Retinal tears and detachment 101?

May 28, 2009 11:35 PM

Retinal tears and detachments 101. Please tell me everything you know or have experienced from symptoms to treatment and aftercare.

I'm pretty sure I've been experiencing the symptoms of threatening retinal detachment/tears for a few months now. I'm getting "floaters" that only move a little bit side to side or up and down and then always "settle" back to the same shape and position - which are probably, now that I really think about it, wrinkles. Wrinkles in my damn retina. Because the goo in my eyes is shrinking. Argh.

To get this part out of the way: Yes, I'm a fucking idiot. Yes, I'm going to go try see a doctor at an ER without insurance real soon now, and try and try again - unless it suddenly worsens in which case I'll go right now.

This isn't a "should I see a doctor for this?" question. The answer is "Yes, you idiot."

So, please... please tell me anything and everything you know about symptoms, diagnosis methods, treatment options and aftercare. I guess the real question is: What am I in for?

posted by loquacious to health & fitness (14 comments total)

I have not had a retinal detachment, thank goodness, but I have had retinal tears, first evidenced by the appearance of new, dramatic floaters. I went to the local emergency room, and then to the nearest big city for treatment. Treatment in my case has been laser surgery (to create scar tissue to strengthen the back wall bit of the eye) and another time, freezing of some sort to fix the tears.

Of course, any dramatic change in vision means "see a doctor immediately" and in my case, the retinal tears have been repaired, and the only result has been the persistent new floaters, which have become less obtrusive over time.

The floaters in my case were not really wrinkles, but fluid leaking into the, um, liquidy stuff in my eye, and there's no way yet to get rid of them once they're there.

Please go to a doctor, with or without insurance, without waiting. Eyesight is way too precious to fuck around with.

I hope you get better answers than mine shortly.
posted by Savannah at 11:50 PM on May 28

Retinal tears and detachments 101. Please tell me everything you know or have experienced from symptoms to treatment and aftercare.

To add a bit more: symptoms were firstly the onset of new, dramatic floaters (literally, a new, very obviously "black thread" in my vision) and then a few days later, seeing a multitude of tiny black specks in my vision, most evident against a plain background like a wall or a piece of paper. Like thousands and thousands of tiny specks that moved with my eye's movement, reminding me of something aquatic, fish eggs or the like.

The laser surgery was incredibly uncomfortable but not painful. The freezing method was both uncomfortable and painful, and resulted in pain, discolouration and swelling afterward. I don't care, as having the treatment may have prevented the tear(s) from becoming a detachment.

I was told to avoid reading or being on a computer or writing for a week or so afterward, as those activities involve the eyes moving a lot, as opposed to vegging out and watching TV, which keeps your eyes focused on a relatively fixed object.
posted by Savannah at 11:56 PM on May 28

I've got a mom who had retinal detachment in both eyes, but thankfully not at the same time. I've also got a friend who had a tear.

What you're describing sounds more like the tear was described to me, unless there's some other reason you think your retinas are coming unglued.

If it's a tear, I'm told the laser treatment isn't too bad or too expensive. Quick procedure and relatively mild healing.

If it's detachment, the Department of Human Services or Lion's Club will likely have people who will help you pay for the treatment. They don't want more people going blind. Human Services here treated it more like a job issue than a health issue. If Mom couldn't see, she couldn't work, and then they'd be out even more money. They paid for pretty much everything. Her case worker was so awesome, I'll hug the guy if I ever meet him. I've dealt with the people for food stamps and other stuff in the past; this guy was nothing like those folks.

On the flip side of the detachment coin... Holy crap! My mom is a superwoman. She didn't call either time until the surgery was done. She didn't want me to worry. They knocked her out before the surgery to prep her, but she was awake during the procedure. She said it wasn't too awful, especially after the second time. I mean, she was making jokes to the doctors while they fiddled with the back of her eyeball both times. But, I'm hesitant to post all the gnarly details unless you really want me to. Let me know here or memail me if you do. Her recovery each time was mostly boring, which is really hard for her, and I'm sure would be for you.

Please go get your eyes checked. Call an ophthalmologist and tell them you just want your retinas checked. Has to be cheaper than an ER bill. Earlier is ALWAYS better. A tear is a much, much easier thing to fix.

I want you to be able to make it to New Orleans in July!
posted by lilywing13 at 12:54 AM on May 29

Oh, at the end of it all, Mom also had a puckered spot in one of her retinas that was especially bad. She said it was shaped like Mickey Mouse and was pretty distracting. Her color vision is way off in that eye, too. She described it as primary colors only and high contrast. She's also got residual floaters in both eyes.

The Mickey Mouse got treated by a spectacular doctor with a laser after the reattachment had healed fully and is much less noticeable now. Also, your brain does amazing things where vision is concerned, and her better eye takes the lead mostly. She said that the floaters start fading into the background after a while, even though if she thinks about it, they're still there.

