Retinal detachment

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Retinal detachment

“You are powerful, but a grit, a milligram of dust enters your right eye and the world goes black and blurry. Take care of the eye! " (Ode to the Eye, Pablo Neruda)

The eye is a very special organ of our body. It is the window to the world through which we can appreciate our environment and place ourselves in it. For the doctor, the eye is the window inwards and through that window he can discover important health conditions in the individual. These conditions can be present in the eye itself such as Cataracts, Glaucoma, Retinal Detachment or they can be reflected in diseases of other devices and systems such as Diabetes, Arterial Hypertension.

All these conditions present to one degree or another a series of symptoms that can range from a simple redness of the conjunctiva, itching or swelling of the eyelid to pain of different intensity, inflammation, the appearance of "floaters" or flashing lights. The latter are important symptoms of the topic that we will cover in this article: Retinal Detachment.

The retina is the light-sensitive tissue that lines the back of the eye. Light rays are focused on the retina through the cornea, pupil, and lens. The retina converts light rays into electrical impulses that travel through the optic nerve to the brain, where they are interpreted as the images we see. Having a healthy and intact retina is key to having clear vision.

The center of our eye is filled with a clear gel called the vitreous, which is attached to the retina. Occasionally, small clumps of gel or cells inside the vitreous cast shadows on the retina, and you may see tiny dots, spots, threads, or clouds that move in your field of vision, called floating spots. They can often be seen when looking at a flat background, such as a wall or the blue sky.

As we age, the vitreous can shrink and pull on the retina. When this happens, you may notice something like flashing lights, streaks of light, or have the sensation of "seeing stars." This is called "flashes." 

The retina does not work when it is detached and vision becomes blurry. A detached retina is a very serious problem that almost always causes blindness if it is not treated with surgery.

The retina is a thin, transparent membrane that lines the inner surface of the eye and is made up of groups of cells that are sensitive to light. These cells collect the image that enters the eye through the pupil through the cornea and the lens of the eye (crystalline), concentrate it and transmit it to the area of vision in the brain through the optic nerve.

Retinal detachment occurs with an incidence between 1: 10,000 to 1: 15,000 people and its proportion is higher in males between 40 to 70 years of age. The risk factors are also numerous, but the most frequent are myopia, diabetic retinopathy, a history of cataract surgeries, previous detachment of the other eye, as well as external trauma, blows to the head that make boxers and other practitioners particularly vulnerable. sports in which there is a high degree of physical contact.

The symptoms of Retinal Detachment in most cases include the sudden appearance of floating spots and / or flashes, but it must be noted that these symptoms are not always related to this condition. Either way, the appearance of these symptoms in people with a history or risk factors such as those mentioned, must be treated in time to prevent a more serious consequence such as loss of vision in the affected eye. As the detachment progresses, a moving gray shadow or curtain appears in any area of the visual field as well as a sudden decrease in vision. It is worth mentioning that this event is painless

The diagnosis of Retinal Detachment is achieved through Indirect Ophthalmoscopy during which the patient remains seated with the eye open and the pupil previously dilated. The examiner approaches with an instrument worn on his head, similar to those used by miners with a flashlight on the forehead and visualizes the back (internal) part of the eye using a manual lens that he holds with one hand, while applying a little pressure on the eye with the other hand or by using a blunt instrument asking the patient to move the eye in different directions. This exam can be complemented with a Slit Lamp Ophthalmoscopy. For this, the patient is seated in the ophthalmologist's examination chair and supports the chin and forehead on a structure that makes the head remain fixed. The ophthalmologist approaches with a lens-microscope directly in front of the eye allowing visualization, with magnification, the same as through Indirect Ophthalmoscopy.

The retina appears as a red circle with structures that are anatomically known and related also known to medical professionals in general, but especially those trained in ophthalmology, internal medicine, and emergency medicine. In the retina, you can see the blood vessels that enter and leave it (two veins and an artery) in an area known as the pap, through which the optic nerve emerges into the brain. It is worth mentioning that the optic nerve is the only nerve that originates in its distal portion and goes to the brain. All other nerves originate in the brain (cranial nerves) or spinal cord and travel distally to organs and other structures in the body. The direction of the stimulus is, however, the same in all cases. Another structure of the retina is the macula lutea, or yellowish spot, which specializes in the fine vision of details and serves to read and distinguish the characteristics of people's features, details in paintings or landscapes, such as stars, animals, etc.

Treatment: Most retinal detachments are treated by surgery that aims to fix the retina to its natural anatomical bed, the back wall of the eye. This surgery can be carried out using several techniques, the most frequent and simple being the photocoagulation. This technique is performed using an Argon laser beam that is fitted to the slit lamp, described above, and is carried out in the ophthalmologist's office under local anesthesia creating a scar.

Other techniques include freezing treatment (cryopexy) which is carried out by using a special catheter or probe for the application of cold and freezing around the torn area, thus fixing the retina to the back wall of the eye.

There are times when the detachment occurs to a greater degree, therefore more serious, and the treatment requires a vitrectomy, or emptying of the vitreous humor, which is a gelatinous liquid that fills the space between the retina and the back of the lens. or lens of the eye. Once this space is emptied, a pneumatic retropexy which consists of injecting a gas bubble into said space and the patient is categorically instructed to remain head down for no less than 23 hours a day for 14 days. This position causes the gas to "push" the retina against the back wall of the eye. To illustrate this technique, the example is made with what happens when we turn a full soda bottle to the ground, the gas inside it "rises" to what would be the floor of the bottle. In the same way, in the eye, the gas "rises" and pushes the retina against what would be in this case, the floor of the eyeball.

During the post-operative period of at least 90 days, the patient must avoid efforts that raise the pressure of the eye, as well as flights by plane or places of high altitude until the air bubble has disappeared.

Another form of treatment is using an oil bubble which must be removed to have the expected effect.

Retinal Detachment is a large subject and requires vast experience on the part of the physician and a lot of patience on the part of the person suffering from it in order to obtain the best results. There are also many other causes, ways of presentation, degrees of detachment, comorbid conditions that make this topic interesting and of great importance.

Prevention is almost non-existent since we cannot accurately predict the appearance of the disease and for that reason, periodic examinations, especially in high-risk people, are the most appropriate measure to act in time and avoid total blindness, which is the complication more frequent when it is not diagnosed and it is not treated in time.

you let it penetrate under my eyelids
an atom of dust.
my vision clouded,
I saw the world blackened.

The eye doctor behind a diving suit
he directed his beam at me
and dropped me
like an oyster
a drop of hell.

regaining sight
and admiring the brown ones,
spacious eyes of the one I adore,
I erased my ingratitude
with this ode

 (Ode to the Eye, Pablo Neruda)

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