Retinal Detachment: Warning Signs, Types and Emergency Treatment

The retina is the thin, light-sensitive layer that lines the back of the eye, a little like the film in an old camera. When it lifts away from the tissue that nourishes it, the condition is called retinal detachment. It is painless, it often begins with symptoms that seem minor, and it can lead to permanent loss of sight in that eye if it is not repaired quickly. At the same time, it is one of the most treatable eye emergencies: modern surgery reattaches the retina in the large majority of cases, especially when people act on the warning signs early.

This guide explains how a detachment develops, the symptoms you should never ignore, the main types and risk factors, and what to expect from the emergency treatments ophthalmologists (eye surgeons) use today. It is written to help you recognise a problem and get to the right place fast, not to replace an examination.

What happens in a retinal detachment?

The inside of the eye is filled with a clear jelly called the vitreous. In youth it is firm and attached to the retina at many points. With age the gel gradually liquefies and shrinks, and at some point, usually between the ages of 50 and 70, it peels away from the retina. This is called a posterior vitreous detachment (PVD) and it is a normal ageing event that happens to most people. You can read more about it in our guide to floaters and flashes.

In most people the vitreous separates cleanly. In a minority, though, it is stuck firmly to one spot and tugs hard enough to tear the retina. Once there is a hole or tear, liquid vitreous can seep through it and collect under the retina, lifting it off the back wall of the eye like wallpaper peeling away from damp plaster. The detached retina stops receiving oxygen and nutrients from the underlying layer, and the light-sensing cells (photoreceptors) begin to suffer within hours to days.

The macula, the small central area responsible for reading and recognising faces, is the most important part. If the detachment is repaired before the macula lifts off, central vision usually stays good. If the macula has already detached, vision can still improve after surgery, but recovery is often incomplete. This is the main reason eye doctors treat detachments with such urgency.

Warning signs: the symptoms you should never ignore

Retinal detachment does not hurt, and the eye usually looks completely normal from the outside. The clues are all in what you see. Typical warning symptoms include:

• A sudden shower of new floaters. Most people have a few old floaters. A burst of many new dots, specks, cobwebs or a cloud of black pepper, especially if it appears in minutes, may mean bleeding from a torn retinal vessel.
• Flashes of light (photopsia). Brief flickers or arcs of light, often at the edge of vision and most noticeable in dim light, are caused by the vitreous tugging on the retina.
• A shadow or curtain. A dark area that starts at the edge of your field of vision and spreads towards the centre, sometimes described as a veil, a grey curtain or a wall of water, means part of the retina has already detached.
• Blurred or distorted central vision. Straight lines that look wavy or a sudden drop in sharpness can mean the macula is involved.

Flashes and floaters on their own are most often caused by a harmless PVD, but nobody can tell the difference without a dilated eye examination. Studies of people who attend with sudden PVD symptoms consistently find that a meaningful minority already have a retinal tear, which is why every new episode deserves a check.

Checking each eye on its own

Because the healthy eye fills in for the affected one, a detachment can go unnoticed for some time. If you suspect a problem, cover one eye and then the other while looking at a plain wall or a door frame. A missing area, a shadow or wavy lines in one eye only are important to report. An online grid such as our Amsler grid test can help you notice central distortion, but it cannot rule out a detachment and is no substitute for urgent examination.

Types of retinal detachment

Eye doctors describe three main types, based on what causes the retina to lift.

The word rhegmatogenous comes from the Greek for a break or tear. This form accounts for the great majority of detachments in adults. Tractional detachment is most often seen in people with long-standing, poorly controlled diabetes, which is one of many reasons to attend regular screening; see our guide on diabetic retinopathy. Exudative detachments are treated by addressing the underlying cause, such as anti-inflammatory treatment for uveitis, rather than by sealing a tear.

Who is at risk?

Retinal detachment can happen to anyone, but some people are much more likely to develop it. Recognised risk factors include:

• Myopia (short-sightedness). A longer eyeball stretches and thins the retina. The risk rises with the degree of myopia, and people with high myopia have a considerably higher lifetime risk than people without it. Laser refractive surgery corrects the focusing error but does not change the shape of the eye or this underlying risk. See our myopia guide.
• Age. Detachments are most common between about 40 and 70, matching the age when the vitreous separates.
• Previous eye surgery. Cataract surgery is very safe, but it slightly increases the long-term risk of detachment, particularly in people who are also short-sighted or in cases with complications.
• Eye injury. A blunt blow, for example from a ball, a fist or a champagne cork, can tear the retina, sometimes weeks after the event.
• A detachment in the other eye. Having had a detachment in one eye increases the chance of one in the fellow eye.
• Family history. Some families carry a higher risk, and certain inherited conditions such as Stickler syndrome are strongly linked to detachment.
• Lattice degeneration. Areas of thin, weak peripheral retina found on examination in some people, often myopes.
• Diabetes and other vascular eye disease for tractional detachments.

