A healthy retina is necessary for good vision. Rays of light are focused onto the retina by the cornea and lens. The amount of light reaching the retina is controlled by the iris. The retina is a thin membrane lining the inner wall at the back of the eye. It is light-sensitive nerve tissue like film in a camera. The retina is composed of millions of light-sensitive rod and cone cells that generate electrical signals when stimulated by light. The macula is a very small area in the center of the retina. The macula has tightly packed cone cells that allow fine pinpoint vision needed for reading and fine visual activities. The peripheral retina also has rod cells and is responsible for peripheral and night vision. The retina cells are connected to the brain via nerve fibers in the optic nerve, transmitting these signals to the brain, where they are interpreted as images.
Learn about retina conditions by selecting from the Retinal Diseases menu below.
More Retinal Diseases
What is a Branch Retinal Vein Occlusion?
A branch retinal vein occlusion (BRVO) is a painless stroke within the eye that occurs when a blood vessel that drains the retina gets blocked. If the blocked retinal veins nourish the macula, the light-sensitive central part of the retina responsible for straight-ahead fine vision, the central vision becomes blurred, distorted, blocked, or lost due to macula edema. About 60% of patients with BRVO develop symptomatic macular edema with swelling of the central macular area. In about one-third of people without treatment, this macular edema will last for more than one year without treatment and vision may not recover. The severity of the loss is related to the degree of blockage, the area involved, how much leakage occurs and the duration.
Causes of Branch Retinal Vein Occlusion
High blood pressure, glaucoma and other vascular diseases can damage the veins in the eye and cause rapid visual loss. The blood can also be too thick, or sticky in certain blood conditions or the blood vessel walls can be inflamed. You may be advised to control your blood pressure and have blood testing.
Diagnosis of Branch Retinal Vein Occlusion
The diagnosis is made on a dilated fundus exam and can be confirmed with fluorescein angiography that pinpoints the areas of blockage and leakage. OCT imaging shows the degree of macular edema leakage. Fundus photographs are often used to document findings and to allow interval management. When the blocked veins cover a large area, new abnormal vessels may grow on the retinal surface, which can bleed into the eye and cause floaters and further blurred vision. This is especially common when there are large areas of the retina that have no blood flow or ischemia.
Branch Retinal Vein Occlusion Treatment
Treatment includes observation, nearly painless, low-risk intravitreal pharmacologic injections, or brief office laser treatment. Injectable FDA-approved medications such as the steroid Ozurdex and anti-VEGF agents, including Lucentis or Eylea, are also effective for treating BRVO along with nonFDA medications. The average patient requires 8-9 treatments but there is great variability. About 50% of patients improve 2 lines of vision. Combination therapy and adjunctive laser may be helpful. If you have had a branch retinal vein occlusion, regular visits to your retinal specialist are essential to protect vision, and periodic monitoring is recommended even after resolution. About 10% of fellow eyes develop the BRVO.
What is Central Serous Retinopathy?
Central Serous Retinopathy (CSR) or central serous choroidopathy, is a blister that develops under the retina, the light-sensitive nerve layer that lines the back of the eye. The leakage blurs, or distorts vision and can cause some missing spots. Usually the effects are temporary and vision generally recovers on its own within six months but often leaves some mild. With CSR, vision may suddenly become blurred and dim, usually in one eye. If the macula (the area of the retina responsible for central vision) is not affected, there may be no obvious symptoms.
Diagnosing Central Serous Retinopathy
Diagnosis is confirmed and followed with OCT and fluorescein and ICG angiography, dilated fundus exam, color photos and visual field testing. CSR typically affects adult males under 50. Some people with frequent episodes may have some permanent vision loss. Recurrences are common and can affect 20% to 50% of people with CSR. While the cause of CSR is unknown, it may be stress related and steroids can precipitate it.
Treatment of Central Serous Retinopathy
CSR usually resolves on its own, so no treatment may be necessary. Sometimes laser surgery can reduce the swelling sooner, but the final visual outcome is usually about the same. If both eyes are involved, or retinal swelling persists for more than three or four months, or if an examination reveals blind spots are developing, thermal or photodynamic laser surgery (PDT) may be helpful.
What is retinal detachment?
