Retinal detachment

Retinal detachment is when your retina (a light-sensitive layer of your eye) separates from the back of your eyeball. This can permanently affect your sight, so it’s important to seek expert advice straight away. Make an urgent appointment with an optician. If an optician isn’t available within 24 hours, find out where your nearest eye casualty is or go to the hospital accident and emergency department.

About retinal detachment

Your retina is a layer of light-sensitive tissue that lines the inside of the back of your eye. When light travels into your eye through your pupil, it's focused onto your retina. The cells of your retina send signals to your brain, which interprets them as the images you see. In the centre of your retina is a small area called the macula. This is responsible for what you see right in front of you and is important for activities such as reading.

If you have a retinal detachment, your retina separates from the layers below it. This affects your vision. Retinal detachment usually just affects one eye, but it can affect both. Most retinal detachments happen in people aged around 60.

Types of retinal detachment

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

Rhegmatogenous retinal detachment

This is the most common type of retinal detachment. It can happen if a tear or hole develops in your retina. Fluid in your eye then seeps underneath your retina and separates it from the back wall of your eye. This type of retinal detachment is often caused by the gel (vitreous) inside the back of your eye becoming more fluid. This is a normal part of ageing. For more information, see our section on causes of retinal detachment.

Exudative retinal detachment

This can happen if fluid builds up under your retina. It’s often caused by leaking blood vessels under your retina. It may be due to severe inflammation in your eye.

Tractional retinal detachment

This is when your retina is pulled away by scar tissue in your eye. It can happen if you have an abnormal growth of blood vessels in your eye – usually caused by diabetes.

Causes of retinal detachment

Retinal detachment is most common in people aged 40 to 70. This is due to age-related changes to the eye. Posterior vitreous detachment (PVD) is when the vitreous (a jelly-like fluid inside your eye) starts to pull away from the back of your eye. It is a natural part of ageing and can lead to a retinal tear. This may then develop into retinal detachment.

Anyone can have retinal detachment, but certain factors may increase your risk. These include the following.

• Having had a previous retinal detachment in your other eye.
• Previous eye surgery for cataracts . This can affect your vitreous so you’re more likely to have PVD.
• Retinal lattice degeneration. The outer edges of your retina get thinner in a lattice pattern, which leads to tear or holes.
• Short-sightedness (myopia). This means you’re more likely to have PVD, often at a younger age.
• An eye injury. Your retina may detach straightaway, but this can also happen months or even years later.
• A family history of retinal detachment.
• Diabetic retinopathy (due to diabetes ). Abnormal growth of blood vessels in the eye can cause bleeding and scarring. This can pull on your retina.
• Inflammatory conditions such as uveitis. Scar tissue in your eye can pull on your retina so it’s more likely to detach.

Symptoms of retinal detachment

Retinal detachment symptoms usually involve changes in your eyesight. These may happen suddenly or over hours, days or weeks. You may notice some warning signs in your vision, such as:

• flashes of light
• spots or floaters

These may be followed by a dark curtain or shadow that spreads across the vision of one eye. If the central macula area of your retina detaches, you may find it difficult to see anything at all.

If you have any of these symptoms, seek expert advice from an optician (optometrist) as soon as possible. If an optician isn’t available, go to your closest eye casualty or your hospital’s accident and emergency department or contact a GP.

Diagnosis of retinal detachment

The sooner you seek expert advice, the less chance there is of permanent damage to your sight.

An optician or doctor will:

• ask about your symptoms and medical history
• do some tests to check your eyesight
• look at the inside and back of your eyes with an ophthalmoscope

Ask a friend or relative to drive you to your appointment. Your optician or doctor may put eye drops in your eye so they can see it more clearly. The drops can affect your vision for a couple of hours afterwards, so you won’t be able to drive.

If the optician suspects your retina is detached or is at risk of detaching, they’ll refer you urgently to an ophthalmologist. This is a doctor who specialises in eye health. You may then have other tests such as an ultrasound scan.

Treatment of retinal detachment

Retinal detachment treatment is usually surgery to reattach your retina. Your doctor may recommend you have retinal detachment surgery within 24 hours or a few days, depending on which part of your eye is affected. If your macula (central part of the retina) isn’t affected yet, urgent surgery may prevent this happening. This will increase the chance of your vision returning to normal.

In about eight out of 10 people, one surgical procedure is enough to repair their detached retina. But some people need more retinal reattachment surgery.

There are three main types of surgery for retinal detachment. These are discussed below. They all aim to make your retina lie flat against the inside of your eye again. Your doctor will also repair any tears or holes using cold treatment (cryotherapy) or light (laser) treatment.

Vitrectomy

Your doctor will remove the vitreous (clear gel) from the back of your eye. They will then replace it with either a gas bubble or, less commonly, a silicone oil bubble. This will hold your retina in place while it heals. The gas bubble will slowly disappear over two to 12 weeks (depending on which type of gas your doctor uses). If your doctor uses a silicone oil bubble, they may need to remove it later.

Scleral buckle surgery

Your doctor will attach a thin band of synthetic material to the outside white of your eye. This will cause the inside wall of your eye to move inwards slightly. This pushes the inside of your eye against the detached retina and into a position that helps it to reattach.

Pneumatic retinopexy

Your doctor will inject a small gas bubble over the site of your detachment. This bubble will press the retina back in place. This procedure is only possible if your retinal detachment covers just a small area.

Retinal detachment surgery can often be done under local anaesthesia but sometimes general anaesthesia is best. Your doctor will discuss which type of anaesthesia is appropriate for you.

Complications of retinal detachment

Complications are problems that may develop as a result of your retinal detachment.

• The most serious complication of retinal detachment is partial or total loss of your eyesight in the affected eye. This is very likely if you don’t get treatment. That’s why you should seek expert help straightaway.
• Some people have another retinal detachment in the same eye, even after treatment.
• If you have a retinal detachment in one eye, you’re more likely to get one in the other eye too. This is because the same things that increased your risk of the first retinal detachment can also affect your other eye. It’s important to watch out for new flashes, floaters and a black curtain across your vision.If you experience these symptoms, make an urgent appointment with your optometrist or doctor.

Prevention of retinal detachment

If you have a tear or hole in your retina, you may be able to have laser treatment or cold treatment (cryotherapy) to repair it. This may help to stop a retinal detachment developing.

You may be able to reduce your chance of getting a retinal detachment. This is particularly important if you’re very short sighted. You should wear eye protection if you’re doing DIY or during contact sports.

If you have diabetes, you should keep your blood sugar levels under control and have your eyes checked regularly through the NHS retinal screening programme.

If you notice symptoms of retinal detachment, get them checked within 24 hours (if possible) to help prevent the detachment getting worse. You can go to an optician, A&E or a walk-in emergency clinic at an eye hospital. It’s also good to have an eye test regularly, at least every two years, to check that your eyes are healthy.