Retinal detachment: how fast to refer
- Emergency
A retinal detachment is repaired by surgery. While central vision is still good it is an emergency, because saving the macula saves reading vision.
What it is
In a retinal detachment the neural retina separates from the layer beneath it. The commonest type, rhegmatogenous, starts at a tear and lets fluid from the vitreous lift the retina. Tractional detachment comes from scar tissue pulling the retina (proliferative diabetic retinopathy); exudative detachment from fluid leaking under it (inflammation, tumours, severe hypertension or pre-eclampsia). The urgency depends on whether the macula is still attached.
How to recognise it
- Floaters and flashes followed by a shadow or curtain from the periphery.
- Central vision still normal: the macula is on, and the case is an emergency.
- Relative afferent pupillary defect if the detachment is large.
- High myopia, previous cataract surgery, trauma or a detachment in the other eye.
- Grey, folded retina on fundoscopy, or a membrane on ocular ultrasound.
What to do at once
- Measure visual acuity in each eye: good central acuity suggests the macula is still attached.
- Map the shadow on the confrontation field: an upper shadow means a lower detachment and the reverse.
- Look at the red reflex and try to see the retina; ocular ultrasound helps when the view is poor.
- Telephone ophthalmology and arrange to be seen the same day.
- Advise the patient to avoid strenuous activity and to travel without delay.
Mistakes that cost sight
- Superior detachments threaten the macula sooner, because fluid tracks downwards with gravity.
- Once the macula has detached, final reading vision falls with each day of delay.
- Treatments are a gas bubble (pneumatic retinopexy), a scleral buckle or a vitrectomy, chosen by the retina surgeon.
Next step / Initial management
- Macula on (good central vision): emergency referral for surgery within about 24 hours.
- Macula off: urgent surgery within a few days.
- Tractional or exudative detachment: ophthalmology the same day or within days, and treatment of the cause (diabetes, inflammation, blood pressure, tumour).
- After repair, warn the patient about the symptoms in the other eye, which has a higher risk.
Test yourself
Think of the answer, then tap the question to see it.
Why is a detachment with normal central vision more urgent than one with poor central vision?
Because the macula is still attached: prompt surgery keeps reading vision, which is lost once the macula detaches.
What are the three types of retinal detachment?
Rhegmatogenous (from a tear), tractional (scar tissue pulling, as in diabetes) and exudative (fluid leaking under the retina).
How can ocular ultrasound help?
It shows a detached retina as a membrane in the vitreous cavity when blood or cataract block the view.
Connections
Educational content; not a clinical guideline and no substitute for assessment by a health professional. For sudden visual loss, severe eye pain, a chemical burn or an eye injury, go to an emergency department at once.
Sources: Retinal Detachment (StatPearls Publishing (NCBI Bookshelf), 2024); Exudative Retinal Detachment (StatPearls Publishing (NCBI Bookshelf), 2024); Point-of-Care Ocular Ultrasound (StatPearls Publishing (NCBI Bookshelf), 2026).
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Representative model, for educational purposes only.