Retinal detachment

Your retina needs to be attached inside your eye to stay healthy and work properly. If it remains detached, it will stop working and affect your sight.

A retinal detachment can be repaired with surgery, but it needs to be detected and treated quickly, or it can cause sight loss in the affected eye.

A retinal detachment is an emergency. It needs to be assessed as soon as possible so that your ophthalmologist (hospital eye doctor) can make decisions about your treatment.

How well your sight recovers can depend on how much and in what areas your retina have detached. Most people have a good level of vision following surgery to re-attach the retina if it is carried out quickly.

This page contains a summary of our information on retinal detachment. To read our full information, download our Understanding retinal detachment booklet, which is accredited by the Royal College of Ophthalmologists:

There are three main causes of retinal detachment.

• Retinal holes and tears. Most retinal detachments happen because a tear or hole in the retina allows fluid to leak between the retinal layers, lifting the retina away from the back of the eye and causing it to detach. Tears happen because the retina has been pulled and torn. The most common cause of a retinal tear is posterior vitreous detachment (PVD) where the vitreous gel naturally comes away from the retina as we get older. the vitreous gel coming away from the retina (known as acute posterior vitreous detachment or PVD). In most people with PVD, the vitreous comes away gently from the retina, but in some people, the vitreous may be more firmly attached in certain places to the retina. So as the vitreous moves away from the retina, it can pull on it, causing it to tear.
• Scar tissue. Eye conditions such as diabetic retinopathy can cause scar tissue to form on the surface of the retina and inside your vitreous. This scar tissue can then lead to traction (pulling on the retina), causing a detachment.
• Fluid. A rare type of retinal detachment happens when fluid from the blood vessels behind the retina leaks between the retinal layers without there being a hole or tear present. This type of detachment happens because of conditions which cause inflammation in the eye or tumours in the eye.

Only about 10 – 15 per one in 100,000 people have one a retinal detachment each year. Retinal detachments are very rare in children and are most likely to occur in people between 40 to 70 years old. Natural ageing changes in the vitreous gel from PVD, known as PVD, can cause retinal tears and PVD is more common as you get older.

Anyone can develop a retinal detachment, but certain people are at higher risk.

• are short-sighted (the more short-sighted you are, the greater the risk)
• have had trauma (an injury or a blow) directly to your eye
• have already had a detachment in one eye (about 1 in 8 people with retinal detachment develop a retinal detachment in the other eye)
• have a family history of retinal detachment.
• have had previous eye surgery in that eye, such as cataract surgery
• have certain other eye conditions such as diabetic retinopathy or inflammation inside the eye.

The following symptoms can be the first signs of a retinal detachment:

• floaters
• flashing lights
• a dark shadow in your vision
• blurred vision.

You may have these symptoms but not develop a retinal detachment, but there isn’t a way to tell what is causing these symptoms unless your eye is examined.

A retinal detachment can cause a permanent loss of vision so it’s best to be cautious and have these symptoms checked, as soon as possible, within 24 hours of noticing any new symptoms. You can do this by having your eyes examined urgently by your optometrist (optician) or by attending Accident & Emergency (A&E) or eye casualty. You can also call 111 for advice about your symptoms and where to go to get your eyes checked.

Floaters

Floaters are caused by floating clumps of cells that form in your vitreous gel which cast a shadow onto your retina. The brain then sees this as something floating around in your vision. Floaters are very common, and most people develop some as they get older. They can take many shapes, for example, black dots, rings, spiders’ legs or cobwebs.

Many people naturally have some floaters in their eyes, which are nothing to worry about, but new floaters or changes to the ones you have already should be checked.

If you start to see floaters or notice a change or increase in the floaters you already have, you should have your eyes examined by an optometrist (optician) or an ophthalmologist as soon as possible. If you see an optometrist and they find, suspect, or can’t rule out a tear in your retina, then they will refer you urgently to an ophthalmologist.

Flashing lights

In most cases flashing lights are caused by a change in your vitreous gel (PVD). This is where the vitreous gel inside the eye moves across and tugs or stimulates the retina. These flashes of light are brief, white and vertical, occurring in the edges or sides of your vision. They may be worse when you move your eye or head and are more noticeable in darker or dimmer environments.

A PVD itself is not harmful, but in some people, it may cause a retinal tear. That’s why if you suddenly experience new flashing lights, you should have your eye examined by an optometrist or ophthalmologist as soon as possible.

Dark shadow

If your retina does detach, this means that it cannot work properly anymore, and you will see this as a solid dark shadow moving in from the edge of your vision. You will not be able to see round or through this shadow. If more of your retina detaches, then the shadow will keep moving towards the centre of your vision.

If you experience a dark shadow moving up, down or across your vision, you must attend your local hospital Accident and Emergency (A&E) department straight away.

Blurring of vision

Your vision can gradually become blurred for many reasons, and a visit to the optometrist will help you find out why. If your vision suddenly becomes blurred, especially if you also have any of the other symptoms of flashing lights, floaters or a shadow, then this is more serious. You should have your eyes examined straight away.

It’s important to have someone examine your eye if you start to have any of these symptoms and in most cases, it is best to have your eyes checked within 24 hours.

Sometimes it is easier get an appointment with an optometrist on the high street, but they may refer you straight away to your local A&E department so that you see an ophthalmologist as soon as possible. A&E departments should have an ophthalmologist on call who can examine your eye and decide what to do next. You can also call 111 for advice about where to go to get your eyes checked.

