Retinal detachment

Retinal detachment is when your retina separates from the inner wall at the back of your eye (where it’s usually attached). This can permanently damage your vision, so emergency surgical treatment is usually needed to reattach it.

About retinal detachment

Your retina is a thin layer of nerve tissue that lines the inner wall at the back of your eye. When you look at an object, light rays pass into your eye through your cornea (the clear part at the front of your eye) and lens, to your retina at the back of your eye. The light-sensitive cells in your retina then send this information via the optic nerve to your brain. Your brain interprets this as the image you see. Just to the side of the optic nerve lies a specialised part of your retina called the macula. The macula is the part of your retina that is used for seeing fine detail, for example, when reading, writing and recognising faces.

You’re more likely to get retinal detachment as you get older – usually from age 60.

Types of retinal detachment

There are three ways that your retina can detach from the back of your eye.

Rhegmatogenous retinal detachment

This is the most common type of retinal detachment. It’s caused by a tear in your retina that allows fluid in your eye to seep underneath your retina and separate it from the back wall of your eye.

Exudative retinal detachment

If the blood vessels underneath your retina start to leak fluid, this can build up underneath your retina, and may push your retina off the back of your eye. There are many possible causes for this, such as inflammation 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 happens as a result of an injury, inflammation or the abnormal growth of blood vessels (common in people with diabetes) in your eye. If the vitreous pulls at your retina or there is scarring on the surface, your retina may be pulled off the back of your eye. 

Symptoms of retinal detachment

The most common symptom of retinal detachment is a gradual deterioration in your vision. It’s often described as a shadow spreading across your vision of one eye.

You may get symptoms such as flashes of light, spots, or floaters appearing in your vision. You may find you have had mild symptoms such as these for some time but they suddenly get worse for no particular reason. This can be a sign of a tear in your retina, or a detachment, which means you need to seek urgent medical treatment.

However, similar symptoms are caused by posterior vitreous detachment (PVD), which is a natural part of ageing. As you get older, the jelly-like vitreous in your eye becomes more liquid in the middle and tends to shrink away from your retina. For about two in 10 people with symptoms of PVD, as the vitreous shrinks away, the attached parts can tug on your retina, causing a tear. If the tear isn’t treated, it can lead to retinal detachment. As PVD is a natural part of ageing, it doesn’t always lead to retinal detachment. Please see our frequently asked questions for more information about PVD.

If you’re having any problems with your vision, see your optometrist (a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses) or your GP.

Complications of retinal detachment

The most serious complication of retinal detachment is partial or total loss of vision.

After retinal detachment, your retina may become scarred, folded and stiff. This is usually because of your body trying to heal itself. If your retina has become stiff and folded, it can make surgery to treat retinal detachment more difficult because it’s not possible to get your retina flat up against the back of your eye to restore your vision.

Causes of retinal detachment

The exact cause of retinal detachment will depend on the type that you have. Causes include the following.

• Age-related changes. As you get older, you’re more likely to get retinal detachment – usually over the age of 60.
• 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. For example, a cataract operation where the jelly-like vitreous inside your eye has been disturbed.
• Injury or trauma to your eye. This may cause retinal detachment immediately, or it can happen months or even years later.
• Inherited conditions such as Stickler’s syndrome.
• Inflammatory conditions such as scleritis (inflammation of the white of your eye).
• Diabetic retinopathy. This is when an abnormal growth of blood vessels from your retina can result in bleeding, scarring and pulling on your retina.
• Eye tumour, which can be cancerous or non-cancerous (benign).
• Eye diseases such as glaucoma, a cataract or retinopathy of prematurity (when a baby is born prematurely before the retina has developed properly).

Diagnosis of retinal detachment

Your optometrist or GP will ask about your symptoms and examine you. He or she will carry out some tests to check your eyesight. This may involve flashing a torch in your eyes and examining them with an ophthalmoscope. An ophthalmoscope is an instrument that is used to take a closer look at the inside and back of your eyes.

If your optometrist or GP suspects that your retina has become detached or that you may be at risk of this happening, he or she may urgently refer you to an ophthalmologist (a doctor who specialises in eye health, including eye surgery) for further tests. Retinal detachment is usually a medical emergency. The sooner you get treatment, the less chance there is of permanent damage to your vision.

Treatment for retinal detachment

You will usually need to have surgery to reattach your retina. There are three types of surgery used to treat a detached retina, which are described below. These treatments aim to make your retina lie flat against the inside of your eye again.

• Scleral buckle surgery. This procedure involves putting pressure on the outside of your eye using a thin band of synthetic material that is stitched to the outer coat of your eye (the conjunctiva). One way this helps is that it causes the inside wall of your eye to indent slightly, allowing all the layers of your retina to come back together.
• Pneumatic retinopexy. If your retinal detachment covers only a small area, you may be able to have a small gas or silicone bubble injected into your vitreous over the site of your detachment. This bubble then presses the retina back in place.
• Vitrectomy. This involves removing the vitreous from the back of your eye and replacing it with either a gas or silicone bubble, which holds your retina in place while it heals.

After your treatment

After surgery, you will 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 for several days after the operation. This is sometimes called ‘posturing’. You will also be advised not 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. The surgery can sometimes increase the pressure inside your eye – so you may be prescribed tablets or eye drops to treat this.

If your central vision has been affected, it may take up to a year or more after your operation for your vision to recover. Most of the improvement in your vision takes place during the first six months after surgery. However, 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 vision. Occasionally, it may not be possible to restore your retina to its correct position and your vision may be lost completely.

Prevention of retinal detachment

If your family has a history of retinal detachment and your doctor finds a weakness in your retina, you may be able to have preventive laser or cryotherapy treatment. However, for most people, it isn’t possible to prevent retinal detachment.

You can prevent injury to your eyes that may cause retinal detachment. Always wear eye protection if you’re doing DIY, sports, such as squash or badminton, or working with materials that could get into your eyes. Have an eye test regularly, at least every two years, to check that your eyes are healthy.

Produced by Louise Abbott, Bupa Health Information Team, February 2013. 

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.