The retina is the light-sensitive layer of tissue that lines the inside of the eye like wallpaper. It sends visual messages through the optic nerve to the brain. The most common type of retinal detachment is a rhegmatogenous detachment usually due to an abnormal adherence of the vitreous gel to the retina, similar to wallpaper lining the inside wall of the eye. When the vitreous shrinks and separates, the abnormal adherence causes the retina to tear. If the tear is not promptly treated, it may lead to leakage through the tear and the retina then detaches from its normal position. As it separates from the inner lining of the eye, it loses its blood supply from the wall of the eye and causes a shadow corresponding to the detached area. If not promptly treated with surgery, the retinal detachment progresses and can cause permanent vision loss.
Who is at risk for retinal detachment?
A retinal detachment can occur at any age, but it is more common in people over age 40 and usually occurs in people 50-70 years old when the vitreous normally shrinks and pulls free from the retina. It affects men more than women, and Whites more than African Americans.
Risk factors for retinal detachment include:
● High degree of myopia (extremely nearsighted).● Retinal detachment in the other eye.● Family history of retinal detachment.● Following cataract surgery.● Following YAG laser for membrane after cataract surgery.● Trauma.● Uveitis.● Retinoschisis.● Lattice degeneration.
What are the symptoms of retinal detachment?
● New or an increase in floaters.● Flashing lights.● A shadow or curtain obscuring a portion of the vision.● There is a painless loss of vision in one eye.A retinal detachment is a medical emergency. Anyone experiencing the symptoms of a retinal detachment should see a retina specialist immediately and limit activities as much as possible.
How is retinal detachment treated?
Retinal detachments are treated with surgery and regardless of the procedure, patients must limit activities for 8-11 days after laser or cryopexy to allow for the retina to adhere to the wall of the eye. If a gas bubble is used, it may be necessary for you to position yourself as instructed. Bubbles last from several days to 6 weeks or more and when present, certain general anesthetic gases must be avoided and you cannot fly until the bubble is reabsorbed. Over 90% of typical retinal detachments can be repaired with one or more operations. The visual outcome may be quite excellent but if the central vision is compromised before surgery with the shadow involving the macula then reading vision may not be restored.
Pneumatic Retinopexy: Depending on the location of the retinal tear(s), some patients may be treated in the office with a gas bubble procedure called pneumatic retinopexy. Although this procedure has the lowest success rate, it is the easiest and gives the best visual results. If unsuccessful, it does not handicap the results of additional surgery.
Scleral Buckle: In some cases, a scleral buckle, a permanent tiny synthetic band, is attached to the outside of the eyeball to gently push the wall of the eye against the detached retina. This is an outpatient procedure that takes under 2 hours and takes about 6 weeks to fully heal. It is usually performed with cryopexy and may be combined with an intraocular gas and or vitrectomy.
Vitrectomy: If necessary, an outpatient vitrectomy may also be performed, usually with local anesthesia with sedation. During a vitrectomy, the retina specialist works inside the eye with a small sucking-cutting instrument to remove the vitreous that pulled on the retina and ripped it. Gas is often injected to into the eye to replace the vitreous and holds the retina back against the wall of the eye until it adheres. The gas bubble resorbs in 1-6 weeks depending on which gas is used and replaced with the normal fluid within the eye.
What are the possible complications of retinal detachment?
● Need for multiple surgeries - With modern therapy, over 90 percent of those with retinal detachment can be successfully treated, although sometimes multiple surgeries are needed.
● Return of partial vision - Once the retina is attached and the bubble reabsorbs, the vision will start to improve, with most of the improvement within 3 months and some up to one year. A change in glasses may be required. If the shadow involves the center of the vision, the macula is detached, and not all the vision will return. Visual results are best if the retinal detachment is repaired before the macula (the center region of the retina responsible for fine, detailed vision) detaches.
● Proliferative vitreoretinopathy (PVR) scar tissue. Even under the best of circumstances, and even after multiple attempts at repair, treatment sometimes fails due to proliferative vitreoretinopathy when scar tissue occurs, and vision may eventually be lost.
● Double vision.
● Progression of cataract.
● Infection.
● Glaucoma.
● Complete loss of vision or a shrunken eye.
● Extrusion of a scleral buckle.
