Retinal Detachment

What is retinal detachment?

The retina is a thin membrane of nerve tissue that lines the back of the eye. Retinal detachment occurs when the inner layer of the retina separates from the wall of the eye.

The nerve cells in the retina normally detect light entering the eye and send signals to the brain about what the eye sees. But when the retina detaches, it no longer works correctly. It can cause blurred and lost vision. Retinal detachment requires immediate medical care. If done soon enough, surgery can save lost vision.

See a picture of a detached retina.

What causes retinal detachment?

Retinal detachment often begins when the vitreous, a thick gel that fills the center of the eye, shrinks and separates from the retina. Called a posterior vitreous detachment (PVD), this often occurs as you age and can be harmless. Sometimes, though, PVD can tear the retina. This happens where the vitreous gel is strongly attached to the retina. As the vitreous gel shrinks, it pulls so hard that the retina tears. The tear allows fluid to collect under the retina and may cause the retina to detach.

Other things that can cause retinal detachment are an eye or head injury, nearsightedness (myopia), eye disease, and conditions such as diabetes.

Unfortunately, most cases of retinal detachment cannot be prevented. But seeing your eye doctor regularly, wearing protective helmets and eyeglasses, and treating diabetes may help protect your vision.

What are the symptoms?

Many people have symptoms of a posterior vitreous detachment, or PVD, before they have symptoms of retinal detachment. When the vitreous gel shrinks and separates from the retina, it causes floaters and flashes. Floaters are spots, specks, and lines that float through your field of vision. Flashes are brief sparkles or lightning streaks that are most easily seen when your eyes are closed. They often appear at the edges of your visual field. Floaters and flashes do not always mean that you will have a retinal detachment. But they may be a warning sign, so it is best to be checked by a doctor.

Sometimes a retinal detachment happens without warning. The first sign of detachment may be a shadow across part of your vision that does not go away. Or you may have new and sudden loss of side (peripheral) vision that gets worse over time.

How is retinal detachment diagnosed?

To diagnose retinal detachment, your doctor will examine your eyes and ask you questions about any symptoms you have.

If you have symptoms of retinal detachment, your doctor will use a lighted magnifying tool called an ophthalmoscope to examine your retina. With this tool, your doctor can see holes, tears, or retinal detachment.

How is it treated?

Retinal detachment requires care right away. Without treatment, vision loss can progress from minor to severe or even to blindness within a few hours or days.

Surgery is the only way to reattach the retina. In most cases, surgery can restore good vision. There are many ways to do the surgery, such as using lasers or a freezing probe to seal the tear in the retina.

Frequently Asked Questions

Retinal detachment most often results when the vitreous gel, the thick fluid that fills the center of the eye, shrinks and separates from the retina. This is called posterior vitreous detachment (PVD). PVD is most common in people older than 60. But an eye or head injury, eye disease, and conditions such as diabetes can lead to retinal detachment at any age. Nearsightedness also raises your risk of retinal detachment.

Causes of retinal detachment are:

• Tears or holes in the retina. These may lead to retinal detachment by allowing fluid from the middle of the eye to collect under the retina. An eye or head injury or other eye disorders, such as lattice degeneration, a condition in which the retina becomes very thin, may also cause tears or holes in the retina.
• Traction on the retina. Traction pulls the retina away from the layers beneath it. The most common cause of this problem is proliferative diabetic retinopathy, a condition that leads to the growth of scar tissue that can pull on the retina.
• Fluid buildup under the retina. Fluid buildup causes the layers of the retina to separate, resulting in retinal detachment. Fluid buildup may be caused by inflammation or disease in the retina, the layer just beneath the retina (choroid), blood vessels, or tissues in the eye.

For more information and illustrations about the eye and how it works, see eye anatomy and function.

Most cases of retinal detachment begin when the vitreous gel that fills the center of the eye shrinks and separates from the retina (called posterior vitreous detachment, or PVD). Symptoms of PVD include:

• Floaters in your field of vision. Floaters are thick strands or clumps of solid vitreous gel that develop as the gel ages and breaks down. Floaters often appear as dark specks, globs, strings, or dots. Floaters may also be caused by loose blood or pigment from retina tears.
• Flashes of light or sparks when you move your eyes or head. These are easier to see against a dark background. The brief flashes occur when the vitreous gel tugs on the retina (vitreous traction). These flashes usually appear at the edge of your visual field.

