"Top Ten" Retinal Eye Emergencies: Part II

"Top Ten" Eye Emergencies: Part 1
February 5, 2010
Never Enough of a Dry Eye
February 10, 2010
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"Top Ten" Retinal Eye Emergencies: Part II

The "Top Ten" of retinal emergencies is completed today. Topping the list is a type of retinal detachment. Cataract surgery can also lead to relative emergent situations. Remember, losing vision, from whatever cause, can be an "emergency."

5.  Surgical Complications from cataract surgery can be a relative emergency.  On occasion, a portion of the cataract may dislodge during cataract surgery and slip into the vitreous.  Patients usually do not see well and may have trouble with high intraocular pressure.

  • Cause – variations in anatomy, surgical complications
  • Concerns – the biggest medical concern is the high eye pressure, it may cause permanent damage and be very painful.
  • Comments – this is one of the biggest “nightmares” of a cataract surgeon, yet it really is not a big deal to rectify as long as referral to a retina specialist is done early.

4.  Posterior Vitreous Detachment – while usually benign, a PVD can cause a retinal tear and possibly a retinal detachment.  With time, the vitreous (the gel inside the eye) separates from the surface of the retina.  This is a normal event as we get older, but it puts us at the highest risk of developing a retinal tear.

  • Cause – the separating/degenerating vitreous changes forces inside the eye causing flashes and floaters.
  • Concerns – there is no way to tell, without examination, if a tear has developed.
  • Comments – same approach as with new “floaters,” can’t tell if there is a tear.

3.  Retinal Tears cause retinal detachments.  The usual cause of a tear is from a Posterior Vitreous Detachment and rarely trauma.  Retinal holes, usually from a condition called Lattice Degeneration, may cause a retinal detachment, too.  Retinal tears may be treated to prevent a retinal detachment, hence, the “emergency.”

  • Cause – either a hole or tear allows fluid to accumulate underneath the retina.
  • Concerns – permanent loss of vision may occur if the macula becomes detached.  Blindness is possible.
  • Comments – progressive loss of peripheral vision should be communicated to your eye doctor immediately.

2.  Endophthalmitis is a true medical emergency and is usually caused by infection of the inside of the eye.  There is usually a history of recent eye surgery.

  • Cause – usually bacterial infection after eye surgery.  Rarely, severely immuno-compromised patients can acquire this infection from an “endogenous” source.
  • Concerns – Blindness can occur within 24 hours.
  • Comments – common signs of infection following eye surgery include decreased vision and usually, pain.

1.  Retinal Detachmentretinal detachments can cause permanent loss of vision or blindness.  The critical aspect of a retinal detachment is the state of the macula, that portion of the retina serving central vision.  If the macula is detached, central vision is already compromised.  While reattachment will likely improve vision, the prognosis is not as good as if surgery were performed before macular detachment.

  • Cause – retinal tears or holes.  Usually preceded by flashes or floaters, but may be asymptomatic.
  • Concerns – state of the macula, is it attached?
  • Comments – the most emergent retinal detachment is where the macula is “on,” or attached, but the portion of the detachment is above the macula.  Gravity will most likely act quickly to detach the macula.  Every effort is made to operate before the macula becomes affected!
Comments
  • John H February 13, 2011 at 6:41 pm

    Hi Dr. Wong,
    I just want to ask about high myopic people. I am highly myopic about -6 in both eye. am I in a high risk of retinal detachment. I start to see floaters too but I check with my doctor and he said that my retina is healthy.

    • Randall V. Wong, M.D. February 19, 2011 at 7:45 pm

      Dear John,

      Technically, anything greater/worse than -5.00 is considered high myopia, but, in my opinion, you are certainly unlikely to detach in your lifetime. Any sudden increase in floaters or an increase in flashes should be checked.

      All the best,

      Randy

  • Hank July 1, 2012 at 12:52 pm

    I’ve got an old friend near Roanoke who’s been told he has a possible retinal tear but “they” have declined laser surgery “at this time” — followup this coming week.

