Retinal Detachment: Symptoms, Causes & Treatment

What Is Retinal Detachment?

Retinal detachment occurs when the retina, the thin layer of light-sensitive tissue at the back of your eye, separates from its underlying support tissue. Without treatment, retinal detachment leads to permanent blindness in the affected eye. It most commonly affects one eye at a time and is considered a medical emergency.

The eye is shaped like a small ball called the eyeball, which contains a gel-like substance known as the vitreous body. The retina lines the inside of the eyeball and contains the photoreceptor cells that convert light into electrical signals sent to your brain. Beneath the retina lies the choroid, a layer of blood vessels that supplies oxygen and nutrients to the retina.

When retinal detachment occurs, the retina separates from the choroid. This separation cuts off the blood supply to the retinal cells, causing them to stop functioning. As more of the retina detaches, vision progressively worsens. If the central part of the retina (called the macula) detaches, central vision becomes severely affected, and some permanent vision loss is likely even with successful treatment.

The most common type of retinal detachment is called rhegmatogenous retinal detachment, which occurs when a tear or hole develops in the retina, allowing fluid to seep underneath and separate it from the underlying tissue. This type accounts for approximately 90% of all retinal detachments and is the focus of this article.

How Common Is Retinal Detachment?

Retinal detachment affects approximately 1 in 10,000 people each year, with a lifetime risk of about 1 in 300. While it can occur at any age, it is most common in people over 65 years old due to age-related changes in the vitreous gel. The condition affects men slightly more often than women, and certain ethnic groups, particularly those of East Asian descent, may have higher rates.

The incidence has increased in recent decades, partly due to better detection and partly due to the growing population of older adults. Additionally, the rise in cataract surgery has contributed to more cases, as previous eye surgery is a known risk factor for retinal detachment.

What Are the Symptoms of Retinal Detachment?

The main symptoms of retinal detachment include sudden flashes of light in your peripheral vision, a sudden increase in floaters, and a shadow or dark curtain spreading across your visual field. These symptoms typically develop quickly over 2-3 days. Importantly, retinal detachment is painless, which may cause people to delay seeking care.

Retinal detachment usually comes on suddenly and progresses rapidly. The typical timeline from initial symptoms to complete detachment is two to three days, though this can vary. Some cases progress more slowly over weeks, while others can advance within hours. Recognizing the warning signs early and seeking immediate care is crucial for preserving vision.

The symptoms of retinal detachment relate to the physical changes occurring inside the eye. When the vitreous gel tugs on the retina, it stimulates the photoreceptor cells, causing you to perceive flashes of light. When the retina tears, small blood vessels may bleed, releasing debris that appears as floaters. As the retina separates, the affected area stops transmitting visual information, creating a shadow or blind area in your vision.

Light Flashes (Photopsia)

Flashes of light, medically called photopsia, are one of the earliest warning signs of potential retinal detachment. These flashes appear in your peripheral (side) vision and may look like lightning streaks, camera flashes, or twinkling lights. They are typically more noticeable in dim lighting or darkness and may occur repeatedly over minutes to hours.

The flashes occur because the vitreous gel is pulling on the retina. This mechanical stimulation triggers the photoreceptor cells to fire, even though no actual light is entering the eye. While occasional flashes can occur without serious cause, especially as people age, new or increased flashing warrants immediate evaluation by an eye doctor.

Floaters

Floaters are small dark spots, threads, cobwebs, or circles that drift across your field of vision. While some floaters are normal, especially with aging, a sudden "shower" of floaters is concerning. This sudden increase often indicates bleeding inside the eye from a torn blood vessel or significant changes to the vitreous gel.

The floaters you see are actually shadows cast on the retina by debris in the vitreous gel. When the vitreous separates from the retina (a common aging change called posterior vitreous detachment), it can pull on the retina and cause a tear. Blood from small torn vessels or clumps of vitreous material create the floaters. A sudden onset of many new floaters, especially combined with flashes, should prompt urgent medical attention.

Shadow or Curtain in Vision

Perhaps the most specific symptom of actual retinal detachment is the appearance of a shadow or dark curtain across part of your vision. This shadow typically starts at the edge of your visual field and gradually spreads. It may come from any direction—top, bottom, or sides—depending on where the detachment originates.

The shadow corresponds to the area of retina that has detached. Since the detached portion is no longer receiving blood supply and cannot transmit visual information, that part of your visual field goes dark. As more retina detaches, the shadow grows larger. If the macula (central vision area) detaches, you may notice significant blurring or distortion of your central vision.

When Should You Seek Medical Care?