Although an occasional floater is normal, floaters and flashes may be warning signs of retinal detachment. A sudden shower of what appear to be hundreds or thousands of little black dots across the field of vision is a distinctive sign of blood and/or pigment in the vitreous gel and may indicate a retinal detachment. This requires immediate medical attention.

Having floaters or flashes does not always mean that you are about to have a retinal detachment, but you should not ignore these symptoms. Call your doctor to discuss whether you need to have an eye exam. If you have a posterior vitreous detachment, your doctor needs to examine your retina to determine your risk for a retinal tear or detachment, if one has not already occurred. If you have a retinal tear, early treatment may prevent a retinal detachment.

Rarely, a retinal detachment can occur without warning. The first signs may be:

• A shadow or curtain effect across part of your visual field that does not go away. Because detachments usually affect peripheral (side) vision first, you may not notice a problem until the detachment has gotten bigger.
• New or sudden vision loss. Vision loss caused by retinal detachment tends to get worse over time. Sudden vision loss is a medical emergency.

If you have new or sudden flashes or floaters, darkness over part of your visual field, or a new loss of vision that does not go away, call your eye doctor or regular doctor right away.

Retinal detachment can progress quickly. Because retinal detachment affects side (peripheral) vision first, you may not notice the vision loss right away. If not treated, detachment can spread to the center of the retina (macula) and damage central vision.

Retinal detachment requires urgent care. Without treatment, vision loss from retinal detachment can progress from minor to severe or even to blindness within a few hours or days.

See an illustration of a detached retina.

Retinal tears and holes, however, may not need treatment. The retina sometimes develops small, round holes as it ages, and many of them will not lead to retinal detachment. Retinal tears caused by the vitreous gel pulling on the retina (vitreous traction) are more likely to cause retinal detachments.

Tears in the retina caused by vitreous traction tend to cause flashes and floaters. A tear that does not occur with vitreous traction and therefore develops without symptoms is far less likely to lead to a retinal detachment than a tear that occurs with symptoms.

If the retina has detached, you will need surgery to reattach it and restore vision. If you have had a retinal detachment in one eye, you have a greater chance of developing one in the other eye.

Things that increase your risk for retinal detachment include:

• A family history of retinal detachment.
• Previous retinal detachment in the other eye.
• Recent posterior vitreous detachment, in which the vitreous gel shrinks and separates from the retina.
• Lattice degeneration, an inherited condition in which parts of the retina become very thin and are easily torn.
• Age older than 50.
• Nearsightedness (myopia). The shape of a nearsighted eye results in more traction on the retina. This in turn can cause premature posterior vitreous detachment. The retina is also thinner and more likely to tear in people who are nearsighted.
• Surgery for cataracts. People who have had cataract surgery are at increased risk for later developing retinal detachment.
• Blunt injury or blow to the head.
• Injury to the eye.
• Diabetes, which can lead to proliferative diabetic retinopathy.
• Other eye disorders or eye tumors.

Flashes of light and floaters often occur as you get older or with migraine headaches. Flashes of light in migraine headaches are often located in the center of your visual field. But flashes of light and floaters can also be signs of a problem that might lead to retinal detachment.

If flashes of light or floaters occur suddenly or in great numbers, or if you are not sure what to do, do not wait for vision loss to occur before you call your doctor. If you cannot reach your doctor, go to the emergency room. Although these symptoms do not cause pain and may seem harmless, getting an eye exam and quick treatment can send you home relieved or, if there is a problem, can save your vision.

Watchful Waiting

Taking a wait-and-see approach, called watchful waiting, is not an option if you have new or sudden flashes or floaters, darkness over part of your visual field, or a new loss of vision that does not go away. Sudden, rapid vision loss is a medical emergency.

Who To See

If you have symptoms that suggest that you might have or are at immediate risk for a retinal detachment, call your doctor immediately. If you do not have an eye doctor (ophthalmologist), call your regular doctor. Based on your symptoms, risk factors, and medical history, your doctor may refer you to an eye doctor for an immediate exam and possible treatment.

Treatment for retinal tears and detachments is often done by an eye doctor who specializes in retinal detachments.

