What is retinal detachment?
Retinal detachment, or a detached retina, is a serious eye condition that affects your vision and can lead to blindness if not treated. It happens to a layer of tissue called the retina that lines the back of the eye. It involves the retina pulling away from tissues supporting it. Symptoms include flashes of light, floaters or seeing a shadow in your vision. Floaters are dark spots and squiggles in your vision.
You may experience warning signs like these before the retina detaches, as in the case of retinal tears. Retinal detachment often happens spontaneously, or suddenly. The risk factors include age, nearsightedness, history of eye surgeries or trauma, and family history of retinal detachments.
Call your eye care provider or go to the emergency room right away if you think you have a detached retina.
What does the retina do?
The retina senses light and sends signals to the brain so we can see. When the retina detaches, it can’t do its job. Your vision might become blurry. And you might lose vision permanently if the detachment isn’t repaired. Getting prompt treatment can save your eyesight.
Who is at risk for retinal detachment?
Your risk for retinal detachment increases as you age. You’re also at higher risk if you have or had:
- Eye injury.
- Family history of retinal detachment.
- Intraocular surgery (any surgery involving the eye, like cataract surgery).
Having certain eye conditions also raises your risk for retinal detachment:
- Significant myopia, or nearsightedness.
- Posterior vitreous detachment, where vitreous (thick fluid in the middle of the eye) pulls away from the retina.
- Other eye conditions, such as lattice degeneration (retina thinning).
- History of retinal tears or detachments in the other eye.
If you’re at high risk for retinal detachment, talk to your healthcare provider. Your provider can help you set an eye exam and suggest other steps to protect your eye health.
How common is retinal detachment?
Retinal detachment is rare for people who have none of the risk factors listed here.
Symptoms and Causes
What causes retinal detachment?
The three causes of retinal detachment are:
- Rhegmatogenous: The most common cause of retinal detachment happens when there’s a small tear in your retina. Eye fluid called vitreous can travel through the tear and collect behind the retina. It then pushes the retina away, detaching it from the back of your eye. This type of detachment usually happens as you get older. As the vitreous shrinks and thins with age, it pulls on the retina, tearing it.
- Tractional: Scar tissue on the retina can pull it away from the back of the eye. Diabetes is a common cause of these retinal detachments. The prolonged high blood sugar can damage blood vessels in your eye and that can result in scar tissue formation. The scars and areas of traction can get bigger, pulling and detaching the retina from the back of the eye.
- Exudative: Fluid builds up behind the retina even though there’s no retinal tear. As the fluid collects, it pushes your retina away. The main causes of fluid buildup are leaking blood vessels or swelling behind the eye, which can happen from such causes as uveitis (eye inflammation).
What are the symptoms of a detached retina?
Some people don’t notice any symptoms of retinal detachment, while others do. It depends on severity — if a larger part of the retina detaches, you’re more likely to experience symptoms.
Symptoms of retinal detachment can happen suddenly and include:
- Seeing flashes of light.
- Seeing a lot of floaters — flecks, threads, dark spots and squiggly lines that drift across your vision. (Seeing a few here and there is normal and not cause for alarm.)
- Darkening of your peripheral vision (side vision).
- Darkening or shadow covering part of your vision.
Does retinal detachment hurt?
Retinal detachment is usually painless. But it’s a serious problem that can threaten your vision. Contact a healthcare provider if you notice any symptoms.
Diagnosis and Tests
How is retinal detachment diagnosed?
You need an eye exam to diagnose retinal detachment. Your eye care provider will use a dilated eye exam to check your retina. They’ll put eye drops in your eyes. The drops dilate, or widen, the pupil. After a few minutes, your provider can get a close look at the retina.
Your provider may recommend other tests after the dilated eye exam. These tests are noninvasive and won’t hurt. They help your provider see your retina clearly and in more detail:
- Optical coherence tomography (OCT): You get dilating eye drops for this imaging. Then you sit in front of the OCT machine. You rest your head on a support, so it stays still. The machine scans your eye but doesn’t touch it.
- Eye (ocular) ultrasound: You won’t need dilating drops for this scan, but your provider may use drops to numb your eyes so you won’t feel any discomfort. You sit in a chair and rest your head on a support, so it stays still. Your provider gently places an instrument against the front of your eye to scan it. Next, you sit with your eyes closed. Your provider puts gel on your eyelids. With your eyes closed, you move your eyeballs as your doctor scans them with the same instrument.
