When a Retinal Detachment Becomes an Emergency

Retinal Detachment Threatening the MaculaMost retinal detachments do not require emergency surgery.  I operated this Saturday morning, however, to repair a retinal detachment for a patient who should not wait through the weekend for the operation.  In this case it was an “emergency.”

First Symptom of Retinal Detachment

Often, as with my patient (RR), there is a history of flashes and/or floaters preceding eventual loss of vision.  RR had some vague symptoms over the past two weeks, but did not become too concerned until he started to lose some of his peripheral vision.

His central vision was unaffected.  He could see well at distance, read and watch TV, but objects located down and to the right in his peripheral vision were missing…and it was getting worse.

“Macula On, Superior Off” Retinal Detachment

There are really only two emergencies faced by a retinal surgeon.  Endophthalmitis, or infection inside the eye is the most devastating and is the biggest eye emergency.

A retinal detachment not including the macula, but is in danger of detaching the macula is a relative emergency.  Fluid located “above” or “superior to” could shift downward, thus detaching this crucial area and decreasing central vision.

In the diagram, the macula (small brown spot in the center of the picture) is still attached. If the area of retinal detachment were to enlarge, the macula might become affected.  Central vision would be lost and permanent visual loss is possible.

Fluid underneath the retina often obeys the laws of physics…and moves with gravity.

The Decision to Operate is Based on Attachment of the Macula

The timing of retinal detachment surgery is basically determined by the state of the macula.  There are three possibilities;

  • Detached.
  • Attached and not likely to detach by waiting.
  • Attached yet may detach with waiting.
Situations where the macula is already detached or where the macula is unlikely to detach in the near future can be usually scheduled for surgery during normal “operating” hours and avoid the pitfalls of emergency surgery.
In this one instance, where the macula is still attached,  but is likely to detach with waiting…surgery should be performed.
What Does This Mean?
There is only one true “emergency” retinal detachment.  If the macula is already detached, surgery can be scheduled within 10-14 days and is not a genuine emergency.
Too many doctors will tell you differently and is based on competition in the area and their personal schedules.  Too often, doctors cram their daily schedules so tightly that there are no opportunities to operate during normal times, and thus, deem every retinal detachment an emergency.
Emergency surgery may be necessary, but often is not the best option although it “sounds” intuitive.  In my opinion, emergency retinal detachment surgery is overplayed…and at the expense of the patient.  I’ll write soon about the disadvantages to emergency eye surgery.

 

 

 

 

 

 

 



Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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***This post is for information purposes only. This posting does not offer legal or medical advice, so nothing in it should be construed as legal or medical advice. The information on this blog/post is only offered for informational purposes. You shouldn’t act or rely on anything in this blog or posting or use it as a substitute for legal/medical advice from a licensed professional. The content of this posting may quickly become outdated, especially due to the nature of the topics covered, which are constantly evolving. The materials and information on this posting/blog are not guaranteed to be correct, complete, or timely. Nothing in this posting/blog and nothing you or I do creates a doctor-patient relationship between you and the blog; between you and me; or between you and Randall Wong, M.D. or RetinaEyeDoctor.com. Even if you try to contact me through the blog or post a comment on the blog you are still not creating a doctor-patient relationship. Although, I am a doctor, I’m not YOUR doctor until and unless there is a written agreement specifically providing for a doctor-patient relationship.***

Comments

  1. Dan Peronis says:

    What if there was reattachment surgery of an already ‘dead’ retina? Is there anything that can be done to restore sight in this eye?

  2. Chester Seaborn says:

    Greetings Dr. Wong

    Sir, could you possibly forward this note to your billing office?

    I am a military retiree and as such I presently carry TriCare Prime insurance coverage. I also am strongly considering switching very soon to the Johns Hopkins US Family Health Care Plan, which, again, is under TriCare Prime but incororates a very large network of providers with various additional other patient benefits etc. Does your office accept such coverage?
    And thank you very much for being able to access your informative emails.

  3. I greatly appreciate you having this site and explaining the procedure in such detail. My son is 19 and he had this type of surgery last week. I saw a few videos but your video was the best. May God bless you for your willingness to openly share. If possible, can you post information about how the patient should care for their eye after surgery. Thanks.

  4. Dear Millie,

    Thanks for the comments! I really appreciate them.

    I can’t make a comment about eye care after surgery other than to say he should be on an antibiotic drop and an anti-inflammatory drop. Other than that, there is too much surgeon to surgeon variation and I’d hate to confuse the issue with my worthless “2 cents.”

    Best of luck to you and your son!

    Randy

  5. Hi Dr. Wong
    I am a glaucoma patient and had three surgery on my right eye in February 2011 to decrease the preasure. The last operation was the diod lazer and now right eye pressure is zero since then. The doctors in my country say there is nothing to do for right eye anymore but the John Hopkins doctors say there ıs a chance of %15 / 20 to fix the right eye with the surgery they plan to do. Please I kindly ask you to send my medical reports of my right eye and learn your thoughts to make my mind clear about the success of the surgery
    Do you have emaıl address to send the reports they are ın pdf format

  6. dear dr wong have you got my message?
    I am askıng sınce ıt ıs not seen here

  7. Dear Isa,

    I am not a glaucoma specialist. I am honored that you respect my opinion. I can not accept medical records to review without establishing a doctor-patient relationship.

