ConditionEyes & vision
Retinal Detachment
Retinal detachment happens when the retina, the light-sensing layer at the back of the eye, peels away from the wall of the eye. It is painless but a medical emergency: without prompt surgery it usually leads to permanent vision loss in that eye. Warning signs are a sudden shower of new floaters, flashes of light, and a dark shadow or curtain spreading across part of your vision. Most detachments start with a retinal tear. Risk is higher with nearsightedness, age over 50, previous eye surgery or injury.
Also called: Detached retina, rhegmatogenous retinal detachment, retinal tear and detachment
At a glance
- What it is
- Separation of the retina from the back wall of the eye, cutting off its blood and oxygen supply.
- Warning signs
- Sudden new floaters, flashes of light, a curtain or shadow over vision, or blurred central vision.
- Types
- Rhegmatogenous (from a tear, most common), tractional (scar tissue pulling, as in diabetes) and exudative (fluid leaking behind the retina).
- Risk factors
- Nearsightedness, age 50 to 75, cataract surgery, eye injury, previous detachment and family history.
- Treatment
- Laser or freezing for tears. Pneumatic retinopexy, scleral buckle or vitrectomy for detachments.
When to get help
Call 911 or go to the ER
- A gray curtain or shadow moving across your vision, or sudden loss of part of your vision: see an ophthalmologist or go to an ER the same day
- A sudden shower of new floaters, with or without flashes of light
- Sudden blurring of central vision with distortion, especially after floaters
See a doctor within a day or two
- New flashes of light or a few new floaters in one eye, even without vision loss (an eye exam within 24 hours is recommended)
- Eye symptoms after a blow to the eye or head
Book a routine appointment
- Long-standing floaters that are not changing
- High nearsightedness or a family history of retinal detachment (regular dilated eye exams)
How retinal detachment happens
The inside of the eye is filled with vitreous, a clear gel. With age, the vitreous liquefies and shrinks, pulling away from the retina. This is posterior vitreous detachment (PVD), common after 50 and usually harmless, causing new floaters and flashes. See posterior vitreous detachment.
In some people, the vitreous pulls hard enough on the retina to tear it. Fluid then passes through the tear and lifts the retina off, like wallpaper peeling from a damp wall. Once detached, retinal cells lose their blood supply and begin to die.
Types
| Type | Cause | Typical setting |
|---|---|---|
| Rhegmatogenous | A tear or hole lets fluid under the retina | Most common. Nearsightedness, PVD, after cataract surgery, injury |
| Tractional | Scar tissue on the retina pulls it off | Advanced diabetic retinopathy, sickle cell disease, premature babies |
| Exudative (serous) | Fluid builds up behind the retina without a tear | Inflammation, tumors, severe high blood pressure, central serous chorioretinopathy |
Symptoms
Retinal detachment is painless. Warning signs:
- floaters: a sudden increase in specks, cobwebs or a "swarm of flies"
- flashes: brief flickers or lightning streaks, often at the side of vision and more noticeable in the dark
- shadow or curtain: a dark area spreading from the side, top or bottom of vision
- blurred or distorted vision, especially if the central retina (macula) detaches
Some detachments develop slowly and are found during routine exams.
Risk factors
- nearsightedness (myopia), especially high degrees
- age 50 to 75
- previous cataract or other eye surgery
- previous retinal detachment in the other eye
- family history of retinal detachment
- lattice degeneration, a thinning of the peripheral retina
- eye injury
- diabetic retinopathy and other retinal disease
- certain genetic conditions such as Stickler syndrome
Diagnosis
An ophthalmologist examines the retina after dilating the pupils, using indirect ophthalmoscopy and a slit lamp, often pressing gently on the eye to see the far edges. Ultrasound is used if bleeding or a cataract blocks the view. Optical coherence tomography (OCT) shows whether the macula is involved.
About 1 in 7 people with sudden symptoms of PVD have a retinal tear, which is why anyone with new flashes or floaters should have a dilated exam promptly.
Treatment
Retinal tears (before detachment)
- laser photocoagulation or cryotherapy (freezing) creates a scar around the tear that seals the retina in place. These are quick office procedures and prevent most tears from progressing to detachment
Retinal detachment
| Procedure | How it works | Notes |
|---|---|---|
| Pneumatic retinopexy | A gas bubble is injected into the eye to press the retina back, then the tear is sealed with laser or freezing | Office procedure for certain detachments. Requires strict head positioning |
| Scleral buckle | A silicone band is sewn onto the outside of the eye to push the wall toward the retina | Often used in younger people. Can increase nearsightedness |
| Vitrectomy | The vitreous gel is removed, the retina flattened, and the eye filled with gas or silicone oil | Most common surgery today, especially in older adults |
Many people need a combination. Success rates for reattaching the retina with one operation are around 80 to 90%, with higher overall success after further surgery.
After surgery
- head positioning for days to weeks if a gas bubble is used
- no air travel, high altitude or nitrous oxide anesthesia while a gas bubble is in the eye, because it can expand and raise eye pressure dangerously
- eye drops to prevent infection and inflammation
- vision improves gradually over weeks to months
Outlook
Outcomes depend mainly on whether the macula was detached and for how long. If the macula is still attached at surgery, good central vision is often preserved. If it has detached, some central vision is usually lost, although many people still recover useful vision. Scar tissue (proliferative vitreoretinopathy) is the main cause of redetachment.
Prevention
- know the warning signs and act quickly
- have dilated eye exams if you are highly nearsighted, have had a detachment in the other eye, or have a family history
- wear protective eyewear for sports and risky work
- control diabetes and blood pressure
Frequently asked questions
What are the warning signs of retinal detachment?
The main warning signs are a sudden increase in floaters, flashes of light, and a shadow or curtain spreading across your vision. Blurred or distorted central vision can also occur. Retinal detachment is painless, so do not wait for pain before seeking care.
Is retinal detachment an emergency?
Yes. A detached retina loses its blood supply and can cause permanent vision loss within hours to days. See an ophthalmologist or go to an ER the same day if you notice a curtain over your vision or a sudden shower of floaters.
Can a retinal tear heal on its own?
Small tears sometimes do not progress, but there is no way to know which will. Most symptomatic tears are treated with laser or freezing in the office, which seals the retina and greatly lowers the risk of detachment.
How long does recovery from retinal detachment surgery take?
Initial recovery takes 2 to 6 weeks. If a gas bubble is used, you may need to keep your head in a specific position and avoid flying until the bubble disappears. Vision can keep improving for several months.
Will I regain my vision after a retinal detachment?
It depends on whether the macula detached and how quickly surgery was done. If the macula was still attached, central vision is often preserved. If it detached, some vision loss is common, but many people regain useful vision.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: Detached retina; Preferred Practice Pattern, Posterior vitreous detachment, retinal breaks and lattice degeneration
- National Eye Institute: Retinal detachment
- American Society of Retina Specialists: Retinal detachment
- MedlinePlus: Retinal detachment
- NHS: Retinal detachment