Seek immediate medical care if you see a shadow or curtain in your vision, have a sudden shower of floaters, or experience flashes with floaters. Contact an ophthalmologist, eye emergency clinic, or hospital emergency department. Do not wait until the next day if you develop a shadow in your vision, even if it's the weekend.

Understanding when to seek care for eye symptoms can be challenging. Many people experience occasional floaters or flashes as part of normal aging, and these usually don't indicate serious problems. However, certain patterns of symptoms require urgent evaluation. The key is recognizing when symptoms represent a significant change from your normal experience.

If you notice only floaters without other symptoms, and this represents only a slight increase from what you're used to, it may be reasonable to schedule an appointment with your eye doctor within a few days. However, if you're uncertain about the severity or if the floaters are accompanied by any other symptoms, err on the side of caution and seek same-day evaluation.

Symptoms Requiring Emergency Care

Certain symptoms indicate that retinal detachment may already be occurring and require emergency evaluation. If you notice a shadow, curtain, or veil across any part of your vision, seek emergency eye care immediately. This is the hallmark sign of retinal detachment in progress, and prompt surgery is needed to prevent permanent vision loss.

Similarly, if you experience a sudden onset of many new floaters, especially if they appear as a "shower" or "swarm," this may indicate bleeding inside the eye from a retinal tear. When floaters are combined with flashes of light, the urgency increases further. These combined symptoms suggest active pulling on the retina that could lead to detachment.

Symptoms Requiring Same-Day Evaluation

New flashes of light in your vision should be evaluated within 24 hours, preferably the same day. While flashes alone don't necessarily mean you have retinal detachment, they indicate that the vitreous gel is pulling on your retina, which creates risk. An eye examination can reveal whether a tear has formed and whether preventive treatment is needed.

A significant increase in floaters, even without other symptoms, also warrants same-day evaluation. Your eye doctor can examine your retina to check for tears or other abnormalities. Early detection of retinal tears allows for preventive laser treatment, which can often prevent progression to full detachment.

What Causes Retinal Detachment?

Retinal detachment most commonly results from changes to the vitreous gel inside the eye. As we age, this gel shrinks and may pull away from the retina, sometimes creating tears. Fluid then enters through these tears and separates the retina from its blood supply. Risk factors include high myopia, previous eye surgery, eye trauma, and family history.

To understand retinal detachment, it helps to understand the structure of the eye. The eye is largely filled with a clear, gel-like substance called the vitreous humor or vitreous body. This gel is firmly attached to the retina at several points, particularly at the edges of the retina and around the optic nerve. In a healthy eye, the vitreous provides structural support and helps maintain the retina's position against the back of the eye.

As we age, typically starting in our 50s, the vitreous gel undergoes natural changes. It becomes less gel-like and more liquid, shrinking in volume. Eventually, this shrunken vitreous separates from the retina, a process called posterior vitreous detachment (PVD). This is extremely common—most people over 65 have experienced it—and is usually harmless, causing only temporary floaters.

How Vitreous Changes Lead to Retinal Tears

While posterior vitreous detachment is usually benign, problems arise when the vitreous gel is abnormally adherent to the retina at certain points. When the vitreous separates but remains stuck at these points, it can pull on the retina with enough force to create a tear or hole. This is when flashes of light typically occur—the pulling stimulates the photoreceptor cells.

Once a retinal tear forms, fluid from the liquefied vitreous can pass through the tear and accumulate between the retina and the underlying tissue. This fluid accumulation progressively separates the retina from its blood supply, causing retinal detachment. The detachment typically starts at the location of the tear and spreads from there.

Risk Factors for Retinal Detachment

Several factors increase the likelihood of retinal detachment. Understanding these risk factors helps identify people who should be particularly vigilant about eye symptoms and may benefit from regular eye examinations.

• High myopia (severe nearsightedness): People with high myopia have elongated eyeballs, which stretches and thins the retina, making it more fragile and prone to tears. High myopia is one of the strongest risk factors for retinal detachment.
• Age over 65: Age-related changes to the vitreous gel increase the risk of posterior vitreous detachment and subsequent retinal tears.
• Previous retinal detachment: If you've had detachment in one eye, your risk of detachment in the other eye is significantly elevated.
• Previous eye surgery: Cataract surgery, in particular, increases the risk of retinal detachment, especially in the first year after surgery.
• Eye trauma: Injuries to the eye, including blunt force trauma, can cause retinal tears and detachment.
• Family history: Having close relatives with retinal detachment increases your risk.
• Lattice degeneration: This condition involves thin, weak areas in the peripheral retina that are prone to developing tears.
• Diabetic retinopathy: Severe diabetic eye disease can lead to tractional retinal detachment.

