Retinal detachment

When your retina separates from the inside of your eye, it is known as a 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. A retinal detachment can be repaired with surgery, but it needs to be detected and in most cases 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 has detached. Most people have a good level of vision following surgery to re-attach the retina.

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

Download Understanding Retinal Detachment in PDF

You can also download Understanding Retinal Detachment in Word.


Quick links
– What's it like to have a retinal detachment?
– What causes retinal detachment?
– Who is at risk?
– What are the symptoms of a retinal detachment?
– What treatment is available for a retinal detachment?
– Coping



What's it like to have a retinal detachment?

In the film below, Nicki talks about her experience of having a retinal detachment:



What causes retinal detachment?

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, causing the retina to detach. Holes in the retina tend to be caused by age-related changes to your eye. Tears happen because the retina has been pulled and torn. The most common cause of a retinal tear is the vitreous gel – which fills your eye and helps it maintain a round shape – coming away from the retina (known as acute posterior vitreous detachment or PVD).
  • Scar tissue. Eye conditions such as diabetic retinopathy can result in scar tissue forming 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 or tumours.


Who is at risk?

Retinal detachments are rare; only about one in 10,000 people have one each year. You have an increased risk of retinal detachment if you:

  • are very short-sighted (more than minus 6.0 D – your optometrist will be able to tell you how short-sighted you are)
  • have had trauma (an injury or a blow) directly to your eye
  • have already had a detachment in one eye (between two and 10 per cent of people have detachments in both eyes)
  • have a family history of retinal detachment.

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What are the symptoms of a retinal detachment?

There are four main symptoms that 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.

Floaters

Floaters are caused by bits of debris floating 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 can expect to 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 suspect, find or can’t rule out a tear in your retina, then they will refer you urgently to an ophthalmologist.

Flashing lights

Lots of people have flashing lights, most commonly around the edges of their vision. Flashing lights happen when the retina is stimulated by something inside the eye rather than by the light entering the eye. They are often caused by the vitreous gel inside the eye moving across and pulling on the retina.

In many cases flashing lights are caused by a gradual change in your vitreous gel and they don’t cause any long-term problems. However, flashing lights may be a sign of a retinal tear or the start of a retinal detachment.

There is no way you can tell whether your flashing lights are caused by your vitreous or by a retinal tear. If you suddenly experience new flashing lights, you should have your eye examined by an optometrist as soon as possible, especially if you also have new floaters.

Dark shadow

If your retina does detach, this means that it doesn’t work properly any more 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.

Who should check my eyes?

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.

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.

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What treatment is available for a retinal detachment?

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 over time.

Surgery for retinal detachment is complicated and individual to each person’s eye. The type of treatment you may need depends on the type of detachment, and any complicating factors, such as any other eye conditions you may have.

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. The timing of your surgery may depend on how much of your retina has become detached and whether or not your macula is involved.

There are various types of surgery used to reattach the retina and your ophthalmologist may combine different methods depending on your detachment.

Vitrectomy

The most common surgery used for a retinal detachment in the UK is a vitrectomy. During surgery your ophthalmologist reattaches the area of your retina that has become detached, removing some of the vitreous gel in your eye and replacing it with a gas bubble. The gas bubble holds your retina in place against the inside of your eye while it heals. The gas slowly disappears over about six weeks following the operation.

Depending on how your retina has detached, your ophthalmologist may chose to use clear silicone oil instead of a gas bubble. The silicone oil keeps your retina in the right place while it heals, but unlike the gas bubble you will need further surgery to remove the oil at some point in the future.

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 (gas bubble surgery)

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, and cryotherapy or laser is applied round the hole or tear. The gas is reabsorbed over a period of weeks and the retina remains in place. 

How successful is treatment?

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

  • how much of your retina detached
  • if your macula 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 will 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.

What if my sight is not as good as before? 

If you have lost vision in one eye due to a detachment, 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 the affected eye was your good eye and you have a sight problem in your unaffected eye, then you may be left with sight problems. A low vision assessment can explore how to make the most of your sight. This may mean making things bigger, using brighter lighting or using colour to make things easier to see. 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 guide:

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Coping

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.

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