A retinal detachment is a medical emergency that can cause permanent vision loss. Prompt evaluation and, when necessary, treatment can help preserve vision and prevent further progression.
What Is a Retinal Detachment?
The retina is the light-sensitive tissue lining the back of the eye. It converts light into electrical signals that are transmitted through the optic nerve to the brain, allowing us to see.
A retinal detachment occurs when the retina separates from the underlying retinal pigment epithelium. The most common type, called a rhegmatogenous retinal detachment, occurs when a retinal tear or hole allows fluid from inside the eye to pass underneath the retina.
Without treatment, a retinal detachment can enlarge and lead to significant or permanent vision loss.
Types of Retinal Detachment
There are three major types of retinal detachment. Each has a different underlying mechanism.
Rhegmatogenous Retinal Detachment
The most common type of retinal detachment occurs when a retinal tear or hole allows fluid to accumulate underneath the retina. Often associated with aging-related changes in the vitreous, significant nearsightedness, previous cataract or other eye surgery, eye trauma, or a personal or family history of retinal detachment.
Tractional Retinal Detachment
- Occurs when scar tissue or abnormal fibrovascular tissue pulls the retina away from the underlying tissue.
- Most commonly associated with advanced proliferative diabetic retinopathy.
- Unlike rhegmatogenous retinal detachment, a retinal tear is not initially required for tractional detachment to occur.
Exudative (Serous) Retinal Detachment
- Occurs when fluid accumulates underneath the retina without a retinal tear or hole.
- Can be associated with inflammation, vascular disorders, tumors, trauma, or other conditions that cause fluid to accumulate beneath the retina.
- Treatment focuses primarily on identifying and treating the underlying cause.
Who Is at Risk for a Retinal Detachment?
Your risk of retinal detachment may be higher if you:
- Are older, particularly as age-related changes occur in the vitreous
- Have significant nearsightedness (high myopia)
- Have had a previous retinal detachment in either eye
- Have a family history of retinal detachment
- Have had cataract or other intraocular surgery
- Have experienced significant eye trauma
- Have certain retinal conditions or peripheral retinal abnormalities
People with diabetes can also develop tractional retinal detachments, particularly when diabetic retinopathy becomes advanced.
Knowing your risk factors can help you recognize symptoms and seek evaluation promptly.
Early Warning Signs of a Retinal Detachment
A retinal detachment is usually painless, and symptoms often develop suddenly.
Warning signs can include:
- Sudden flashes of light, particularly in the peripheral vision
- A sudden increase in floaters, including new spots, lines, or cobweb-like shapes
- A dark shadow or curtain moving across part of your vision
- Loss of peripheral vision
- Blurred or decreased vision, particularly if the retinal detachment involves the macula, the central portion of the retina responsible for detailed vision
Flashes and new floaters do not necessarily mean that a retinal detachment is present. They can also occur with a posterior vitreous detachment, which is common and often harmless but can sometimes cause a retinal tear.
Because a retinal tear can progress to a retinal detachment, new flashes, a sudden increase in floaters, or a curtain/shadow in your vision should be evaluated promptly by an eye-care professional.
If you experience a sudden curtain or significant loss of vision, seek immediate ophthalmic evaluation.
How Is a Retinal Detachment Diagnosed?
An ophthalmologist typically diagnoses retinal detachment with a dilated retinal examination.
The examination may include:
- Careful examination of the peripheral retina to look for retinal tears, holes, or detachment
- Examination of the vitreous for signs of bleeding or posterior vitreous separation
- Optical coherence tomography (OCT) when additional information about the macula is needed
- B-scan ultrasonography when the retina cannot be adequately visualized, such as when there is a dense vitreous hemorrhage or other media opacity
These examinations help determine whether a retinal tear or detachment is present and, if a detachment exists, whether the macula is involved.
Treatment Options for a Retinal Detachment
Treatment depends on the type, location, size, and severity of the retinal detachment, as well as whether the macula is involved.
The primary goal of surgery for a rhegmatogenous retinal detachment is to close the retinal break and reattach the retina.
Pneumatic Retinopexy
- A small gas bubble is injected into the eye.
- The patient may need to maintain a specific head position so the bubble can support the retinal break.
- Laser photocoagulation or cryotherapy is used to seal the retinal tear.
- This procedure is appropriate for selected retinal detachments with suitable break locations and characteristics.
Scleral Buckle
- A flexible silicone band is placed around the outside of the eye.
- The buckle changes the contour of the eye wall and reduces traction on the retinal break.
- Laser or cryotherapy is used to create a permanent seal around the retinal tear.
- Scleral buckling is commonly used in certain retinal detachments, particularly in younger patients or detachments with specific tear patterns.
Vitrectomy
- Small instruments are used to remove the vitreous gel that is pulling on the retina.
- The surgeon identifies and treats retinal tears and removes any significant traction.
- The retina is flattened against the underlying tissue.
- The eye may be filled with a gas bubble or silicone oil to help maintain retinal attachment while the eye heals.
- If a gas bubble is used, patients generally must follow specific positioning instructions and must not fly or travel to high altitude while the gas remains in the eye.
In some cases, more than one surgical technique may be used together.
What to Expect After Treatment
Recovery varies depending on the type and extent of the retinal detachment, the procedure performed, and whether the macula was detached.
Some discomfort, redness, blurred vision, or temporary visual distortion can occur after surgery. Vision may take weeks or months to improve, and the final visual outcome depends in part on how much of the retina was affected and whether the macula was involved before repair.
Patients may need:
- Prescription eye drops
- Specific head positioning
- Temporary restrictions on strenuous activity
- Close postoperative examinations
Additional treatment or another procedure may occasionally be necessary if the retina does not remain attached or if complications develop.
Even when the retina is successfully reattached, visual recovery is not always complete, particularly when the macula was detached for an extended period before treatment.
Act Quickly to Protect Your Vision
A retinal detachment can progress and may result in permanent vision loss if left untreated.
Do not ignore sudden flashes of light, a sudden increase in floaters, a curtain or shadow over your vision, or sudden loss of peripheral or central vision.
These symptoms do not always mean that you have a retinal detachment, but they can indicate a retinal tear or other potentially serious retinal condition that requires prompt evaluation.
If you experience these symptoms, seek an urgent dilated eye examination. Early diagnosis allows retinal tears to be treated before they progress to a retinal detachment and allows retinal detachments to be treated before additional vision is lost.
If you are experiencing sudden flashes, new floaters, a curtain or shadow, or sudden vision loss, contact Southwestern Eye Center for urgent evaluation.