Other Types of Retinal Detachment

While rhegmatogenous (tear-related) retinal detachment is most common, two other types exist. Tractional retinal detachment occurs when scar tissue on the retina contracts and pulls the retina away from its underlying layer. This type is most common in people with advanced diabetic retinopathy or other conditions that cause abnormal blood vessel growth in the eye.

Exudative or serous retinal detachment occurs when fluid accumulates under the retina without any tear being present. This can result from inflammatory conditions, certain tumors, or abnormal blood vessel leakage. Treatment for these types differs from rhegmatogenous detachment and focuses on addressing the underlying cause.

How Is Retinal Detachment Diagnosed?

Retinal detachment is diagnosed through a comprehensive eye examination by an ophthalmologist. The exam includes testing visual acuity, measuring eye pressure, and examining the retina with dilated pupils using specialized instruments. If the view is blocked by bleeding, ultrasound imaging can visualize the retina.

When you present with symptoms suggestive of retinal detachment, the ophthalmologist will perform several tests to evaluate your retina's condition. The examination is designed to determine whether a retinal tear or detachment is present, assess its extent, and plan appropriate treatment. The complete evaluation typically takes 30-60 minutes.

Visual Acuity Testing

The examination typically begins with testing your visual acuity—how well you can see at various distances. This is done using a standard eye chart with letters of decreasing size. If the macula (central vision area) is affected by the detachment, visual acuity will be reduced. Documenting visual acuity before treatment provides an important baseline for monitoring recovery.

Eye Pressure Measurement

Intraocular pressure (the pressure inside your eye) is typically measured during the examination. Retinal detachment often causes the eye pressure to be lower than normal because the detached retina affects fluid dynamics within the eye. This finding, along with your symptoms, helps support the diagnosis.

Dilated Fundus Examination

The most important part of the examination is the dilated fundus examination. You'll receive eye drops that widen (dilate) your pupils, allowing the doctor to see the retina more completely. The dilation drops take about 20-30 minutes to work fully and cause temporary blurring and light sensitivity that typically lasts several hours.

Once your pupils are dilated, the ophthalmologist examines your retina using specialized instruments. An indirect ophthalmoscope, worn on the doctor's head, provides a wide view of the retina including the far peripheral areas where tears often occur. A slit lamp with a special lens allows detailed examination under magnification. The doctor carefully examines the entire retina, looking for tears, holes, areas of detachment, and other abnormalities.

Ultrasound Imaging

Sometimes the view of the retina is obscured by bleeding in the vitreous cavity. When this occurs, the doctor cannot directly see the retina. In these cases, ultrasound imaging provides crucial information. A small probe is placed gently against your closed eyelid, and sound waves create an image of the structures inside your eye. Ultrasound can detect retinal detachment even when direct visualization is impossible.

Optical Coherence Tomography (OCT)

In some cases, optical coherence tomography may be performed. This imaging technique uses light waves to create detailed cross-sectional images of the retina. OCT is particularly useful for evaluating the macula and can reveal subtle changes not visible with standard examination. It helps determine whether the macula is attached or detached, which significantly impacts prognosis.

How Is Retinal Detachment Treated?

Treatment depends on whether you have only a retinal tear or actual detachment. Tears without detachment can be sealed with laser or freezing treatment in the office. Actual detachment requires surgery—options include pneumatic retinopexy (gas bubble injection), vitrectomy (removal of vitreous gel), or scleral buckling (silicone band around the eye). Success rates are 85-90% with modern techniques.

The treatment approach for retinal detachment depends on the extent of the problem. If examination reveals only a retinal tear without significant detachment, preventive treatment can often seal the tear and prevent progression to full detachment. However, once the retina has actually detached, surgery is required to reattach it.

Laser Photocoagulation for Retinal Tears

When a retinal tear is detected before significant detachment has occurred, laser treatment can prevent progression. Laser photocoagulation creates small burns around the tear that form scar tissue as they heal. This scar tissue essentially "welds" the retina to the underlying tissue, preventing fluid from entering through the tear.

The procedure takes about 10 minutes and is performed in the office. After numbing drops are applied, a special contact lens is placed on your eye to focus the laser beam. You may feel a mild sensation during the treatment. The laser creates a barrier around the tear that takes a few weeks to fully mature. During this time, you should avoid strenuous activity and follow your doctor's instructions.

Cryopexy (Freezing Treatment)

Cryopexy is an alternative to laser treatment for sealing retinal tears. A freezing probe is applied to the outside of the eye, over the area of the tear. The freezing creates controlled damage that, like laser, produces scar tissue to seal the tear. Cryopexy is sometimes preferred for tears located far in the peripheral retina where laser access is difficult.