To prepare for your appointment, see the topic Making the Most of Your Appointment

To diagnose retinal detachment, your doctor will ask you questions about your symptoms, past eye problems, and risk factors. The doctor will also test your near and distance vision (visual acuity) and side (peripheral) vision. These routine vision tests do not detect retinal detachment, but they can find problems that could lead to or result from retinal detachment.

A doctor can usually see a retinal tear or detachment while examining the retina using ophthalmoscopy. This test allows the doctor to see inside the back of the eye using a magnifying instrument with a light.

If a retinal tear or detachment involves blood vessels in the retina, you may have bleeding in the middle of the eye. In these cases, your doctor can view the retina using ultrasound, a test that uses sound waves to form an image of the retina on a computer screen.

Early Detection

If you have a condition that puts you at high risk for retinal detachment—such as nearsightedness, recent cataract surgery, diabetes, a family history of retinal detachment, or a prior retinal detachment in your other eye—talk to your doctor about how often you should have your eyes checked. You may need more frequent exams to detect problems in their early stages.

Many retinal detachments are triggered when the vitreous gel that fills the center of the eye shrinks and separates from the retina, which is called posterior vitreous detachment (PVD). The main symptoms of PVD are dark floaters and flashes of light. It is important to pay attention to these symptoms, because they could be a warning sign of a retinal tear that can lead to detachment. Getting treatment quickly after you notice these symptoms can save your vision.

Only surgery can repair retinal detachment. It is usually successful and, in many cases, restores good vision.

The most common methods of repairing a retinal detachment are:

• Scleral buckling surgery. Your eye doctor (ophthalmologist) places a piece of silicone sponge, rubber, or semi-hard plastic on the outer layer of your eye and sews it in place. This relieves traction on the retina, preventing tears from getting worse, and it supports the layers of the retina.
• Pneumatic retinopexy. Your eye doctor injects a gas bubble into your eye. The bubble floats to the detached area and presses lightly against the tear, closing the tear and flattening the retina so that no fluid can build up under it. Your doctor then uses a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear in the retina.
• Vitrectomy, or the removal of the vitreous gel from the eye. Vitrectomy gives the eye doctor better access to the retina to repair holes and close very large tears.

The most common methods of repairing a retinal tear are:

• Laser photocoagulation. Your eye doctor uses an intense beam of light that travels through the eye to make tiny burns around the tear in the retina. The burns form scar tissue, which prevents fluid from entering the tear and collecting under the retina.
• Cryopexy (freezing). Your eye doctor uses a probe to freeze and seal the retina around the tear.

Retinal tears that occur with symptoms (such as floaters or flashes of light) are more likely to lead to a detachment. In these cases, repairing the tear can often prevent detachment. The decision to treat a tear depends on whether the tear is likely to progress to a detachment. For more information, see when to treat a retinal tear.

If you have new or sudden flashes or floaters, darkness over part of your visual field, or a new loss of vision that does not go away, see a doctor or seek emergency care immediately. Sudden, rapid vision loss is a medical emergency.

You cannot prevent most cases of retinal detachment.

Some eye injuries can damage the retina and cause detachment. You can reduce your risk of these types of injuries if you:

• Wear safety glasses when you use a hammer or saw, work with power tools or yard tools such as weed eaters and lawn mowers, or do any activity that might result in small objects flying into your eye.
• Wear special sports glasses or goggles during boxing, racquetball, soccer, squash, and other sports in which you might receive a blow to the eye.
• Use appropriate safety measures when you use fireworks or firearms.

Diabetes puts you at greater risk for developing diabetic retinopathy, an eye disease that can lead to tractional retinal detachment. If you have diabetes, you can help control and prevent eye problems by having regular eye exams and by keeping your blood sugar levels as close to normal as possible.

Treating a retinal tear can often prevent retinal detachment, but not all tears need treatment. The decision to treat a tear depends on whether the tear is likely to progress to a detachment. For more information, see when to treat a retinal tear.

You cannot treat retinal detachment at home. Surgery is the only treatment.

After surgery to repair retinal detachment, your doctor may give you specific instructions to help your eye recover. You may need to rest and sleep with your head in a certain position, for example, and you may be asked to wear an eye patch or use eyedrops.

Some types of surgery to treat retinal detachments involve injecting a small bubble of gas into the eye. Afterward, you may be asked to avoid air travel until your eye has healed, because the changes in air pressure may cause pain and affect your eye.

There is no medication to treat retinal detachment.