Management and Treatment
How is retinal detachment treated?
Your eye care provider will discuss treatment options with you. You may need a combination of treatments for the best results.
Laser (thermal) therapy or cryopexy (freezing). Sometimes, your provider will diagnose a retinal tear before the retina starts pulling away. Your provider uses a medical laser or a freezing tool to seal the tear. These devices create a scar that holds the retina in place.
Pneumatic retinopexy. Your provider may recommend this approach if the detachment isn’t as extensive. During pneumatic retinopexy:
- Your provider injects a small gas bubble into the vitreous, the fluid in the eye.
- The bubble presses against the retina, closing the tear.
- You may need laser or cryopexy to seal the tear.
- The fluid that collected under the retina gets reabsorbed by the body. The retina can now stick to the eye wall like it should. Eventually, the gas bubble also gets reabsorbed.
After surgery, your provider will recommend that you keep your head still for a few days to promote healing. You also may be told not to lie on your back.
Scleral buckle. During this procedure:
- Your provider surgically places a silicone band (buckle) around the eye.
- The band holds the retina in place and stays there permanently. You can’t see the band.
- The detached retina starts healing.
- Laser or cryopexy are used to seal the tear.
Vitrectomy. During a vitrectomy, your provider:
- Surgically removes the vitreous.
- Places a bubble of air, gas or oil in the eye to push the retina back in place.
If your provider uses an oil bubble, you’ll have it removed a few months later. Gas and air bubbles get reabsorbed.
If you have a gas bubble, you may have to avoid activities at certain altitudes. The altitude change can increase the size of the gas bubble and the pressure in your eye. You'll have to avoid flying and traveling to high altitudes. Your provider will tell you when you can start these activities again.
Can I prevent retinal detachment?
You can’t prevent retinal detachment, but you can take steps to lower your risk:
- Get regular eye care: Eye exams protect your eye health. If you have nearsightedness, eye exams are especially important. Myopia makes you more prone to retinal detachment. Your eye care provider should include dilated exams to find small retinal tears.
- Stay safe: Use safety goggles or other protection for your eyes when playing sports or doing other risky activities.
- Get prompt treatment: If you notice detached retina symptoms, see your eye care provider right away or go to the emergency room.
How often should I get regular eye exams?
People who have an average risk of eye disease should get eye exams once a year. If you’re at higher risk for eye disease, you may need checkups more frequently. Talk to your provider to figure out your best exam schedule.
Outlook / Prognosis
What is the outlook for people with retinal detachment?
Your outlook depends on factors like how your vision was before the retinal detachment, how extensive your detachment was and if there are any other complicating factors. Your provider will talk to you about what type of vision improvement you can expect.
In general, surgery for retinal detachment is very successful — the repair works about nine out of 10 times. Sometimes, people need more than one procedure to return the retina to its place.
Can I get a detached retina again?
It’s possible to get a detached retina more than once. You may need a second surgery if this happens. Talk to your provider about preventive steps you can take to protect your vision. If you notice symptoms returning, call your provider right away.
What can I expect after retinal detachment surgery?
After retinal detachment surgery, you may have some discomfort. It can last for a few weeks. Your provider will discuss pain medicine and other forms of relief. You’ll also need to take it easy for a few weeks. Talk with your provider about when you can exercise, drive and get back to your regular activities.
Other things you can expect after surgery:
- Eye patch: Wear the eye patch for as long as your provider tells you it’s needed.
- Head position: If your provider put a bubble in your eye, follow instructions for your head position. Your provider will let you know the position your head should be in and how long to keep it there to help heal the eye.
- Eye drops: Your provider will instruct you on how to use the drops to help your eye heal.
- Improved vision: About four to six weeks after surgery, you’ll start to notice your eyesight improving. It may take a few months until you notice the full effects.
What should I ask my healthcare provider?
If you have retinal detachment (or face a higher risk), ask your provider:
- Which retinal detachment treatment is best for me?
- Will I need surgery?
- How can I protect my eye health after surgery?
- How often should I have eye exams?
- What else can I do to lower my risk for retinal detachment?
A note from Cleveland Clinic
Retinal detachment is a painless but serious condition. If you notice detached retina symptoms, such as sudden eye floaters, flashes of light or darkening of your vision, get care right away. Call your eye care provider or go to the emergency room. Preventive care is always the best, so protect your eyes and vision health by having regular eye exams.
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