I forgot to mention earlier that she's a commercial artist for a screen-printing business and is still working.

One of the neat things that happened is that, when the second retina detached, she drew a picture for the doctor of what she was seeing. It was a totally different set of circumstances from the first time, but he knew immediately what was going on from her drawing and got her straight into surgery.
posted by lilywing13 at 1:05 AM on May 29

I suffered from retinal detachment on my left eye when I was six or seven years old (i.e. early eighties) after an accident. A couple of weeks after getting hit with a tennis ball on my eye I woke up one morning and the lower half of my field of vision on my left eye was black. I don't remember if I had any spots and other signs before that, but if I did i didn't tell anyone about it at least.

I was rushed to the nearest university hospital (a couple of hours by car. Mom declined the offer of going by ambulance...) for surgery. The surgery was done under general anesthesia where they sliced the eye open and put the retina back in place and fixed it in position. After the surgery I was supposed to keep still for about a week or two, which wasn't easy for a kid in the summer... I kind of remember an eye-patch of some sort as well. I also remember that you could actually see the stitches on my eye-ball for a while, which was pretty cool (they dissolved in some way).

My vision on the left eye was basically restored. It's not perfect, but pretty good. I remember them telling me the good result was a bit unusual, but basically due to my young age.

As I was quite young, I might not remember all details correctly.
posted by rpn at 1:31 AM on May 29

I had vitreous separation in one eye this year. The symptoms are initially very similar to the other problems, but eventually resolve (although with future risk of retinal detachment or tearing). It was diagnosed by an ophthalmologist using dilation and thorough observation of the retina, and then a recheck a week later. I agree with the earlier suggestion that an ophthalmologist is both cheaper and more qualified than the ER for this situation.
posted by hydropsyche at 4:22 AM on May 29

A friend of mine waited a couple of weeks after his retinal detachment to seek help. It was too late to fix the problem, and his vision in that eye will never be the same. Once you have an actual detachment, you need help TODAY, not next week, maybe not even tomorrow.

I've had a lot of those symptoms, due to vitreous separation, lattice degeneration, a tiny hemorrhage in one retina, and now a tiny hole in the other, but so far nothing that's required treatment.
posted by Ery at 6:56 AM on May 29

I have had three detachments, the most recent four years ago. Yes, as the vitreous pulls away, it can make big floaters/spots that don’t move around too much. They can look like fingers of thick liquid or like blobs that change the color/brightness of your vision whilst looking through them. As the vitreous bounces around, you *might* see black dot showers, but more likely, you’ll see flashes of light—either a whole eye flash or maybe a trace flash, where the border around the vitreous blob lights up like an electric flash.

The problem with the vitreous moving/pulling away is that your eye doctor can’t necessarily see it. That is, they might be able to see the vitreous pooling and thickening, but they might not. Mine never were able to. But really, until it actually pulls away, taking a piece or section of your retina down with it, it’s a waiting game. That is, unless the doctor sees a tear or obvious wrinkle or really thin spot, they might not do anything because actually, the vitreous pulling away does not always mean a retinal tear or detachment. It depends on how stressed your retinas are. Are you highly myopic?

My vitreous detachments (two as an adolescent, one as an adult) have always begun with the fingers/globs of breaking down vitreous. I go to the retina specialist, who tells me he/she can’t see anything. The globs get worse. I go back to the retina specialist, who tells me he/she still can’t see anything. Repeat for a while, then all of the sudden, the dam breaks, my retina tears/detaches, and I lose a great deal of vision. This last one was kind of exciting (in a terrifying sort of way) since I was sitting in a strange doc’s office (having given up on my doctors at Texas Retina Associates, who wouldn’t see me on Good Friday, even though it was an emergency) when the tear actually occurred (after a day of the blob getting bigger and more obscuring). It was like a rush of seawater filled my eye and just didn’t go away.

So, yes, if your symptoms escalate, and you lose vision (black or dark grey), you have about 24-36 hours to save your central vision. Depending on the tear, you will most likely need a vitrectomy, where the vitreous is removed, and gas exchange, where a bubble of some gas is put in place of the vitreous to hold the surgically reattached (either by laser or silicon “buckle” or both) retina in place. This can be done either under GA or sedation and local (I had GA). As your body replaces the vitreous, the gas “bubble” will recede. This receding is by far the most tedious part of the thing, as it takes weeks for you to get vision back. And then months until your vision in that eye settles.

I’ve also had a scleral buckle—which seems to be more what rpn is talking about. In this, they separate the eyeball from the sclera, pull and reattach the retina to sclera with silicon “buckles,” and then reattach eye and sclera. I have scars around my eyeball that I used to freak my friends out with. Fun!

