07 Feb "Top Ten" Retinal Eye Emergencies: Part II
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 Detachment – retinal 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!