Surgery for retinal detachment

Surgery is the only treatment for retinal detachment. The goals of surgery are:

• To reattach the retina. See an illustration of a detached retina.
• To prevent or reverse vision loss.

Almost all retinal detachments can be repaired with scleral buckle surgery or pneumatic retinopexy.¹

But even with such a high rate of success for surgery, it is important to act quickly. The longer you wait to have surgery, the lower the chances that good vision will be restored. Once the retina loses contact with its supporting layers, vision begins to get worse. An eye doctor (ophthalmologist) who specializes in retinal detachments will usually perform surgery within a few days of your being diagnosed with a detachment.

How soon you need surgery usually depends on whether the retinal detachment has or could spread far enough to affect central vision. Once the macula, the part of the retina that provides central vision, loses contact with the layer beneath it, it quickly loses its ability to process what the eye sees.

• Having surgery while the macula is still attached will usually save vision. But surgery restores good vision in less than half of people who have surgery after the macula has already become detached.¹
• If the macula has become detached, surgery may be delayed. If more than a few days have passed since the detachment occurred, severe central vision loss may already have occurred, and surgery is much less likely to restore vision completely.

Your doctor will decide how soon you need surgery based on the result of the retinal exam and the doctor's experience in treating retinal detachment.

Surgery for retinal tears

Treating a retinal tear may be useful if the tear is likely to lead to detachment. Symptoms such as floaters or flashing lights are key factors in deciding whether to treat a tear. A tear that occurs right after a posterior vitreous detachment (PVD) with symptoms is usually much more dangerous and more likely to progress to a retinal detachment than one that occurs without symptoms.

In deciding when to treat a retinal tear, your doctor will evaluate whether the torn retina is likely to detach. If the tear is very likely to lead to detachment, treatment can usually repair it and prevent detachment and potential vision loss. If the tear is not likely to lead to detachment, you may not need treatment.

Surgery Choices

The most common methods of repairing a retinal detachment include:

• Scleral buckling surgery. This is the most common way to repair a detached retina. Your eye doctor (ophthalmologist) places a piece of silicone sponge, rubber, or semi-hard plastic on the outer layer of your eye and sews it in place. This relieves traction on the retina, preventing tears from getting worse, and it supports the layers of the retina.
• Pneumatic retinopexy. In this procedure, your eye doctor injects a gas bubble into the middle of the eyeball. The gas bubble floats to the detached area and presses lightly against the detached retina, flattening it so that the fluid below it can be reabsorbed. The eye doctor then uses a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear in the retina.
• Vitrectomy. This is the removal of the vitreous gel from the eye. Vitrectomy gives your eye doctor better access to the retina and other tissues. It allows him or her to peel scar tissue off the retina, repair holes, close very large tears, and directly flatten a retinal detachment.

The most common methods of repairing a retinal tear include:

• Laser photocoagulation, in which an intense beam of light travels through the eye and makes tiny burns around the tear in the retina. The burns form scars that prevent fluid from getting under the retina.
• Cryopexy (freezing), in which your eye doctor uses a probe to freeze and seal the retina around the tear.

The decision about when to treat a retinal tear is based on whether the tear is likely to progress to a retinal detachment. If the tear is not likely to lead to a detachment, treatment may not be necessary.

What To Think About

You have several surgical options to repair a retinal detachment. Their success in restoring good vision varies from case to case. The cause, location, and type of detachment usually determine which surgery will work best. Other conditions or eye problems may also play a role when you choose the best type of surgery.

You may need more than one surgery to reattach the retina. The growth of scar tissue on the surface of the retina often leads to failure of retinal detachment surgery.

Factors that may make surgery more difficult include:

• Glaucoma.
• Pupils that will not get larger (dilate).
• Infection inside or outside the eye.
• Scarring from previous surgery.
• Bleeding (hemorrhage) in the vitreous gel.
• Scars on or cloudiness in the cornea.
• Clouding of the lens (cataract).

Surgery is the only treatment for retinal detachment at this time.

Organizations

• Eye Injuries

Citations

1. Mieler WF (2002). Rhegmatogenous retinal detachment section of Vitreous/vitreoretinal disorders. In DH Gold et al., eds., Clinical Eye Atlas, pp. 812-815. Chicago: AMA Press.

Other Works Consulted

• American Academy of Ophthalmology (2003). Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology.