 Flashes & Floaters and Retinal Detachment
The specialists at Eye Institute are acknowledged leaders
in ophthalmology, including vitreo-retinal
surgery, refractive surgery, laser,
cataract and glaucoma surgery. We also
offer expertise in retina, squint,
eyelid surgery, eye infections and
inflammation, and neuro-ophthalmology.
The eye is a ball of about 2.5cm diameter.
The cornea and lens at the front of
the eye focus light onto the retina
(Figure 1). The eye is similar to a
camera, with the focusing lenses in
front, and the light sensitive film
(retina) lining the back. The retina
transforms light into electrical impulses,
which travel up the optic nerve to
the brain. The vitreous is the clear
gel (jelly) which fills up the space
inside the eyeball, behind the iris
(the blue or brown part) and the lens,
while the retina lines the inside of
the wall of the eye.
| FIGURE 1:
ANATOMY OF THE EYE |
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Floaters
& Flashes
These occur with age changes in the clear
vitreous gel. Parts of the gel become liquid,
pushing the remains of the gel forward, a
condition called posterior vitreous detachment.
At the same time opacities frequently form
at the liquid-gel interface (Figure 2).
These
are seen as floaters. They are common, and
harmless in themselves. However, with this
degeneration in the vitreous, there is sometimes
associated pulling on the retina, as in places
the vitreous is adherent to the retina. Pulling
on the retina causes
the sensation of flashes. If this pulling
is severe enough, a hole or tear may occur
in the retina. Then liquid vitreous may pass
through the hole, peeling the retina off
the back wall of the eye (Figure 3), which
is a retinal detachment. Sometimes also there
may be enough floaters or they are in such an
annoying position that people want to
remove them,
which can be done. Also, view our pdf on Floater Removal.
What
should you do if you have floaters or flashes?
- If you have had occasional floaters for years,
don’t worry. The chance of retinal detachment is
small.
- If you suddenly notice
floaters, or experience at sudden increase
in floaters, you should have your eyes examined promptly. This
examination is to search for any
retinal tears. If a tear is found before
a retinal
detachment occurs, laser or cryotherapy
can be used to weld down the tear and reduce
the chance of a later retinal detachment.
- If you develop flashing
lights, seen usually at night, again you
should have your eyes examined promptly.
Flashing lights mean pulling on the retina
and the risk of detachment is significant. However
there are other possible causes of flashes,
one of which is migraine. Nevertheless
the sudden onset of flashes demands
prompt examination
of the retina. Floaters and flashes are
warning symptoms which demand prompt
examination, but most people who experience
them never
develop a retinal detachment.
| FIGURE 2: POSTERIOR
VITREOUS DETACHMENT WITH VITREORETINAL
ADHESION (arrow) Strong focal
traction may cause a retinal
tear. |
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| FIGURE 3: RETINAL
TEAR & DETACHMENT |
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Retinal Detachment
A retinal detachment occurs when the retina
peels off the inside of the back wall of
the eye. When detached, the retina does
not function, so that when part of the
retina is detached there is a gap in the
vision and when the whole retina is detached
the eye is blind. Retinal detachment occurs
in about 0.01% of the population, but is
more common in myopic (shortsighted) eyes.
Symptoms of Retinal Detachment
Retinal detachment itself causes a sudden
loss of part or all of the vision in the
eye. It does not cause any pain. In many
cases, as explained, a retinal detachment
is preceded by floaters and flashing
lights.
Treatment for Retinal Tears
As mentioned, retinal tears can be welded
down with a laser or cryotherapy (freezing).
However a few retinal tears are better left,
a decision which needs to be made by your
eye specialist. Treatment of retinal tears
causes little or no discomfort and is performed
as an outpatient.
Treatment for Retinal Detachment
Almost all retinal detachments require
surgery, which should be carried out within
a few days..
Retinal Detachment Operations
All retinal detachments are different, and
the characteristics of the detachment determine
the type of surgery. In most cases the surgery
is done under local anaesthetic, although
general anaesthesia may be preferable in
certain circumstances.
- Pneumatic Retinopexy -
This technique is reserved for the least
complicated detachments. A gas bubble
is injected into the vitreous. It prevents
liquid from travelling through the retinal
tear and thus the retina re-attaches.
At the same time or later, either laser
or cryotherapy is used to seal the retinal
tear to the back wall of the eye. It
is necessary to stay in a particular
posture for a few days afterwards to
keep the bubble in the correct position.
- Scleral Buckle
-
A piece of silicone is sutured onto
the wall of the eye to counteract
the force pulling the retina out of place. This
is often combined with draining fluid
from inside the eye and with injecting gas.
- Vitrectomy
-
The vitreous gel, which is pulling
on the retina, is removed from the eye. This
is usually combined with injection of
gas or silicone oil, and often also with a scleral
buckle. This combined technique is often
reserved for more complicated detachments.
After Eye Surgery
There is usually some discomfort after surgery.
If gas has been inserted, then it may be
necessary to assume a particular head position
for a few days. Air travel is unwise with
a gas bubble in the eye, as the bubble
may expand and cause a dangerous rise in
the eye pressure.
Results
of Surgery
If the retina can be successfully re-attached,
the vision improves. However if the centre
of the retina has been detached, the vision
may never return fully. The sooner surgery
is carried out the better, so it is important
to see an eye specialist as soon as you suspect
any trouble.
The Complete Eye-Care Specialists
Eye Institute is considered to be Retina Specialists in New Zealand. Our focus on excellence prompted us to develop
New Zealand’s first purpose-built day-stay hospital.
This enables us to enhance our quality of
care while keeping costs amongst the lowest
in the eye care field. As an added benefit
we also offer a special finance plan to help
you with your budgeting.
We provide free
video tapes and brochures answering common
questions about laser vision correction,
cataract surgery, glaucoma, retinal surgery,
vitreoretinal surgery, macular degeneration, pterygium, dry eyes
and strabismus (squint). Please don’t hesitate to ask
for more information.
To make an appointment, or
to find out more information, fill out our enquiry
form, or contact Eye Institute's
friendly team on free phone 0800 393 527.
Affiliated provider benefit to Cataract Patients
- no need for prior approval
- no money up front for surgery
- Southern Cross pays us directly
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