There are three ways that your retina can detach from the back of your eye.
Rhegmatogenous retinal detachment
This is the most common type and can happen if a tear develops in your retina. This can cause fluid in your eye to seep underneath your retina and separate it from the back wall of your eye.
Tractional retinal detachment
Your retina and vitreous, which is the clear jelly-like fluid inside your eye, can become tightly stuck together. This can happen if you have an abnormal growth of blood vessels in your eye, most often in people with diabetes. It can also happen if you injure your eye or have inflammation within it. If the vitreous pulls at your retina or there’s scarring on the surface, your retina might be pulled off the back of your eye.
Exudative retinal detachment
If the blood vessels underneath your retina start to leak fluid, this can build up underneath your retina. This can sometimes push your retina off the back of your eye. There are many reasons this can happen, such as having severe inflammation in your eye.
The most common symptom of retinal detachment is a gradual deterioration in your eyesight. You may get things appearing in your vision such as:
- flashes of light
- spots or floaters
This may be followed by a shadow spreading across your vision of one eye.
If you get these symptoms, see an optometrist (a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses). Or, contact your GP as soon as possible.
Sometimes you can have mild symptoms for some time, but they suddenly get worse for no particular reason. This can be a sign you have a tear in your retina that may have detached. If this happens, seek urgent medical treatment.
Your optometrist or GP will ask about your symptoms and examine you. They will ask about your medical history too.
They will do some tests to check your eyesight. For example, they might look at the inside and back of your eyes with an ophthalmoscope instrument. Ask a friend or relative to drive you to your appointment as these tests might affect your vision for a couple of hours afterwards.
If your optometrist or GP suspects your retina is detached, or is at risk of detaching, they will urgently refer you to an ophthalmologist. This is a doctor who specialises in eye health, including eye surgery. You might then have other tests such as an ultrasound scan.
Retinal detachment is usually a medical emergency. The sooner you get treatment, the less chance there is of permanent damage to your sight.
You’ll usually need to have surgery to reattach your retina. There are three types of surgery to do this, which are described below. They all aim to make your retina lie flat against the inside of your eye again.
- Vitrectomy. This involves removing the vitreous (clear jelly-like fluid) from the back of your eye and replacing it with either a gas or silicone bubble. This holds your retina in place while it heals.
- Scleral buckle surgery. In this procedure, your ophthalmologist will attach a thin band of synthetic material to the outside of your eye. This presses on the outside of your eye, which causes the inside wall of your eye to indent slightly. This pushes the inside of your eye against the detached retina and into a position that helps it to reattach. The area around the hole is then sealed using cryotherapy or laser treatment.
- Pneumatic retinopexy. Your ophthalmologist may be able to inject a small gas or silicone bubble into your vitreous over the site of your detachment. This bubble then presses the retina back in place, and they will use cryotherapy or laser around the tear. This procedure is only possible if your retinal detachment covers just a small area.
After surgery, you’ll be given antibiotics and corticosteroid eye drops. These will help prevent infection and reduce any inflammation.
If you have had gas put into your eye, you may be asked to keep your head in a certain position afterwards. This could be on one side or face down and is called ‘posturing’. You’ll need to do this for about a week to 10 days after your operation. You won’t be able to travel on an aeroplane while any gas remains in your eye. This is because the change in air pressure can affect the bubble of gas and increase pressure inside your eye. While any gas remains in your eye your vision will be blurred. It can take about 10 days to a few weeks for the gas to be reabsorbed.
If your central vision has been affected, it may take a year or more after your operation for your eyesight to fully recover. Most of the improvement in your sight will happen during the first six months after surgery. But for some people, their vision may never fully recover. It often depends on if and for how long the macula part of your retina was detached.
Surgery is most successful when your macula hasn’t become fully detached. This is why it’s important to seek medical attention as soon as possible after noticing changes in your sight. Occasionally, it may not be possible to restore your retina to its correct position and your vision may be lost completely.
Causes of retinal detachment include the following.
- Age-related changes to your eye. As you get older, you’re more likely to get retinal detachment – usually when you’re over 60. One condition you can get as a natural part of ageing called posterior vitreous detachment (PVD) can lead to retinal detachment. See our information on PVD further down the page.