Finally, if you have small tears or weak spots, these can be dealt with non-invasive means through laser or cryotherapy. I’ve had both of these, as well. Laser is irritating. Cryo leaves you with black eyes and hurts while it’s going on.
posted by girlbowler at 8:18 AM on May 29

Loquacious, can I ask you how these tears came about and why your concerned about an imminent retinal detachment?
posted by Skygazer at 10:46 AM on May 29

Loquacious, can I ask you how these tears came about and why your concerned about an imminent retinal detachment?

Old age and blue eyes with a family medical history of eye issues, combined with lifestyle choices like smoking and drinking, I'm assuming.

I'm concerned because it matches the symptoms of vitreous detachment or retinal tears, and I've been trying to ignore it and hoping it goes away, and it hasn't, so I need to address the issue before it gets worse.

My body heals fast, so that's not an unreasonable request of it. I've set my own broken nose, toes and fingers and have had them heal nicely, and I've even sutured or glued my own wounds in the past well enough you can't even see the scars unless I point them out to you in a clear light. Hell, I've had to pull one of my own teeth, once.

I haven't been to a doctor in 13-15 years or so, and that was just to walk in and get a scrip for antibiotics because I had dual ear infections and was running 106-107 degree fever. So, I've been to a doctor once in my adult life. Actually, I think I just talked to the nurse, who took my temperature and about had a heart attack. "WHY, NO, HOW ARE YOU WALKING!? TAKE THESE RIGHT NOW AND DON'T STOP FOR TWO WEEKS. YOU SHOULD BE DEAD."

Anyway. Reading over some of the symptoms posted here I totally have the goopy-looking thread-like things, so it could be vitreous detachment or symptoms of tearing or potential tears. I'm not yet getting "flashes" or "shadows", but if I wiggle or dart my eyes I get very mild effects like flashes and light/dark distortions. But no showers of sparks or showers of particles, no obvious black areas, but if I do I'll call a cab or an ambulance. The symptoms are stable and not suddenly degrading, but it's high time I go get checked out before I do.

Thanks all.
posted by loquacious at 2:18 PM on May 29

Reason I ask is that, I have had considerable floaters and even a nasty black thread that has since either lightened up or I'm not so aware of it anymore.

I went to an eye doctor who did a whole check up of the inside of the eyes with some sort of eyedrops and then an incredible flash of light (you see it for the rest of the day like a big white planet over everything), and she gave me pretty much a clean bill of health. She said that as we age (I'm over 40), floaters are normal, as is a certain amount of distortion and weakening od night vision etc....

I also have light (green) eyes, and she said to invest in a good pair of sunglasses with UV protection (if they cost 5 to 10 bucks they're probably not great, really spend the money it's worth it). I guess drinking and smoking has an effect as well and also I wear contacts and spend too much time in front of a computer and not focusing out (Your supposed to look at the window every once in a while).

Anyhow, this is all to say, it might not be as bad as you think, and that being said and taking your medical exploits into account above, DO NOT TAKE THAT TO MEAN YOU DON'T HAVE TO GO TO AN EYE DOCTOR LIKE NOW, PAL!! Like yesterday, actually. Also as much as it sucks you should probably have your blood pressure and cholesterol checked at the very least, but first things first.

Good luck with it and let us know how it goes.
posted by Skygazer at 3:05 PM on May 29

If you are smoking marijuana, stop instantly and completely.

All the pro-marijuana sites talk about its utility in glaucoma (pressure too high in the eyeball), and a vitreous detachment is, among other things, pressure in the eyeball which is much too low.

If there is a particle of truth to the claim of benefits for glaucoma, marijuana is the last thing you should be taking if your suspicions are justified.
posted by jamjam at 4:47 PM on May 29

Update.

With the financial support of a friend (thank you) I went to a decent walk-in optometrist on Monday, had a complete check up, got new glasses and frames I like for the first time in about 9 years and pestered the very knowledgeable optometrist with a lot of questions and made sure he took his time looking over my retinas and checking out all other possibilities and was given a clean bill of health. Eye pressure is fine, corneas are great, retina looks clean and he said he could only barely see the main floater in my right eye on manual visual inspection with the slit-scan scope and whatever else it is they use to peer into your eyeball and look for stuff.

I'm just getting old and haven't ever had any major sight issues at all other than relative mild nearsightedness. No cornea scratches or anything like that. I think the worst I've ever had was fogged eyes from pool chlorine.
posted by loquacious at 5:56 PM on June 3

I just checked this thread again. I'm glad you got it checked out. It's a reminder that I need my 40-year-old eyeballs looked at, since they haven't been checked since the summer I read Dune and Shogun back to back and got eyestrain. I've been having obvious symptoms of farsightedness and it's time for a checkup.

Glad everything is OK!
posted by lilywing13 at 1:55 AM on June 24