Tractional Retinal Detachment: Causes, Treatment, and Prevention

A retinal detachment is an emergency eye condition in which the thin, light-sensing layer of tissue (the retina) at the back of the eye separates from the tissue beneath it holding it in place. If it isn’t treated immediately, you could permanently lose your sight.

The expert team of ophthalmologists at Retina Specialists, with five locations in and around Dallas, Texas, specializes in diagnosing and treating retinal detachments, including tractional retinal detachments, which occur most commonly in people with diabetes. Here’s what you need to know about the causes, treatment, and prevention of tractional retinal detachments.

Retinal detachment mechanics and types

A retinal detachment occurs when the retinal cells separate from the layer of blood vessels that deliver oxygen and other nutrients to the eye. The longer the detachment goes untreated, the greater the risk of permanent vision loss.

Most frequently caused by a blow to the head from a sports injury or car accident, retinal detachments come with warning signs that may include one or all of the following:

• The sudden appearance of many floaters, tiny specks that drift through your visual field
• Flashes of light in one or both eyes (photopsia)
• Blurred vision
• Gradually reduced peripheral (side) vision
• A curtainlike shadow over your visual field

There are three different types of retinal detachment:

1. Rhegmatogenous

This is the most common type, caused by a hole or tear in the retina that allows fluid to enter and collect beneath the retinal tissue. As the fluid builds up, so does the pressure within the tissue, causing the retina to detach from its moorings. The detached areas lose their blood supply and stop working, causing vision loss.

The most common cause of a rhegmatogenous detachment is getting older. The vitreous chamber within the eyeball contains a gel-like material called the vitreous humor. As you age, the humor may change its consistency, becoming more liquid, or the whole chamber might contract. Normally, when the vitreous contracts, it separates from the retinal surface without complications. If it tugs hard enough, though, it can cause a retinal tear or even a detachment.

2. Tractional

Tractional detachment occurs when blood vessels and scar tissue grow on the retina's surface. The vessels can bleed into the middle part of the eye and/or cause dangerously high pressure within the eye, leading to the retinal tissue pulling away from its support. This form of detachment is typically seen in people with poorly controlled diabetes or other underlying medical conditions.

Diabetic retinopathy is the condition where weak or abnormal blood vessels first bleed into the retinal tissue then grow on the retina’s surface. It’s a leading cause of blindness among diabetics, affecting one in three American adults over 40 with the disease.

3. Exudative

In this type, fluid accumulates beneath the retina, but the retina itself contains no tears or holes. Exudative detachment can be caused by age-related macular degeneration (AMD), injury to the eye, tumors, or some types of inflammatory disorders.

Preventing and treating tractional retinal detachments

Retinal detachments, as a whole, are mostly due to getting older, meaning there’s very little you can do to prevent the problem. However, if you’re a diabetic, getting your blood sugar levels under control is the best way to forestall a problem. So is getting annual comprehensive diabetic eye exams, which can pick up on problems when they’re in their early stages and are easier to treat successfully.

If you notice any of the warning signs of a retinal detachment and get prompt medical attention, in most cases we can save your sight by performing one of two surgeries — or both.

Vitrectomy

Your ophthalmologist removes the vitreous that’s tugging on the retina and replaces it with an air, gas, or oil bubble. The bubble helps push the retina back into place so it can heal properly. If your doctor uses an oil bubble, he’ll remove it several months later when the retina has healed. If he uses an air or gas bubble, you’ll have some restrictions: you won’t be able to scuba dive, travel to high altitudes, or even fly in a plane because the change in outside pressure causes the gas to expand, increasing the intraocular eye pressure.

Scleral buckle

With this procedure, your ophthalmologist sews a band of rubber or soft plastic to the outside of your eyeball; it gently presses the eye inward, allowing the retina to heal against the eye wall. He usually leaves the buckle on permanently, but you won’t be able to see it, and it won’t adversely affect your vision.

Do you have diabetes that isn’t well controlled? Then you’re at risk for developing a tractional retinal detachment. To get ahead of complications, give Retina Specialists a call at any of our locations to schedule a consultation with one of our ophthalmologists today.