1. Rhegmatogenous Retinal Detachment

This is the most common type of retinal detachment and occurs when a tear or hole in the retina allows fluid to seep underneath. This fluid then separates the retina from the back of the eye, similar to how wallpaper might peel off a wall if water gets behind it.

⇒Symptoms of Rhegmatogenous Detachment:

• Floaters in your vision (black spots that look like small specks or cobwebs).
• Flashes of light, especially in the corner of your eyes.
• A “curtain-like” shadow across part of your visual field.

⇒Causes and Risk Factors:

• Aging: After 50, the vitreous (the jelly-like substance in your eye) begins to shrink, increasing the risk of retinal tears.
• Extreme Myopia (Nearsightedness): People with high prescriptions have longer-shaped eyes, stretching the retina and making tears more likely.
• Trauma: A blow to the head or eye can damage the retina and lead to tears.
• Previous Eye Surgeries: Procedures like cataract surgery can slightly increase risks.

⇒Diagnosis and Treatment:

Diagnosing rhegmatogenous detachment involves dilating your pupils for an exam or imaging tests like an optical coherence tomography (OCT). Treatment options may include:

• Laser Surgery: Seals small tears to prevent detachment.
• Cryopexy: Freezes the retina to secure it in place.
• Vitrectomy: Removes vitreous gel to allow repairs.
• Scleral Buckling: Places a band around the eye to reattach the retina in more severe cases.

Quick action is key. For example, Priya’s treatment involved urgent laser surgery to seal her retina tear, and within days, her vision stabilised.

2. Tractional Retinal Detachment

This type occurs when scar tissue on the retina’s surface contracts, pulling the retina away from the back of the eye. It’s less common but often seen in people with diabetic retinopathy.

⇒Symptoms of Tractional Detachment:

• Blurry or distorted vision.
• Gradual loss of vision (unlike the sudden symptoms in rhegmatogenous detachment).
• Vision that seems “pulled” or uneven.

⇒Causes and Risk Factors:

• Diabetes: Poorly controlled blood sugar can damage blood vessels in the retina, leading to scarring.
• Retinal Vein Occlusion: Blocked veins in the eye can create abnormal blood vessels and scarring.
• Inflammatory Eye Conditions: Severe inflammation can cause the body to form scar tissue around the retina.

⇒Diagnosis and Treatment:

Doctors may use an ultrasound or OCT scan to assess scar tissue and pulling. Treatment often involves:

• Vitrectomy Surgery: This removes scar tissue pulling the retina out of place.
• Anti-VEGF Medications: Injected into the eye to reduce abnormal blood vessel growth and inflammation.

For one patient with diabetes, I recommended surgery and regular follow-ups post-detachment. He was relieved to find that with proper monitoring, his vision didn’t worsen and he regained clarity in one eye.

3. Exudative Retinal Detachment

This type is different because there’s no tear or hole in the retina. Instead, fluid builds up under the retina, pushing it away from its normal position.

⇒Symptoms of Exudative Detachment:

• Sudden blurry vision.
• Spots or shadows that seem to grow larger.
• Central vision loss (in advanced cases).

⇒Causes and Risk Factors:

• Choroidal Tumours: Tumours in the eye can release fluid.
• Inflammatory Disorders: Conditions such as uveitis increase fluid production.
• Leaking Blood Vessels: Seen in diseases like certain vascular issues or macular degeneration.

⇒Diagnosis and Treatment:

To diagnose exudative detachment, your ophthalmologist will look for fluid pockets with imaging tools. Treatments aim to manage the underlying condition:

• Medications: Steroids or anti-inflammatory drugs can reduce swelling.
• Laser Therapy: Seals leaky blood vessels.
• Drainage Surgery: Removes excess fluid to allow the retina to reattach.

A middle-aged patient I treated with macular degeneration came in with blurry central vision. After laser therapy and medication for swelling, we stabilised his retina to avoid permanent detachment.