are performed on an outpatient basis, and the patient is seen the next day for a follow-up examination and closely monitored thereafter as required. Postoperative complications in these patients may include increased IOP, endophthalmitis, development of other retinal detachments, development of cataracts, and loss of turgor of the eye. Patients must be taught the signs and symptoms of complications, particularly of increasing IOP and postoperative infection.
NURSING DIAGNOSIS
I. Disturbed sensory perception (visual)rt alteration in retinal structure and function eb blurred vision /flashes
2. Anxiety rt unknown prognosis of disease eb pt's uncooperative attitude /pt's verbalization
3. Disturbed Body image rt eye defect/altered retinal function eb vision loss.
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