    Randy

  8. Isa,

    Yes. I did. I answer questions and comments every 7-14 days….there are quite a few!

    Randy

  9. Doctor,
    My 13 year old daughter had a blunt force trauma to her eye which resulted in her retina detaching in May 2012 the Doctor put silcone in her ey and kept it there until August of 2012. Well 2 weeks later her retina detached again and he did emergency surgery on her that same day..will this happen again I am worried and I know she is scared to have the silcone back in her eye plus after all of this we have to see a cataract specialist because her lens is off center and has some what he say fog on it..??

  10. After having retna surgery with oil I have had a lot of pain. It was much worse this summer when it was very hot. Why does the heat my pain increase. Also can you tell me if there is anything I could do to reduce chances for retina to detatch again? Vitamens ect. Just want to do what I can to improve chances of this not happening again. What can I do to reduce pain. Do cold or hot packs work? Is there something I am doing wrong that is causing my retina to detatch. There hasn’t been any family history of this. Just want to say it is so refreshing to see a physician that is so dedicated to his work. Thank You, Cheri

  11. After retina surgery with gas , now I have cataract ( 3 months after retina surgery) Have blur vision. Please advice. Thank you

  12. Dear Elisa,

    This is an unfortunate but not surprising result. Not sure why silicone oil was used initially, but worried about the redetachment. Have no idea if this will happen again because, unfortunately, it can.

    r

  13. Dear Kim,

    Could be anything: from the retinal detachment, cataract, ERM. I’d have to defer to your doctor.

    R

  14. DR I had laser in my right eye but and abeen haven lots of pain and tears could I put anny drops to reliff the pain got and appoinment octber 24 for avastin injections on my left eye

  15. Dear Maria,

    Hope this has resolved. Make sure to follow up if not.

    r

  16. Todd Wilkins says:

    Hello Dr. Wong,

    last Friday, my mother (53 year old, high myopia, amblyopia in right eye, no diabetes, no trauma) started seeing bubbles from her left eye, sometimes scotoma. She consulted her ophtalmologist, who told her she was suffering from retinal detachment with extension to the vitrous humor. Yet, he told her he couldn’t do anything for her and planned for a follow-up visit in 2 months. She still is suffering from those “bubbles” floating in her left eye. Why did the eye doctor not tell her a surgery would be needed? I’ve been reading on the subject and it seems most retinal detachment require surgery. You can understand my concern when I hear blindness is a potential complication. I thank you dearly in advance,
    Todd.

  17. Todd Wilkins says:

    Me again, sorry for the double email,

    I was just wondering if my mother should ask for a second opinion to another ophtalmologist if her symptoms persist for more than 7 days. I thank you again,

    Todd.

  18. Dear Todd,

    Perhaps mom has a posterior vitreous detachment (PVD). A PVD can lead to a retinal detachment.

    This can be confusing because both have the word detachment. This might explain why the doctor is not operating.

    Randy

  19. Dear Todd,

    Second opinions are never a bad idea. At the very least, you know you did everything for your mom.

    Randy

  20. Hello,
    I have some vitreous tufts found during a dilated exam in my left eye. I am a 38 years old. I just had a 1 year follow up and my doctor said no changes. I’m a bit concerned because he said it could potentially become serious (even though he said it’s mild now) if it were to pull my retina and cause tears/detachment. I would love to hear your thoughts on this as I’m beginning to become quite nervous about this. Thanks in advance and I thoroughly enjoy reading your blog!

  21. Angela,

    I am guessing that your doctor was concerned about the appearance of your vitreous and a potential risk of developing a tear?

    I have never been able to predict, by examination, an area of the retina that ends up tearing. Maybe I am just not that gifted.

    Be concerned about new symptoms of floaters, and perhaps flashes.

    Chance of tearing is remote in the general population.

    Randy

  22. Thanks Randy! So “tufts” really nothing to be concerned about then? Are tufts normal in the general population as the vitreous starts detaching?

  23. Angela,

    Can’t be sure what your doctor meant. There are some “tufts” located in the very peripheral retina…perhaps she is worried that they may cause/lead to a tear, but I’d ask her for a more exact term.

    randy

  24. Dr. Wong,

    One and a half years ago, I had emergency surgery on a detached retina in El Paso Texas. I quit my job (that had insurance) and moved to Hobbs, NM. I recently had the same symptoms in my other eye. I am without insurance and in need of locating a doctor to do an exam and possibly surgery. do you have any suggestions?

    Thank you for your attention.

    Audra

  25. Audra,

    I hope by now you have been examined to make sure you don’t have another detached retina. That is the best suggestion I can give you. Hopefully you’ve done this and are ok!

    Randy

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  1. [...] two situations where retina surgery is an emergency; intraocular infection (endophthalmitis) and a retinal detachment where the macula is attached, but the retina immediately above the macula is [...]

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