Pneumatic Retinopexy

For certain types of retinal detachment, particularly small detachments with tears in the upper part of the retina, pneumatic retinopexy may be an option. In this procedure, a gas bubble is injected into the eye. You then position your head so that the bubble floats up against the tear, pushing the retina back into place.

The tear is then sealed with either laser or cryopexy. The gas bubble gradually absorbs over 2-6 weeks, during which you must avoid air travel and maintain specific head positions as instructed by your doctor. This procedure can be performed in the office and has the advantage of avoiding more invasive surgery, though it's not appropriate for all types of detachment.

Vitrectomy

Vitrectomy is the most common surgical treatment for retinal detachment. In this procedure, the surgeon removes the vitreous gel from inside the eye. This eliminates any pulling forces on the retina and allows direct access to treat the detachment. After removing the vitreous, the surgeon uses laser to seal any retinal tears.

The eye is then filled with either gas or silicone oil to hold the retina in place while it heals. Gas bubbles absorb naturally over 2-6 weeks, during which you must avoid flying and maintain certain head positions. Silicone oil remains in the eye and is typically removed in a second surgery several months later, once the retina has firmly reattached.

Vitrectomy is performed in an operating room, usually under local anesthesia, though general anesthesia may be used in some cases. The surgery typically takes about one hour. Most patients go home the same day, though some may stay overnight.

Scleral Buckling

Scleral buckling is a surgical technique where a silicone band or sponge is sewn onto the outside of the eye (the sclera). This band indents the wall of the eye, pushing it inward toward the detached retina. This helps close retinal tears and reduces the pulling forces on the retina.

The band is positioned around the eye beneath the eye muscles and is not visible after surgery. It remains in place permanently and does not cause problems. Scleral buckling is often combined with cryopexy to seal tears and may be used alone or in combination with vitrectomy.

What Happens After Treatment?

Recovery after retinal detachment surgery takes several weeks to months. You'll need follow-up appointments to monitor healing. If gas was used, you must avoid flying until it absorbs (2-6 weeks) and maintain specific head positions. Vision recovery varies depending on whether the macula was affected. Eye irritation and redness are normal and typically resolve within 1-2 weeks.

The recovery period after retinal detachment surgery requires patience and careful adherence to your doctor's instructions. Surgery typically takes about an hour, and you can usually go home the same day after minor procedures or within 1-2 days after more extensive surgery. Understanding what to expect helps ensure optimal recovery.

Immediate Post-Surgery Period

After surgery, your eye will likely be red, irritated, and sensitive. This is normal and typically improves over the first week or two. You'll be prescribed eye drops, including antibiotics to prevent infection and anti-inflammatory medications to reduce swelling. Follow the drop schedule carefully—it's important for proper healing.

Mild pain or discomfort is common and can usually be managed with over-the-counter pain relievers. If you experience severe pain, sudden vision loss, or signs of infection (increasing redness, discharge, or fever), contact your doctor immediately.

Head Positioning After Gas Treatment

If your surgery involved gas injection, you'll need to maintain specific head positions for several days to weeks. The gas bubble floats upward, so you must position your head to keep the bubble against the area of retinal detachment. Your surgeon will give you specific instructions based on the location of your detachment.

This positioning requirement can be challenging, as you may need to keep your head in a particular position even while sleeping. Special positioning aids and pillows are available to help. The gas bubble gradually shrinks and absorbs over 2-6 weeks, and you'll see it as a dark shadow that moves in your vision. As it shrinks, you'll see more clearly around it.

Follow-Up Care

You'll typically have your first follow-up appointment about one week after surgery, with additional visits over the following months. During these appointments, your doctor examines your retina to ensure it remains attached and heals properly. Additional laser treatment may be needed to reinforce the attachment.

Most patients have 3-4 follow-up visits in the first six months after surgery. The frequency decreases as your eye heals. Continue all follow-up appointments even if your vision seems fine—problems can sometimes occur without obvious symptoms.

Activity Restrictions

You'll need to limit physical activity during recovery. Avoid strenuous exercise, heavy lifting, and bending over for the period specified by your doctor, typically 2-4 weeks. These activities can increase pressure in the eye and potentially disrupt healing. You should also avoid rubbing or pressing on your eye.

Your doctor will advise when you can return to work, drive, and resume normal activities. This depends on the type of surgery performed, your occupation, and your recovery progress. Many people can return to sedentary work within a week or two, while more physical jobs may require longer recovery.

What Will My Vision Be Like After Treatment?

