Retinal Detachment: Causes, Symptoms and Treatment

What Is Retinal Detachment?

The retina is a thin layer of light-sensitive tissue lining the inside of the back of the eye. It converts light into electrical signals that travel via the optic nerve to the brain, creating vision. Beneath the retina sits the retinal pigment epithelium (RPE), which supplies oxygen and nutrients to the photoreceptor cells.

When the retina separates from the RPE — a retinal detachment — photoreceptors are rapidly deprived of their blood supply. Without prompt treatment, these cells begin to die and vision is permanently lost. The longer the detachment persists, especially if the central retina (the macula) is involved, the worse the visual outcome.

Types of Retinal Detachment

• Rhegmatogenous (most common)— A tear or break in the retina allows liquid vitreous to pass underneath, progressively lifting the retina away from the RPE. This is the type most commonly requiring emergency surgery and is often preceded by a posterior vitreous detachment (PVD).
• Tractional— Fibrous scar tissue on the surface of the retina (often from diabetic retinopathy or a previous eye injury) contracts and mechanically pulls the retina away from the RPE. There is no break — the retina is physically tugged off.
• Exudative (secondary)— Fluid accumulates beneath the retina without a tear or traction, typically due to an underlying condition such as an ocular tumour, severe uveitis or hypertensive retinopathy. Treatment targets the underlying cause rather than the retina directly.

Risk Factors

Anyone can develop a retinal detachment, but certain factors increase the risk significantly:

• • High myopia (short-sightedness) — a longer eyeball means a thinner, more stretched retina with greater risk of peripheral tears
• • Prior cataract surgery or eye trauma — both can alter vitreous dynamics and increase traction
• • Previous retinal detachment in the fellow eye — risk is elevated in the second eye
• • Family history of retinal detachment
• • Posterior vitreous detachment (PVD) — the vitreous gel liquefies and collapses with age; if it pulls strongly at a weak point, a tear can form
• • Lattice degeneration (thinning of the peripheral retina)

Symptoms & Warning Signs

Retinal detachment is painless, which is why recognising the visual warning signs is critical:

• • Sudden flashes of light (photopsia) — especially in peripheral vision, often described as lightning streaks
• • A sudden shower of new floaters — cobwebs, spots or a dark cloud floating in vision; caused by vitreous pulling or blood in the vitreous
• • A grey curtain or shadow advancing from one side across the visual field
• • Reduced or distorted central vision if the macula becomes involved
• • A sensation of “a veil” over part of the visual field that does not clear

Treatment Options

Surgery is always required for a rhegmatogenous or tractional retinal detachment. There is no medical or laser treatment that can reattach the retina once fluid has passed beneath it. The choice of surgical approach depends on the type of detachment, location of the tear, extent of involvement and the surgeon’s assessment.

• Pneumatic retinopexy— A gas bubble is injected into the vitreous cavity, where it floats up and presses against the tear, sealing it. Laser or cryotherapy is applied around the break to create a permanent adhesion. This is an outpatient procedure suited to selected cases with superior breaks. The patient must maintain a specific head position for several days.
• Scleral buckling— A silicone band is sutured around the outside of the eye to indent the sclera inward, reducing traction on the retinal break and supporting reattachment. Often used for younger patients or those with inferior breaks.
• Pars plana vitrectomy (PPV)— The most versatile approach. The vitreous gel is removed, the subretinal fluid drained, the break treated with laser, and the eye filled with a gas bubble or silicone oil to tamponade the retina. PPV is used for complex detachments, including tractional and posterior breaks.

Recovery

Recovery depends on the surgical approach and the extent of the detachment before surgery:

• • If a gas bubble was used, face-down or specific head positioning is required for several days to weeks to ensure the bubble tamponades the correct area of retina
• • Air travel is prohibited until the gas bubble has fully absorbed (usually 6–8 weeks), as altitude changes cause the gas to expand and dangerously raise eye pressure
• • Vision typically improves gradually over weeks to months; central vision recovery is better the sooner the macula is reattached
• • A second operation is sometimes needed if the retina re-detaches or proliferative vitreoretinopathy (PVR) develops

Success rates are high — greater than 85–90% achieve reattachment with a single operation — but final visual acuity depends critically on whether the macula was involved and for how long.

Conclusion

Retinal detachment is one of the most time-critical emergencies in ophthalmology. Recognising the warning signs — sudden flashes, a shower of floaters or a curtain across the vision — and seeking immediate assessment can mean the difference between full vision recovery and permanent vision loss. Modern surgical techniques achieve excellent reattachment rates, but only when the diagnosis and treatment are not delayed.

Frequently Asked Questions