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The retina is a thin membrane of nerve tissue that lines the back of the eye. When part or all of the retina comes off (detaches from) the back of the eye, it is called 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.
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.
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.
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.
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. 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:
Most cases of retinal detachment begin with a retinal tear. A retinal tear or another eye problem may cause:
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 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:
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.
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. 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:
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.
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.
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 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.
It's important to have routine eye exams 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 exams to detect problems in their early stages.
If you notice floaters or flashes of light, let your doctor know about it right away. These symptoms could be a warning sign of a retinal tear that can lead to detachment.
Only surgery can repair retinal detachment. For more information, see Surgery.
You cannot prevent most cases of retinal detachment. But having routine eye exams 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:
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 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 is the only treatment for retinal detachment. The goals of surgery are:
Almost all retinal detachments can be repaired with scleral buckle surgery, pneumatic retinopexy, or vitrectomy.
But 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.
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.
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:
Common methods of repairing a retinal tear include:
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:
After surgery, you may need to use antibiotic eyedrops and corticosteroid medicines for a short time.
Other Works Consulted
American Academy of Ophthalmology (2014). Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. https://www.aao.org/ppp. Accessed July 5, 2018.
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 (2014). Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database of Systematic Reviews(9): CD003170. DOI: 10.1002/14651858.CD003170.pub4. Accessed July 5, 2018.
Current as of: May 5, 2019
Author: Healthwise StaffMedical Review: Adam Husney, MD - Family MedicineE. Gregory Thompson, MD - Internal Medicine
Current as of:
May 5, 2019
Medical Review:Adam Husney, MD - Family Medicine & E. Gregory Thompson, MD - Internal Medicine
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