If you have been checked for retinal detachment in the past, you should have been given clear instructions on what to do if you have further symptoms. You should follow these if more symptoms develop. This usually involves contacting the hospital eye clinic if you have any concerns.

Retinal detachment can be treated by surgery to re-attach the retina to the back of the eye. The sooner surgery is carried out the better the results are likely to be. If your retinal detachment isn’t treated, then you are likely to lose all the vision in the affected eye.

Once your ophthalmologist has examined your eye, they will decide how quickly surgery needs to be done – this may be within 24 hours or within a few days.

There are three main types of surgery used to reattach the retina. They all aim to make your retina lie flat against the inside of your eye again.

Surgery for retinal detachment is complicated and individual to each person’s eye. The type of treatmentsurgery you may need depends on the type and cause of the detachment, and any complicating factors, such as any other eye conditions you may already have. Your ophthalmologist will decide on what type of surgery is most appropriate for your individual circumstances, and they may combine different options depending on the extent of your detachment.

Vitrectomy

The most common surgery used for a retinal detachment in the UK is a vitrectomy. During surgery your ophthalmologist removes some of the vitreous gel in your eye and replaces it with a gas bubble. Removing some of the vitreous gel helps to remove the traction (pulling) of the gel on the retina. The gas bubble holds your retina in place against the inside of your eye while it heals. The gas slowly disappears over time; it may take between two to 12 weeks depending on the type and concentration of gas used.

Your ophthalmologist may choose to use clear silicone oil instead of a gas bubble. The silicone oil is heavier than gas and is effective for longer at keeping s your retina in the right place while it heals. However, but unlike the gas bubble, you will need further surgery to remove the oil at some point in the future. Silicone oil is generally used for more complex retinal detachments.

Scleral buckle

Your ophthalmologist may use a scleral buckle to treat your detachment. The sclera is the white outer layer of your eye.

A scleral buckle involves attaching a tiny piece of silicone sponge or harder plastic to the outside white of your eye. This presses on the outside of the eye, causing the inside of your eye to slightly move inwards. This pushes the inside of the eye against the detached retina and into a position which helps the retina to reattach. Cryotherapy or laser treatment is then used to seal the area around the detachment. The buckle is usually left in place permanently and can’t be seen once surgery is finished.

Pneumatic retinopexy

If your retinal detachment is small and uncomplicated, a gas bubble can be injected into the vitreous of the eye, without removing any of the vitreous. This bubble then presses the retina back in place. Like with vitrectomy, the gas is reabsorbed over a period of weeks. This type of surgery has been found to be less successful than other types and is not often done in the UK but may be carried out for a small number of straightforward and small retinal detachments.

Surgery is usually very successful at reattaching the retina, but how well your vision recovers depends on:

• how much of your retina detached
• if your macula (the central part of your retina, used for seeing detail and reading) was detached
• how long your retina was detached
• if you have another eye condition, such as diabetic retinopathy.

If your macula, which allows you to see fine detail, remained attached, then results are often very good, and your central vision may not be affected at all.

If you had a shadow in your peripheral vision, this should disappear after surgery. You may be left with some changes in your peripheral vision, which can be picked up by an eye examination, although you may not notice these on a day-to-day basis.

If your macula detached, but surgery was carried out quickly, then your central vision can return, but it may be distorted. You will probably adapt to this distortion with time, especially if you have good vision in your other eye.

Unfortunately, for some people, surgery may be successful at reattaching the retina, but it may not bring back detailed central vision or areas of peripheral vision. This can happen in any circumstance, but the risk is higher the longer the retina has been detached without any surgery.

Around one in 10 people may need more than one operation to treat a retinal detachment. The reasons for this are new tears forming in the retina, or the formation of scar tissue which contracts and pulls the retina off again.

In these cases, it is possible to have more surgery to reattach the retina. At each stage, your ophthalmologist will discuss with you the likelihood of success and the need to have more surgery or treatments.

If your retinal detachment is detected early and treated successfully, you may not be left with any long-term problems with your vision once your eye has recovered from surgery.

If your retinal detachment has left you with sight loss in one eye, you may still have useful vision in your other eye. It can take a few months to get used to seeing with only your good eye, because sometimes the eye with poor vision will interfere with clear vision. With time, the brain learns to ignore the eye with poorer vision in most situations.

If a retinal detachment has caused sight loss in your good eye and you have reduced sight in your unaffected eye, then you may be left with sight problems. There are lots of things you can do to make the most of your remaining vision. This may mean making things bigger, using brighter lighting or using colour to make things easier to see. A low vision assessment can explore how to make the most of your sight. Your GP, optometrist or ophthalmologist can refer you to your local low vision service for an assessment. You can also find out tips for making the most of your sight by downloading our booklet:

It’s completely natural to be upset when you’ve been diagnosed with a retinal detachment. Often there can be a lot of changes, including surgery, in a short space of time. You may find that you are worried about the future and how you will manage with a change in your vision. We’re here to support you every step of the way, and to answer any questions you may have – just get in touch with our Sight Loss Advice Service.

Useful contacts

• The NHS website has information on retinal detachment.
• Moorfields Eye Hospital also has helpful information on retinal detachment

Watch our Living with Retinal detachment story