    I don’t know who “they” is and am worried it might be his health insurance rather than his eye doctor making the decision. Is that possible?

    I will be seeing him in a few weeks — and want to know before we go bumping around that part of Virginia what his real risk is and how it should be handled.

    My thought — I had cataract surgery very young, unusually, so I”ve been at risk and been educated on this — is he should have a package of medical info with him saying where the problem was, and a list of every possible emergency location within 50 miles of wherever we might be traveling to go to if his vision suddenly gets bad. And he should know where the suspected failure in the eyeball is so he can put his head in the best position to minimize the force of gravity or any bump or movement while being driven somewhere.

    And that if “they” putting him off was his health insurance Delay and Befuddle Department — how to get around those people ahead of time and pre-clear getting him the laser surgery without delay if needed.

    • Randall V. Wong, M.D. July 10, 2012 at 6:33 am

      Dear Hank,

      You are good friend.

      Not sure your story sound right about delaying the laser…maybe they are simply worried (“they” being the doctors) about a tear developing and at the time of his last visit, simply didn’t need laser.

      I have doubts the insurance company is speaking. It’s a good thing that the docs are seeing him again soon. By now, he must have had his follow up?

      Regarding the information packet, a good idea, but not absolutely necessary. Any subsequent doctor would do his/her own examination.

      r

  • Supersavers Optician in Dublin November 29, 2012 at 3:45 am

    Hi!
    I am an optician in Ireland and thinking of doing higher studies in the same field. You have provided very useful information and hopes that it will help me in future.
    Thanks

  • Kenni André Pedersen April 12, 2013 at 5:26 am

    Hi Dr. Wong. I’ve been in contact with you before when I had the worst year of my life in 2012. I went trough 4 surgeries in my left eye for a retinal detachment, here in Norway, at the age of 26. It finally stuck but not before I had the Vitrectomy, and surgery for cataract. It has now been on since April 2012, so thats great. My vision in that eye is great in good lighted settings, but a little impaired when its dark. You we’re a great help in answering my questions, and no doubt you have a lot of “eye” wisdom. 🙂

    The reason im contacting you know is I have a strange phenomena going on my right eye, which no one seems to know what is over here. I will try to explain my symptoms as I see them. In my peripheral vision a shadow appears after i blink, and dissapears just as fast. I see it best against a white wall. Its like a delay in the visual processing. Its only a spot (formed like a flower) in my peripheral vision. And because i’ve had surgery in my left eye, it freaks me out a little that I have this going on in my right eye. I am currently being investigated for sinus-problems, and I’ve had CT’s done of my sinuses which showed massive congestion of the maxillary sinuses and medium congestion of the ethmoidal sinuses. Can that be the problem? I also have a pain in and around that eye that comes and goes. Been having it for a long time now.

    I have gotten my retina checked out by a specialist, but he didn’t find anything wrong. Mysterious.

    Im looking forward to your answer Dr.

    Thanks!

    • Randall V. Wong, M.D. April 23, 2013 at 11:15 am

      Dear Kenni,

      I really don’t know what may be causing the issue, but sinus disease does not usually cause intermittent visual changes. I wish I could be of more help.

      Randy

  • James Ryan September 28, 2013 at 11:19 am

    Hi Dr.Wong,

    Just asking for your opinion. I had surgery for retinal detachment and a cataract on 02/07/13. Silicon oil was used to attach my retina. I had two surgerys prior to that 1st in Dec 2012 and 2nd Jan 2013 when gas and a buckle was used. My surgeon says that my retina appears stable now and the oil can be remove and another gas bubble will be put in. I am a little nervous about having it but it is very annoying with the oil now, I sometime have 20-100 vision with the oil in now. Also, I have High IOP 32 and some distortion in my vision-ie. a small blind spot which my surgeon says may be correctable to some extent with laser. He say there is a 10-20% chance retina could detach-I am 59-the oil has been in for nearly 8 months now. What would you advise?Would waiting a while longer be advisable?
    Thanks, Jim

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