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Retinal detachment: Quick help with black spots in the eye

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Flashes of light and black spots: Retinal detachment causes no pain – this is what makes the vision disorder treacherous. She can be treated well if you recognize the symptoms early.

Twitching lines and dark spots in the field of vision will not be so bad? Soot stains that flutter into the field of vision are only temporary? Some underestimate the symptoms, as retinal detachment (retinal detachment, retinal detachment) inside the eye is not painful . But sufferers should immediately go to the ophthalmologist, who gets the complaints usually well under control. If left untreated, however, it can lead to blindness in the worst case.

Black spots and “mosquito swarms”: symptoms of retinal detachment

The symptoms of retinal detachment begin at the edge of the field of vision and widen from there.

“Typical initial symptoms of retinal detachment are flashes of light and moving black spots,” explains Frank Holz, director of the University Eye Hospital Bonn.

The person concerned perceives numerous “soot flakes” or a “swarm of black mosquitoes”. They are the shadows of vitreous hemorrhages that develop when the retina breaks.

The symptoms show up in one eye and can quickly get worse. The field of vision then turns black in large parts: “A curtain falls into the picture or a wall grows up,” Holz explains vividly, what those affected see.

As long as only the periphery of the visual field is affected, vision is reduced. When retinal detachment covers the center, visual acuity drops rapidly. Under certain circumstances, only light impressions are perceptible.

Retinal detachment can have various causes

The eye is comparatively simple in structure. Through the pupil, light falls into the interior and throws an image of what is seen to the back wall of the eye, in much the same way as inside an old camera. Instead of the photo film, the retina absorbs light in the human eye. However, this sensitive organ with millions of photoreceptors is not firmly fused with the rest of the eye, but adheres to the back wall with a kind of biological Velcro .

The glass body – the gel-like and transparent filling of the eye – ensures that the retina is always pressed lightly against this adhesive layer. Thus, the layer with the important photoreceptors is supplied with nutrients via the underlying skin layers.

Common causes of retinal detachment are degenerative changes of the peripheral retina and vitreous , which can lead to retinal tears.

Nutrient supply breaks down

A retinal tear occurs where the vitreous adheres to the peripheral retina. When the vitreous body lifts off due to age changes , severe nearsightedness (more than six dioptres), or as a result of cataract surgery , a mechanical pull is created at the attachment sites. Gravity then pulls down the age-related liquefied or restructured vitreous body, which is why retinal tears occur much more often in the upper half of the retina than in the lower one.

In addition, vitreous fluid can penetrate into the area between the retina and the underlying pigment epithelium – these are the precursors of a retinal detachment. Due to the replacement, the supply of the photoreceptors is cut off, in extreme cases, these die off.

A special form of retinal detachment is the so-called giant ablation , in which the vitreous body pull attaches not to the marginal areas, but to the central edge of the tear. This leads to cracks that extend over large retinal areas.

Hereditary predisposition can also tear down an undamaged retina. Retinal holes may also be secondary (due to a first cause) after injuries and bruises to the eye. After bruising of the eye, for example as a result of a snow, squash or tennis ball, a retinal necrosis develops at the point of impact (degenerate retina and die), from which a retinal hole can form. Or it comes relatively soon after the accident to an acute withdrawal of the vitreous body with cracking of the retina. It can take years to retinal detachment after a delayed tear.

However, rather rare causes of retinal detachment are inflammation or choroidal melanoma. In addition, retinal detachment, retinal shrinkage, secondary puncture of diabetic retinopathy, retinal vein occlusion, and other forms of retinal ischemia may occur, as well as late retinal retinopathy retinal detachment.

Doctor detects retinal detachment with ophthalmoscope

If light flashes suddenly reappear, an ophthalmologist should be consulted immediately – only then can a threatening retinal detachment be detected and treated in good time. “The decisive factor is whether the point of sharpest vision is affected,” explains Peter Wiedemann, who heads ophthalmology at the University Hospital in Leipzig. “If everything was okay in the morning and then it gets worse during the day, that’s an emergency.”

In any case, calm is important . Because movement can cause the loose retina to tear off further. The ophthalmologist may recommend a special reclining position in which it pulls the least in the sore spot in the eye.