Uveitis refers to a rare group of inflammatory diseases of the uveal tissue in the eye. The uvea includes the choroid, ciliary body, and the iris. The uvea is rich in blood vessels and is the source of the inflammatory cells that enter the eye. Uveitis inflammation can damage the lens, retina, optic nerve, or vitreous. Uveitis is estimated to be responsible for approximately 10%-20% of blindness in the United States. Uveitis treatment is challenging since it can damage many parts of the eye. It can cause minor symptoms or lead to severe vision loss. Uveitis affects approximately 1 in 4500 people and is most common between the ages 20 to 60 with men and women affected equally. It can also occur in children and seniors. Uveitis may be caused by problems or diseases isolated to the eye or it can be part of an inflammatory disease affecting other parts of the body. It may have slow or sudden onset and last for days to many years with recurrences. Uveitis may develop suddenly with redness and pain or with just a blurring of vision.
Uveitis Classification
Uveitis is classified based on the cause as infectious or non-infectious (autoimmune) or by the area of the eye involved as:
● Anterior uveitis: Anterior uveitis occurs in the front of the eye. It is the most common form of uveitis, predominantly occurring in young and middle-aged people. Many cases occur in healthy people and may only affect one eye but some are associated with joint, skin, gastrointestinal, lung and infectious diseases. In anterior uveitis, no associated condition or syndrome is found in approximately one-half of cases. However, anterior uveitis is often one of the syndromes associated with HLA-B27.● Intermediate uveitis: Intermediate uveitis is commonly seen in young adults. The center of the inflammation often appears in the vitreous. It has been linked to several disorders including, sarcoidosis and multiple sclerosis.● Posterior uveitis: Posterior uveitis is the least common form of uveitis. It primarily occurs in the back of the eye, often involving both the retina and the choroid. It is often called choroditis or chorioretinitis. There are many infectious and non-infectious causes to posterior uveitis.● Panuveitis uveitis: Pan-uveitis is when all three major parts of the eye are affected by inflammation. Behcet’s disease is one of the most well-known forms of pan-uveitis and it greatly damages the retina.
Intermediate, posterior, and panuveitis are the most severe and highly recurrent forms of uveitis. They often cause blindness if left untreated.
The uveal tissue includes the Choroid, ciliary body and the iris.● Lens: Transparent tissue that allows light into the eye.● Retina: The layer of cells on the back, inside part of the eye that converts light into electrical signals sent to the brain.● Optic Nerve: A bundle of nerve fibers that transmits electrical signals from the retina to the brain.● Vitreous: The fluid filled space inside the eye.
What are the Symptoms of Uveitis?
Uveitis can affect one or both eyes. Symptoms may develop gradually or rapidly and are variable in severity and may last weeks to years and include:
● Blurred vision or a change in vision.● Dark, floating spots in the vision (floaters).● Eye pain or burning of the eye.● Redness of the eye ringing the eye or throughout the white portion.● An irregular shaped pupil.● Light sensitivity or photophobia.● Headaches.
How is Uveitis Diagnosed?
Diagnosis of uveitis includes obtaining an extensive medical history and performing a thorough eye examination with dilation of the pupils and a neurologic exam in some cases. Laboratory tests may be done to rule out an infection or an autoimmune disorder and x-rays may be taken of the spine and chest. If a specific cause or infection is suspected, more specific treatment can be utilized.
What Causes Uveitis?
Infectious● AIDS.● Brucellosis.● CMV.● Herpes Zoster.● Leptospirosis.● Lyme Disease.● Presumed Ocular Histoplasmosis Syndrome.● Syphilis.● Toxocariasis.● Toxoplasmic Chorioretinitis.● Tuberculosis.● Vaccinations.● Zika Fever.
Noninfectious Or Autoimmune Causes● Behçet Disease.● Crohn's Disease.● Fuchs Heterochromic Iridocyclitis.● Granulomatosis With Polyangiitis.● Hla-b27 Related Uveitis.● Juvenile Idiopathic Arthritis.● Kawasaki Disease.● Multiple Sclerosis.● Polyarteritis Nodosa.● Sarcoidosis.● Spondyloarthritis.● Sympathetic Ophthalmia Following Eye Injury.● Tubulointerstitial Nephritis And Uveitis Syndrome.● Ulcerative Colitis.● Vogt Koyanagi Harada’s Disease.● Whipple Disease.