Vision recovery depends heavily on whether the macula (central vision area) was affected. If the macula remained attached and treatment was prompt, excellent vision recovery is possible. If the macula detached, some permanent central vision loss is likely, though peripheral vision usually recovers. Full visual recovery may take several months.

One of the most common questions patients have is what their vision will be like after successful surgery. The answer depends primarily on two factors: whether the macula was involved in the detachment, and how quickly treatment was received. Understanding realistic expectations helps with the adjustment process.

When the Macula Was Not Affected

If your retinal detachment was detected and treated before reaching the macula, your prognosis for vision recovery is generally excellent. The peripheral retinal cells may recover fully, and your central vision (which relies on the macula) should be preserved. Most patients in this situation achieve good functional vision after recovery.

However, even with successful surgery, you may notice some differences in vision. The affected eye may see slightly differently than before, and some distortion or changes in color perception can occur. These changes are usually minor and improve over time as the retina heals.

When the Macula Was Affected

If the macula detached, some permanent reduction in central vision is likely even with successful surgery. The photoreceptor cells in the macula are highly specialized and sensitive to damage from loss of blood supply. The longer the macula was detached, the greater the potential for permanent damage.

Even so, surgery is still important and beneficial. Without treatment, vision would be lost entirely. With surgery, while central vision may be reduced, peripheral vision typically recovers, and the eye may still have useful function. Many patients adapt well to changes in their vision over time.

Recovery Timeline

Vision typically does not return to its final level immediately after surgery. In the early days and weeks, your vision may be blurry due to the gas bubble, swelling, and healing process. As the gas absorbs and inflammation resolves, vision gradually improves.

Most vision improvement occurs in the first three months after surgery, but recovery can continue for six months to a year. The shadow in your vision from the detachment disappears once the retina reattaches. Visual acuity improvements may be gradual and subtle. Some patients benefit from updated glasses prescriptions several months after surgery once their vision stabilizes.

If Your Vision Remains Significantly Reduced

If significant vision loss persists after recovery, low vision rehabilitation services can help you maximize your remaining vision. These services provide training in using magnifiers, adaptive devices, and techniques for daily activities. Many people with reduced vision in one eye adapt well, using their other eye for detailed tasks while the affected eye contributes to peripheral awareness and depth perception.

What Complications Can Occur?

While modern surgery is highly successful, complications can include cataract formation (common after vitrectomy), increased eye pressure, infection, recurrent detachment requiring additional surgery, and double vision (rare). The most common complication is cataract development, which can be treated with cataract surgery if needed.

Surgery for retinal detachment is generally safe and effective, with success rates of 85-90% for reattaching the retina with a single operation. However, like any surgery, complications can occur. Understanding potential complications helps you recognize problems early and know when to contact your doctor.

Cataract Formation

Development of cataract (clouding of the eye's lens) is one of the most common complications after vitrectomy surgery. The risk is particularly high in patients over 50 years old who already have some age-related lens changes. The cataract may develop months to years after the retinal surgery.

If a cataract develops and significantly affects your vision, it can be treated with standard cataract surgery. Many patients undergo cataract surgery 6-12 months after their retinal surgery. Some surgeons may recommend combined procedures if cataract is already present at the time of retinal surgery.

Elevated Eye Pressure

Eye pressure can increase after retinal surgery, particularly in the early recovery period. This elevated pressure (ocular hypertension) is usually temporary and manageable with eye drops. However, if not properly controlled, high eye pressure can damage the optic nerve. Your doctor will monitor your eye pressure at follow-up visits and prescribe treatment if needed.

Recurrent Retinal Detachment

In some cases, the retina may detach again after surgery. This occurs in approximately 10-15% of patients and may require additional surgery. Recurrent detachment can happen for various reasons, including development of scar tissue on the retina (proliferative vitreoretinopathy), new retinal tears, or incomplete sealing of the original tear.

Multiple surgeries are sometimes needed to achieve stable retinal attachment. While this is discouraging, many patients ultimately achieve successful outcomes after additional procedures. Your surgeon will discuss the specific situation if recurrence occurs.

Risk of Detachment in the Other Eye

Having had retinal detachment in one eye increases your risk of detachment in the other eye. This risk is particularly elevated in people with high myopia, those with lattice degeneration in both eyes, or those with a strong family history. Estimates suggest the lifetime risk for the fellow eye is approximately 10-15%.

Because of this increased risk, your doctor will carefully examine your other eye and may recommend preventive laser treatment if concerning findings are present. You should be vigilant about symptoms in your other eye and seek immediate evaluation if you experience flashes, floaters, or shadows.