What is retinal detachment?
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.
What causes retinal detachment?
Retinal detachment usually happens because there's a tear (hole) in the retina. The most common cause of a tear is posterior vitreous detachment (PVD). Vitreous gel fluid flows through the tear, pools beneath the retina, and lifts the retina off the back of the eye.
Retinal detachment can also happen without a retinal tear. Scar tissue buildup in the eye may pull on the retina. This is called traction. Or, fluid can build up under the retina for a different reason than a retinal tear.
Some of the reasons that make a person more likely to get a retinal detachment are an eye or head injury, nearsightedness, eye disease, and 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 see floaters and flashes of light before they have symptoms of retinal detachment. 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 right away.
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, air bubbles, or a freezing probe to seal a tear in the retina and reattach the retina.
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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 (vitreous gel) to collect under the retina. A common cause of retinal tears is posterior vitreous detachment (PVD). 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 . If tissue builds up between the vitreous gel and the retina, it can pull the retina away from the back of the eye. 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 under the retina can cause the retina to come off the back of the eye. Fluid buildup may be caused by inflammation or disease in the retina, in the layer just beneath the retina (choroid), in blood vessels, or in tissues in the eye.
- For more information about and pictures of the eye and how it works, see Eye Anatomy and Function.
Most cases of retinal detachment begin with a retinal tear. A retinal tear or another eye problem may cause:
- 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 tears in the retina.
- 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.
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 examination.
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. 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.
In rare cases, 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.
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 centre 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.
Retinal tears and holes, though, 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.
What Increases Your Risk
Things that increase your risk for retinal detachment include:
- A family history of retinal detachment.
- Previous retinal detachment in the other eye.
- 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 pulling (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 tumours.
When To Call a Doctor
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 centre 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 examination and quick treatment can send you home relieved or, if there is a problem, can save your vision.
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 examination and possible treatment.
Treatment for retinal tears and detachments is often done by an eye doctor who specializes in retinal detachments.
Examinations and Tests
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.
Depending on your age, it's important to have routine eye examinations so that your eye doctor can look for retinal tears or other eye problems that could lead to retinal detachment. 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 having more frequent examinations to detect problems in their early stages.
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.
Only surgery can repair retinal detachment. It is usually successful and, in many cases, restores good vision.
For more information, see Surgery.
You cannot prevent most cases of retinal detachment. But having routine eye examinations is important so that your eye doctor can look for signs that you might be more likely to have a 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 examinations and by keeping your blood sugar levels within a target range.
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.
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 need to keep your head in a certain position for a few days or weeks, so that the gas bubble won't move. Also, you may need to avoid air travel until your eye has healed and the bubble is gone, because the changes in air pressure may cause pain and affect your eye.
If you have reduced vision after treatment, your eye doctor can help you learn ways to keep your independence and continue the activities you enjoy.
Surgery for retinal detachment
Surgery is the only treatment for retinal detachment. The goals of surgery are:
- To reattach the retina.
- To prevent or reverse vision loss.
Almost all retinal detachments can be repaired with scleral buckle surgery, pneumatic retinopexy, or vitrectomy.
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. When the retina loses contact with its supporting layers, vision begins to get worse. An eye doctor (ophthalmologist) who specializes in retinal detachments will usually do 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. When 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.
- If the macula has become detached, surgery may occur a few days later than it would have otherwise. Good vision after surgery is still possible but less likely.
Your doctor will decide how soon you need surgery based on the result of the retinal examination 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.
Common methods of repairing a retinal detachment include:
- 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 lightly presses the detached retina to the wall of the eye. The eye doctor then uses a freezing probe (cryopexy) or laser beam (photocoagulation) to seal the tear in the retina.
- Scleral buckling surgery. Your eye doctor 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 pulling (traction) on the retina, preventing tears from getting worse, and it supports the layers of 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.
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.
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 if scar tissue from the first surgery grows over the surface of your retina.
Things that may make surgery more difficult include:
- 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).
After surgery, you may need to use antibiotic eyedrops and corticosteroid medicines for a short time.
Other Works Consulted
- American Academy of Ophthalmology (2008). Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology.
- Fletcher EC, et al. (2008). Retina. In P Riordan-Eva, JP Whitcher, eds., General Ophthalmology, 17th ed., pp. 186–211. New York: McGraw-Hill.
- Kang HK, Luff AJ (2008). Management of retinal detachment: A guide for non-ophthalmologists. BMJ, 336(7655):1235–1240.
- Steel D (2014). Retinal detachment. BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/pdf/clinical-evidence/en-gb/systematic-review/0710.pdf. Accessed March 21, 2014.
- Trobe JD (2006). Retinal detachment section of Principal ophthalmic conditions. In Physician's Guide to Eye Care, 3rd ed, pp. 124–129. San Francisco: American Academy of Ophthalmology.
- Wilkinson CP (2012). Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database of Systematic Reviews (3).
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Donald Sproule, MDCM, CCFP - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Carol L. Karp, MD - Ophthalmology
Christopher Joseph Rudnisky, MD, MPH, FRCSC - Ophthalmology
Current as ofDecember 3, 2017