Associated with systemic diseases.In most cases, uveitis is an isolated illness only involving the eyes but there is no association of uveitis with other diseases. However, uveitis can be associated with many diseases including:● AIDS.● Ankylosing Spondylitis.● Behcet’s Syndrome.● CMV Retinitis.● Eye Injuries.● Herpes Zoster Infection.● Histoplasmosis.● Kawasaki Disease.● Multiple Sclerosis.● Psoriasis.● Reactive Arthritis.● Rheumatoid Arthritis.● Sarcoidosis.● Syphilis.● Toxoplasmosis.● Tuberculosis.● Ulcerative Colitis.● Vogt Koyanagi Harada’s Disease.● Drug Related Side Effects.● Rifabutin.● Quinolone Antibiotics such as Moxifloxacin.● All Widely Administered Vaccines.
White Dot Syndromes● Acute Posterior Multifocal Placoid Pigment Epitheliopathy.● Birdshot Chorioretinopathy.● Multifocal Choroiditis and Panuveitis.● Multiple Evanescent White Dot Syndrome.● Punctate Inner Choroiditis.● Serpiginous Choroiditis.● Acute Zonal Occult Outer Retinopathy.
What Are Masquerade Syndromes?Masquerade Syndromes May Also Mimic Uveitis With Intraocular Cells Resembling Inflammatory Cells Within the Eye but Are Not Due to Immune-mediated Uveitis Entities. These May Represent Cancer (Neoplastic) Involving the Eye or Non-neoplastic Conditions.
Non-neoplastic:● Retinitis Pigmentosa.● Intraocular Foreign Body.● Juvenile Xanthogranuloma.● Retinal Detachment.
Neoplastic:● Retinoblastoma.● Lymphoma.● Malignant Melanoma.● Leukemia.● Reticulum Cell Sarcoma.
How is Uveitis Treated?
Because uveitis is a serious condition that can cause permanent damage to the eye, it needs to be treated as soon as possible. Uveitis treatments primarily try to eliminate inflammation, alleviate pain, prevent further tissue damage, and restore any loss of vision. Treatment may be very specific or generalized depending on the type of uveitis a patient displays. If an infectious etiology is found, it is specifically treated. In non-infectious cases, drops to dilate the pupil and steroids are usually initiated in the form of eye drops or injections around or inside the eye. Steroids may also be administered by mouth, but oral or intravenous immunosuppressive medications may be used when the disease is occurring in both eyes, particularly in the back of both eyes that may be safer than long-term steroid therapy that can produce side effects such as stomach ulcers, osteoporosis (bone thinning), diabetes, cataracts, glaucoma, cardiovascular disease, weight gain, fluid retention, and Cushing’s syndrome. Usually, other agents are started if it appears that patients need moderate or high doses of oral steroids for more than 3 months.
Other immunosuppressive agents that are commonly used include medications such as methotrexate, mycophenolate, azathioprine, and cyclosporine. These treatments require regular blood tests to monitor for possible side effects. In some cases, biologic response modifiers (BRM) or biologics, such as adalimumab, infliximab, daclizumab, abatacept, and rituximab, are used. These drugs target specific elements of the immune system. Some of these drugs may increase the risk of having cancer. If uveitis is associated with other conditions like glaucoma or retinal damage, surgery may be required.
Prognosis
The prognosis is generally good for those who receive prompt diagnosis and treatment, but serious complications include:
● Cataracts.
● Laucoma.
● Band Keratopathy.
● Cystoid Macular Edema.
● Permanent vision loss may result if left untreated.
Central Serous Retinopathy (CSR) or central serous choroidopathy, is a blister that develops under the retina, the light-sensitive nerve layer that lines the back of the eye. The leakage blurs, or distorts vision and can cause some missing spots. Usually the effects are temporary and vision generally recovers on its own within six months but often leaves some mild. With CSR, vision may suddenly become blurred and dim, usually in one eye. If the macula (the area of the retina responsible for central vision) is not affected, there may be no obvious symptoms.
Diagnosing Central Serous Retinopathy
Diagnosis is confirmed and followed with OCT and fluorescein and ICG angiography, dilated fundus exam, color photos and visual field testing. CSR typically affects adult males under 50. Some people with frequent episodes may have some permanent vision loss. Recurrences are common and can affect 20% to 50% of people with CSR. While the cause of CSR is unknown, it may be stress related and steroids can precipitate it.
Treatment of Central Serous Retinopathy
CSR usually resolves on its own, so no treatment may be necessary. Sometimes laser surgery can reduce the swelling sooner, but the final visual outcome is usually about the same. If both eyes are involved, or retinal swelling persists for more than three or four months, or if an examination reveals blind spots are developing, thermal or photodynamic laser surgery (PDT) may be helpful.
Age-Related Macular Degeneration (AMD) is a deterioration of the macula, the central area of the retina, that can cause substantial central visual loss but almost never total blindness. AMD is the leading cause of significant visual acuity loss in seniors and dramatically increases with age. There are 2 types of AMD: non-neovascular or dry AMD; and neovascular or wet AMD.
The retina is a thin layer of light sensitive nerve tissue lining the inner wall of the eye. When light is focused onto the retina, the images are converted into electrical signals that are carried from the eye to the brain by the trunk line of the optic nerve. The visual portion of the brain interprets these as images. The macula is the specialized portion of the central retina packed with cone photoreceptors and is the only part of the retina capable of fine vision and reading. Imaging can visualize most of the layers of the retina that are only a few hundred microns thick in the center.
A branch retinal vein occlusion (BRVO) is a painless stroke within the eye that occurs when a blood vessel that drains the retina get blocked. If the blocked retinal veins nourish the macula, the light sensitive central part of the retina responsible for straight-ahead fine vision, the central vision becomes blurred, distorted, blocked or lost due to macula edema. About 60% of patients with BRVO develop symptomatic macular edema with swelling of the central macular area. In about one-third of people without treatment, this macular edema will last for more than one year without treatment and vision may not recover. The severity of the loss is related to the degree of blockage, the area involved, how much leakage occurs and the duration.
Causes of Branch Retinal Vein Occlusion
High blood pressure, glaucoma and other vascular diseases can damage the veins in the eye and cause rapid visual loss. The blood can also be too thick, or sticky in certain blood conditions or the blood vessel walls can be inflamed. You may be advised to control your blood pressure and have blood testing.
Diagnosis of Branch Retinal Vein Occlusion
The diagnosis is made on dilated fundus exam and can be confirmed with fluorescein angiography that pinpoints the areas of blockage and leakage. OCT imaging shows the degree of the macular edema leakage. Fundus photographs are often used to document findings and to allow interval management. When the blocked veins cover a large area, new abnormal vessels may grow on the retinal surface, which can bleed into the eye and cause floaters and further blurred vision. This is especially common when there are large areas of the retina that have no blood flow, ischemia.
Branch Retinal Vein Occlusion Treatment
Treatment includes observation, nearly painless, low risk intravitreal pharmacologic injections, or brief office laser treatment. Injectable FDA approved medications such as the steroid Ozurdex and anti-VEGF agents including Lucentis or Eylea are also effective for treating BRVO along with nonFDA medications. The average patient requires 8-9 treatments but there is great variability. About 50% of patients improve 2 lines of vision. Combination therapy and adjunctive laser may be helpful. If you have had a branch retinal vein occlusion, regular visits to your retinal specialist are essential to protect vision and periodic monitoring are recommended even after resolution. About 10% of fellow eyes develop the BRVO.
Background diabetic retinopathy may cause macular edema, or swelling of the central portion of the retina, which may result in blurred vision.
The National Eye Institute concluded that laser treatment was more effective than observation for diabetic retinopathy with clinically significant macular edema in a national trial completed in 1985. Treatment reduced the risk of visual loss by more than 50 percent, increased the chance of visual improvement and decreased the frequency of persistent macular edema. The treatment was found to be better at preventing visual loss than improving It and may be indicated even with 20/20 vision if the center of the macula is threatened. There is no alternative treatment for background diabetic retinopathy other than good control of underlying medical problems, laser therapy or intravitreal injections. Laser is often used as an adjunctive therapy with diabetics to decrease the injection burden.