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Retinal Detachment

DESCRIPTION: The retina is only firmly attached at the optic nerve head and at the ora serrata; elsewhere, the vitreous and general structure of the eye hold the retina in place. If, through disease, trauma, or a puncture wound, the retina is thinned or tears, vitreous fluid can leak behind the retina and cause it to pull away from its normal position. If the peripheral retina pulls away it can usually be reattached with little loss of visual function. If, however, the macular area is pulled away and is separated from its capillary nourishing connections, severe visual impairment (even total blindness) can result. Among the predisposing conditions for retinal detachment are: high myopia, aphakia, vitreous abnormalities (including diabetic retinopathy), retinal degeneration, and trauma. Symptoms may range from none, to "flashing lights" and/or "floaters," to loss of visual function. Immediate medical attention is essential.

TREATMENT: Treatment consists of bonding the retina to the choroid through diathermy (high frequency current which sears the choroid and retina), cryothermy (freeze-bonding) or photocoagulation (laser burning). All three procedures induce scar tissue (essentially, "spot welding"). Scleral buckling (literally, a "buckle" around the outer sclera, which, when tightened, forces the choroid to make a contact with the retina) may assist with the bonding procedure.

Educational adjustments include increased illumination and optical aids.

IMPLICATIONS: Prognosis depends on the cause of the detachment. Any eye report for a school child which indicates a detached retina in one eye should raise questions about contact sports and strenuous activity.

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