How a detachment is diagnosed

Diagnosis is clinical and usually quick. After drops to widen (dilate) the pupils, the eye doctor examines the retina with a bright light and special lenses, sometimes pressing gently on the eyelid to see the far edges of the retina (scleral indentation). This is the only reliable way to find small peripheral tears.

If blood inside the eye blocks the view, an ultrasound scan (B-scan) can show whether the retina is attached. Optical coherence tomography (OCT), a non-invasive scan, gives detailed cross-sections of the macula and helps judge whether the centre is involved. Our guide to eye examinations explains these tests in more detail. Expect blurred vision and light sensitivity for a few hours after dilation, and do not drive until it wears off.

Emergency treatment options

The right treatment depends on whether there is only a tear or a true detachment, where the break is, how much retina is lifted, whether the macula is involved and the surgeon's experience. All approaches share the same aims: find and seal every break, relieve any traction, and let the retina settle back against the eye wall.

Sealing a tear before it detaches

When a tear is found before significant fluid has collected beneath it, it can usually be treated in the clinic in a few minutes. Laser retinopexy places a ring of tiny burns around the tear; cryotherapy uses a freezing probe applied to the outside of the eye. Both create a scar over the following one to two weeks that welds the retina down. These procedures are done with local anaesthetic drops and you go home the same day. They do not restore lost vision, but they greatly reduce the chance of the tear progressing to a detachment.

Pneumatic retinopexy

For selected detachments, typically caused by a single break in the upper part of the retina, the surgeon injects a small gas bubble into the eye. You then hold a specific head position so the bubble floats up and presses the retina back into place, after which the tear is sealed with laser or freezing. It is less invasive than other operations, but it requires strict positioning for several days and is not suitable for every case.

Scleral buckle

In this operation a soft silicone band or sponge is stitched to the outside wall of the eye (the sclera). It indents the eye wall inwards towards the tear and relieves the pull of the vitreous. The buckle usually stays in place permanently and cannot be seen. Scleral buckling is often favoured in younger patients, especially those whose vitreous has not yet separated. It can make the eye slightly more short-sighted, so glasses may need updating afterwards.

Vitrectomy

Vitrectomy is now the most commonly performed operation for retinal detachment in many countries. Using fine instruments inserted through tiny ports in the white of the eye, the surgeon removes the vitreous gel, flattens the retina, treats the breaks with laser and fills the eye with a gas bubble or, in complex cases, silicone oil. The gas is slowly absorbed and replaced by the eye's own fluid over a few weeks. Silicone oil does not disappear and usually needs a second operation to remove it. Vitrectomy speeds up cataract formation in people who still have their natural lens, so many patients later need cataract surgery.

Recovery after surgery

Recovery takes weeks rather than days. Your surgeon will give specific instructions, but common elements include:

1. Head positioning. After gas or pneumatic procedures you may need to keep your head in a set position for much of the day for several days so the bubble presses on the right spot.
2. No flying or high altitude while gas is in the eye. Gas expands at altitude and can dangerously raise eye pressure. The same applies to nitrous oxide anaesthesia, so always tell any doctor or dentist that you have gas in your eye. Many surgeons fit a wristband as a reminder.
3. Drops. Antibiotic and anti-inflammatory drops are used for several weeks. Our guide on using eye drops correctly can help.
4. Activity. Avoid heavy lifting, contact sport and swimming until your surgeon agrees. Light walking is usually fine.
5. Vision. Sight is very blurred while gas fills the eye; you may see a wobbling line as it shrinks. Final vision may take several months to settle.

Most detachments are successfully reattached with a single operation, and a further procedure can repair many of those that recur. A condition called proliferative vitreoretinopathy, in which scar tissue forms on the retina, is the most common reason for failure. How well you eventually see depends mainly on how long the macula was detached and on any other eye conditions.

Reducing your risk and protecting your sight

Most detachments cannot be completely prevented, but you can reduce the chance of losing sight from one:

• Learn the warning signs and share them with family members, particularly if you are short-sighted or have had eye surgery.
• Wear appropriate protective eyewear for racket sports, ball games, power tools and workshops; see our guide to eye safety at work and in sports.
• Keep diabetes and blood pressure well controlled and attend retinal screening.
• Have regular eye examinations, and a dilated check soon after any significant eye injury.
• If you have had a detachment in one eye, ask whether the other eye needs preventive treatment of weak areas.

When to see a doctor

Retinal detachment is one of the situations in eye care where hours can matter. Seek urgent same-day assessment if you experience:

If you were examined for new floaters and told your retina is fine, return promptly if symptoms change: a new burst of floaters, more flashes or any shadow mean you need another check, because a tear can develop in the weeks after a vitreous detachment.