- Short-sightedness (myopia). If you’re very short-sighted, you’re likely to have a thinner retina, which can tear or break more easily.
- Previous eye surgery. If you had a cataract operation, for example, the jelly-like vitreous inside your eye can be disturbed.
- An eye injury. This may cause your retina to detach straightaway, or it can happen months or even years later.
- A family history of retinal detachment can make you more likely to get it.
- Diabetic retinopathy. An abnormal growth of blood vessels from your retina that can cause bleeding and scarring that can pull on your retina.
The most serious complication of retinal detachment is partial or total loss of your eyesight.
If your retina detaches from your eye, it may become scarred, folded and stiff as your body tries to heal itself. If this happens, it can make surgery to treat retinal detachment more difficult. This is because it’s not possible to get your retina flat up against the back of your eye to restore your sight.
If you have a weakness in your retina, you may be able to have preventive laser or cryotherapy treatment to repair it.
The only other thing you can do is try to prevent any potential causes of retinal detachment. One way you can prevent injuring your eyes, for example, is by wearing eye protection if you’re doing DIY, or during sports like squash. Have an eye test regularly too, at least every two years, to check that your eyes are healthy.
This will depend on the type of retinal detachment you had, how successful your treatment has been and the type of work you do.
After retinal reattachment surgery, your eye may feel bruised and your eyelids may be sticky. You might want to wait for this to ease before you go back to work. You might have been told to hold your head in a certain position after your operation to help your retina to heal. You might need to do this for up to 10 days after your operation, which will delay your return to work. Although this might sound daunting, it’s worth persevering with as it’s an important part of your recovery.
If you usually drive to work or drive as part of your job, you may not be able to return to full duties straightaway. This is because your eyesight may not be as good as it was before and it may take some time for it to return to normal. Speak to your insurance company before you drive so that you’re aware of their recommendations and check the Driver and Vehicle Licensing Agency (DVLA) website.
If retinal detachment has affected your eyesight, you might need to make some adaptations at work, such as using magnifiers or access to larger print. Ask your doctor about the services available for people with poor vision.
Posterior vitreous detachment (PVD) is a condition that affects your vitreous, a jelly-like fluid in the centre of your eye. As you get older, your vitreous in your eye becomes more liquid than jelly-like in the middle and tends to shrink away from your retina. PVD is a natural part of the ageing process.
By the time you're in your 80s, you have an almost nine in 10 chance of having PVD. This compares with a one in 10 chance when you’re less than 60.
As you get older, the vitreous begins to lose its shape and consistency, and can start to pull away from the back of your eye. PVD may occur suddenly (over a matter of days) and may pass without you noticing. But it may cause new floaters or spots in your vision. You don’t usually need any treatment for PVD and you’re likely to gradually get used to any new floaters in your vision.
The symptoms of PVD are similar to those for a retinal detachment so it can be difficult to tell the difference. As they may be the only symptoms that you have a tear in your retina, it's important to get it checked. See an ophthalmologist (a doctor who specialises in eye health, including eye surgery) who will examine the back of your eye thoroughly. Ask a friend or relative to drive you to your appointment as this examination can affect your sight for a couple of hours afterwards.
It’s possible, but it depends on whether your macula is affected in the detachment and how long your retina is detached before you get treatment.
When your retina becomes detached from the back wall of your eye, your eyesight will be affected straightaway. It’s often described as a shadow spreading across one of your eyes.
In nine out of 10 people, the retina can be reattached and you usually only need one operation to do this. If you have the operation soon enough, your vision might be as good as it was before. Getting prompt treatment is vital in saving your sight. The longer your retina is detached, the less likely it is that your eyesight will fully recover.
The greatest risk of permanent damage to your eyesight is if your macula becomes detached. The macula is the part of your retina that processes sharp, clear vision. If this is detached, your sight may never fully recover.
If you think you have a retinal detachment, see your optometrist immediately. If they aren't available, go to the accident and emergency department of your local hospital.
- Royal National Institute of Blind People
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Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, Bupa Health Content Team, January 2016.
Peer reviewed by Professor Simon Taylor, Consultant Ophthalmic Surgeon.
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