Retinal detachment

Retinal detachment is when your retina (the 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 straightaway (within 24 hours). Make an urgent appointment with an optician. If they aren’t available, look up 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 there’s a small area called the macula, which is responsible for what you see right in front of you. The macula is important for things like reading.

If you have a retinal detachment, this thin layer of light-sensitive tissue separates from the layers beneath. Your vision can then become increasingly distorted and blurred, or you develop a black shadow in your vision.

Retinal detachment usually just affects one eye, but it can affect both. Most retinal detachments happen in people aged between 60 and 70.

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 can happen if a tear or hole 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. This is often caused by shrinkage of the gel (the vitreous) inside the back of the eye, which is a normal part of ageing. For more information, see our FAQ on Posterior vitreous detachment (PVD).

Tractional retinal detachment

This is a rare type of retinal detachment. If the blood vessels underneath your retina start to leak fluid, it can build up underneath your retina, which can sometimes cause it to detach. There are many reasons why this can happen – for example, having severe inflammation in your eye.

Exudative retinal detachment

This is a rare type of retinal detachment. If the blood vessels underneath your retina start to leak fluid, it can build up underneath your retina, which can sometimes cause it to detach. There are many reasons why this can happen – for example, having severe inflammation in your eye.

Causes of retinal detachment

Causes of retinal detachment include the following.

• Age-related changes to your eye. Getting older can make you 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 FAQ below: What is posterior vitreous detachment (PVD)?
• Previous eye surgery for cataracts. If you’ve had a cataract operation, the jelly-like vitreous inside your eye can be disturbed, which may accelerate the normal ageing process of PVD.
• Lattice degeneration. This is when the outer edges of your retina become thinned in a lattice pattern. It may then tear, or holes may form.
• Short-sightedness (myopia) can make you develop a detached retina at a younger age. This may be due to lattice degeneration.
• 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. This is an abnormal growth of blood vessels from your retina that can cause bleeding and scarring, which can pull on your retina.

Symptoms of retinal detachment

The most common symptoms of retinal detachment are changes in your eyesight that may happen suddenly or over hours, days or weeks. There may be some warning signs of a detached retina. You may get things appearing in your vision for the first time such as:

• flashes of light
• spots or floaters

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

If you get these symptoms, seek expert advice within 24 hours from an optician (optometrist). If they aren’t available, go to your closest eye casualty or your hospital’s accident and emergency department, or contact your doctor.

Diagnosis of retinal detachment

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

Your optician or doctor will ask about your symptoms and do some tests to check your eyesight. For example, they might look at the inside and back of your eyes with an ophthalmoscope. Ask a friend or relative to drive you to your appointment as these tests might affect your vision for a couple of hours afterwards. This is because of the eye drops that your optician or doctor may put in your eye.

If your 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 might then have other tests such as an ultrasound scan.

Treatment of retinal detachment

You’ll usually need surgery to reattach your retina. Your doctor may recommend this is done within 24 hours or within a few days, depending on which part of your eye is affected. If your macula (for central vision) isn’t affected yet, urgent surgery may prevent this happening. This will increase the chance of your vision returning to normal. If your macula is already affected, a few days’ delay won’t make such a difference.

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

There are three main types of surgery for retinal detachment. 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 cryotherapy (cold treatment) or laser (light) treatment.

• Vitrectomy. Your doctor will remove the vitreous (clear gel) from the back of your eye and 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 about six weeks. If your doctor uses a silicone oil bubble, this may need to be removed later.
• Scleral buckle surgery. Your doctor will attach a thin band of synthetic material to the outside of your eye. This will press on the outside of your eye, which 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, without removing any of the vitreous. This bubble then presses the retina back in place. This procedure is only possible if your retinal detachment covers just a small area. There are other medicines that your doctor may suggest you try, which work in similar ways to those listed above. They will talk to you about how these medicines may help, and any potential side-effects of taking them. Always read carefully the patient information leaflet that comes with your medicine. If you have any questions about taking your medicines, ask your pharmacist.

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

After your treatment

Your doctor will give you antibiotics and corticosteroid eye drops after retinal reattachment surgery. These will help prevent infection and reduce any swelling.

After the operation, your eye may feel bruised and your eyelids may be sticky. Your eye may feel uncomfortable for a few weeks too. Over-the-counter painkillers should help.

Your doctor or nurse will give you advice about what to do when you get home and when you can return to work or drive again. It’s best not to play contact sports where you could get hit in your eye if you’ve had a retinal detachment, for example.

You may have blurry vision for a few days or even weeks after your surgery. It usually takes about six to eight weeks before you and your doctor can get an idea about how well you’ll see again.

If you have a gas bubble in your eye

If you had gas put into your eye during your treatment, your doctor may ask you to keep your head in a certain position afterwards. This is to keep the gas bubble in position to help it heal. You may need to keep your head on one side or be face down. You may need to do this for up to 10 days after your operation. Ask a friend or family member to come and stay with you to help during this time if you can.

While any gas remains in your eye, your vision will be blurred. This will gradually improve as the gas disappears. You may notice a line across your vision that will move down and disappear over the next weeks or months.

There are some restrictions, while the gas remains in your eye. You won’t be able to fly, for example. The change in air pressure can expand the bubble of gas and increase the pressure inside your eye. This would be really painful and you would lose your sight.

If you need a general anaesthetic for another operation while you still have gas in your eye, tell your anaesthetist. Some anaesthetics can have an effect on it.

Ask your doctor how long the gas will be in your eye because this can vary depending on what type they use. Your doctor will give you a bracelet to wear, which will tell medical staff which gas is in your eye. Keep this on until they tell you the gas bubble has fully dispersed.

Complications of retinal detachment

The most serious complication of retinal detachment is partial or total loss of your eyesight, which is very likely if you don’t get treatment. That’s why you should seek expert help straightaway.

Having a retinal detachment in one eye might mean the other eye will also be affected. This is because the same things that led to you getting a detachment in one eye may cause it to happen in the other. Some people have another retinal detachment in the same eye, even after treatment.

Prevention of retinal detachment

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

You may be able to reduce your chance of getting a retinal detachment by helping prevent the causes. This includes wearing eye protection if you’re doing DIY or during contact sport, or squash. If you have diabetes, keeping it under control will help to prevent the eye problems that can lead to retinal detachment.

If you notice symptoms of retinal detachment, get them checked quickly to help prevent the detachment getting worse. It’s also good to have an eye test regularly, at least every two years, to check that your eyes are healthy.