The doctor will examine both eyes with the ophthalmoscope (indirect binocular ophthalmoscopy) and the contact lens in case of suspected retinal detachment. For this purpose, the pupils are maximally enlarged with pupil-dilating agents. When the retina is highly detached, gray wrinkles or the wavy displacement of the retinal vessels can be seen.

The cracks are usually in the shape of a horseshoe or a shark’s mouth . Sometimes peripheral round holes are recognizable. In shallow or circumscribed retinal detachment, the retina is usually still transparent, which is why exactly to look for a retinal tear. Careful documentation is important and serves the subsequent therapy.

It is also necessary to differentiate between diseases such as choroidal melanoma, retinal vascular tumors, peripheral retinal splitting or Harada’s disease, since these can be very similar to the clinical picture of retinal detachment.

Treatment of retinal detachment: laser or surgery

If the affected person corrects the initial symptoms correctly, the risk of blindness is soon averted. “A thin part of the retina can be bombarded with a laser beam ,” explains Georg Eckert, spokesman for the Ophthalmologists’ Association. For small holes or cracks that have not led to any separation, the cold-pin method can help. Both therapies are done on an outpatient basis.

Only when the retina has resolved, surgery with hospitalization is necessary. The doctor puts the retina back in the right place. As a result, the supply of the receptors and therefore the sight returns .

Constricting operation

It is exerted from the outside pressure on the eyeball and that by indenting the eyeball by means of a seal, for example made of silicone rubber. This is sewn directly above the retinal tear on the outside of the eyeball. At the end of the procedure, the conjunctiva is closed again above the seal. The external pressure brings the nourishing pigment epithelium to the retina. At the same time, the indentation relieves the vitreous membrane.

In widely distributed retinal holes, the eyeball can be strapped. It is also possible to aspirate fluid between retina and pigment epithelium. Even after completed scarring of the retina, the invading seals are not removed, because this can be permanently relieved the attached at the edge of the teardrop vitreous body. On the other hand, a small balloon filled with fluid is removed, which, with a very small detachment of the retina, incises the globe wall until a solid scar has formed.

At the beginning of the operation, ie before a seal is sewn on to dent the eyeball, the surgeon can additionally stimulate the subsequent scarring by means of a cold probe. He achieves this by creating a small focal point of inflammation, which forms a solid scar within ten to fourteen days between the retina resting on the seal and the pigment epithelium / choroid. In medical jargon this is referred to as cryo-scarring.

Vitrectomy

An operation with removal of the vitreous body (vitrectomy) and an “inner tamponade” by means of an expanding gas (sulfur hexafluoride) or by silicone oil is the appropriate therapy when holes occur at the posterior pole or papilla.

Combination of vitrectomy and surgery

A combination of vitreous removal (vitrectomy), dimpling surgery, and internal tamponade is required if complicated retinal detachment or giant tear ablation is present.

The smaller the retinal detachment and the sooner the retina is re-established, the better the prognosis. In uncomplicated retinal detachment, 85 to 95 percent of cases succeed in restoring the retina by surgery. The size of the still possible visual acuity depends on how long the macula (macula = area of ​​sharpest vision) was lifted, as the sensory cells located in the macula were not nourished during this time and therefore were damaged. After retinal detachment with prolonged macula lift, it may take a year for the maximum achievable (final) visual acuity to set.

Retinal detachment should be prevented by regular controls

After the first eye disease, the second, healthy eye should be examined to avoid further retinal detachment.

Adults should be checked regularly. Expert Wiedemann recommends the check-up to the ophthalmologist every two years at the latest from the age of 40 years. Children and adolescents are less at risk because their vitreous body has a firmer consistency.

Short-sighted people should take precautionary measures sooner and earlier: their retina is “thinner and can be easily injured,” says Eckert.

“In addition to myopia , diabetes is a risk factor,” explains Holz. Because diabetes changes the composition of the vitreous body. Anyone who is unsure whether they suffer from a retinal detachment, should always consult the doctor: He may recognize irregularities even with a simple look in the eye, says Eckert.