Retinal detachment !
Retinal detachment is when the retina, the light-sensing layer at the back of the eye, peels away; it threatens sight and is an emergency.
Updated 2026-10-29
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In histology
In the clinical exam
In physiology
What it is
Separation of the neurosensory retina from the underlying retinal pigment epithelium, cutting off its blood supply from the choroid. It is a sight-threatening emergency, especially before the macula detaches.
Who gets it
Most common in middle-aged and older adults and in people with high myopia. Ocular trauma and previous eye surgery are frequent causes in younger patients.
Causes
- Rhegmatogenous: a retinal tear or hole lets fluid pass under the retina (commonest)
- Tractional: fibrovascular membranes pull the retina off (proliferative diabetic retinopathy)
- Exudative: fluid collects under the retina without a tear (inflammation, tumour, severe hypertension, preeclampsia)
Risk factors
- High myopia
- Posterior vitreous detachment with age
- Previous cataract surgery
- Eye trauma
- Lattice degeneration of the peripheral retina
- Detachment in the other eye or a family history
- Proliferative diabetic retinopathy
Pathophysiology
With age the vitreous liquefies and separates from the retina. Where it is firmly attached, traction can tear the retina, and liquid vitreous then flows through the break and lifts the retina away. Detached photoreceptors lose their supply from the choroid and degenerate over time; once the macula is involved, central vision falls.
Classification
- Rhegmatogenous, tractional or exudative (serous)
- Macula-on or macula-off
Symptoms and signs
- Sudden new floaters
- Flashes of light (photopsia)
- A shadow or curtain spreading across the visual field
- Loss of central vision when the macula detaches
- Painless
Diagnosis
- Clinical
- Dilated fundus examination with indirect ophthalmoscopy and scleral depression shows the elevated retina and any breaks. Pigment cells in the anterior vitreous (tobacco dust) suggest a tear. Visual acuity and fields are documented.
- Tests
- No routine laboratory tests. In exudative detachment, tests look for the underlying inflammatory, infectious or systemic cause.
- Imaging
- B-scan ocular ultrasound when the view is blocked by cataract or haemorrhage. Optical coherence tomography shows whether the macula is attached.
Differential diagnosis
- Posterior vitreous detachment without a tear
- Retinoschisis
- Vitreous haemorrhage
- Choroidal detachment
- Migraine aura (flashes without floaters)
Goal of treatment
Close every retinal break and reattach the retina as soon as possible, ideally before the macula detaches, to preserve vision.
Treatment
- Procedure
- Laser retinopexy or cryotherapy around a retinal tear without detachment, creating a scar that seals the retina and prevents detachment.
- Procedure
- Pneumatic retinopexy: a gas bubble injected into the eye pushes the retina back, followed by laser or cryotherapy; needs specific head positioning.
- Surgical
- Scleral buckle or pars plana vitrectomy with gas or silicone oil tamponade, chosen by the type and extent of the detachment.
- Medical
- Exudative detachment: treatment of the cause (inflammation, tumour, hypertension); surgery is usually not needed.
- Follow-up
- Follow-up for new tears or redetachment, and examination of the other eye.
Complications
- Permanent loss of central or peripheral vision
- Proliferative vitreoretinopathy (scarring) and redetachment
- Cataract after vitrectomy
- Raised eye pressure after gas or silicone oil
- Detachment in the other eye
Prognosis
Most detachments can be reattached surgically. Final vision depends mainly on whether the macula was involved and for how long; macula-on detachments repaired promptly do best.
Prevention
- Urgent examination after new floaters or flashes
- Treating symptomatic retinal tears
- Protective eyewear in contact sports and risky work
Test yourself
Think of the answer, then tap the question to see it.
Which triad of symptoms suggests a rhegmatogenous retinal detachment?
Sudden floaters, flashes of light and a spreading shadow or curtain in the visual field, without pain.
What are the three types of retinal detachment?
Rhegmatogenous (through a break), tractional (pulled by membranes) and exudative (fluid without a break).
Why does macular status matter in a retinal detachment?
If the macula is still attached, urgent repair can preserve central vision; once it detaches, the visual outcome is worse.
Which test is used when a dense cataract or haemorrhage blocks the view of the retina?
B-scan ocular ultrasound.
Which refractive error is a major risk factor for retinal detachment?
High myopia, because the long eye has a thinner peripheral retina and earlier vitreous changes.
Related conditions
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Retinal Detachment (StatPearls (NCBI Bookshelf), 2024).
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