retina is a thin membrane of nerve tissue that lines
the back of the
eye. When part or all of the retina comes off (detaches from) the back of the eye, it is called retinal detachment.
The nerve cells in
the retina normally detect light entering the eye and send signals to the brain
about what the eye sees. But when the retina detaches, it no longer works
correctly. It can cause blurred and lost vision. Retinal detachment requires
immediate medical care. If done soon enough, surgery can save lost
detachment often begins when the
vitreous gel, a thick gel that fills the center of the
eye, shrinks and separates from the retina. Called a posterior vitreous
detachment (PVD), this is a normal part of aging and can
be harmless. Sometimes, though, PVD can tear the retina. This happens where the
vitreous gel is strongly attached to the retina. As the vitreous gel shrinks,
it pulls so hard that the retina tears. The tear allows fluid to collect under
the retina and may cause the retina to detach.
Other things that can
lead to retinal detachment are an eye or head injury,
nearsightedness, eye disease, and conditions
most cases of retinal detachment cannot be prevented. But seeing your eye
doctor regularly, wearing protective helmets and eyeglasses, and treating
diabetes may help protect your vision.
Many people have symptoms
of a posterior vitreous detachment, or PVD, before they have symptoms of
retinal detachment. When the vitreous gel shrinks and separates from the
retina, it causes
floaters and flashes. Floaters are spots, specks, and
lines that float through your field of vision. Flashes are brief sparkles or
lightning streaks that are most easily seen when your eyes are closed. They
often appear at the edges of your visual field. Floaters and flashes do not
always mean that you will have a retinal detachment. But they may be a warning
sign, so it is best to be checked by a doctor.
Sometimes a retinal
detachment happens without warning. The first sign of detachment may be a
shadow across part of your vision that does not go away. Or you may have new
and sudden loss of side (peripheral) vision that gets worse over time.
retinal detachment, your doctor will examine your eyes and ask you questions
about any symptoms you have.
If you have symptoms of retinal
detachment, your doctor will use a lighted magnifying tool called an
ophthalmoscope to examine your retina. With this tool, your doctor can see
holes, tears, or retinal detachment.
Retinal detachment requires
care right away. Without treatment, vision loss can progress from minor to
severe or even to blindness within a few hours or days.
the only way to reattach the retina. In most cases, surgery can restore good
vision. There are many ways to do the surgery, such as using lasers, air bubbles, or a
freezing probe to seal a tear in the retina and reattach the retina.
Learning about retinal detachment:
Living with retinal detachment:
Causes of retinal detachment are:
Most cases of
retinal detachment begin when the
vitreous gel that fills the center of the eye shrinks
and separates from the retina (called
posterior vitreous detachment, or PVD). Symptoms of
Having floaters or flashes does not always mean that
you are about to have a retinal detachment, but you should not ignore these
symptoms. Call your doctor to discuss whether you need to have an eye exam.
If you have new or sudden flashes or floaters, darkness
over part of your visual field, or a new loss of vision that does not go away,
call your eye doctor or regular doctor right away. Floaters and
flashes may be warning signs of retinal detachment. A sudden shower of what
appear to be hundreds or thousands of little black dots across the field of
vision is a distinctive sign of blood and/or pigment in the vitreous gel and
may indicate a retinal detachment. This requires immediate medical
In rare cases, a retinal detachment can occur without warning. The first signs
Retinal detachment can progress quickly. Because retinal detachment affects side
(peripheral) vision first, you may not notice the vision loss right away. If
not treated, detachment can spread to the center of the retina (macula) and damage
Retinal detachment requires urgent care. Without treatment, vision loss from retinal detachment
can progress from minor to severe or even to blindness within a few hours or
Retinal tears and holes, though, may not need
retina sometimes develops small, round holes as it
ages, and many of them will not lead to retinal detachment. Retinal tears
caused by the
vitreous gel pulling on the retina (vitreous traction)
are more likely to cause retinal detachments.
Tears in the retina
caused by vitreous traction tend to cause flashes and floaters. A tear that
does not occur with vitreous traction and therefore develops without symptoms is far less likely to lead to a retinal
detachment than a tear that occurs with symptoms.
If the retina has detached, you will need surgery to reattach it and
restore vision. If you have had a retinal detachment in one eye, you have a
greater chance of developing one in the other eye.
Things that increase your
retinal detachment include:
Flashes of light and
floaters often occur as you get older or with
migraine headaches. Flashes of light in migraine
headaches are often located in the center of your visual field. But flashes of
light and floaters can also be signs of a problem that might lead to
If flashes of light
or floaters occur suddenly or in great numbers, or if you are not sure what to
do, do not wait for vision loss to occur before you call
your doctor. If you cannot reach your doctor, go to the emergency room. Although these symptoms do not cause pain and may seem
harmless, getting an eye exam and quick treatment can send you home relieved
or, if there is a problem, can save your vision.
Taking a wait-and-see approach, called watchful
waiting, is not an option if you have new or sudden flashes or floaters,
darkness over part of your visual field, or a new loss of vision that does not
go away. Sudden, rapid vision loss is a medical emergency.
If you have symptoms that suggest that you might have
or are at immediate risk for a retinal detachment, call your doctor immediately. If you do not have an eye doctor (ophthalmologist), call your regular doctor. Based on
your symptoms, risk factors, and medical history, your doctor may refer you to
an eye doctor for an immediate exam and possible treatment.
Treatment for retinal tears and detachments is often done by an eye doctor who
specializes in retinal detachments.
To prepare for your appointment, see the topic Making the Most of Your Appointment.
retinal detachment, your doctor will ask you questions
about your symptoms, past eye problems, and risk factors. The doctor will also
test your near and distance vision (visual acuity) and side (peripheral)
vision. These routine vision tests do not detect retinal detachment, but they
can find problems that could lead to or result from retinal detachment.
A doctor can usually see a retinal tear or detachment while examining the
ophthalmoscopy. This test allows the doctor to see
inside the back of the eye using a magnifying instrument with a light.
If a retinal tear or detachment involves blood vessels in the retina, you
may have bleeding in the middle of the eye. In these cases, your doctor can
view the retina using
ultrasound, a test that uses sound waves to form an
image of the retina on a computer screen.
If you have a condition that puts you at high
risk for retinal detachment—such as nearsightedness, recent
family history of retinal detachment, or a prior
retinal detachment in your other eye—talk to your doctor about how often you
should have your eyes checked. You may need more frequent exams to detect
problems in their early stages.
Many retinal detachments are
triggered when the
vitreous gel that fills the center of the eye shrinks
and separates from the retina, which is called
posterior vitreous detachment (PVD). The main symptoms
of PVD are dark
flashes of light. It is important to pay attention to
these symptoms, because they could be a warning sign of a retinal tear that can
lead to detachment. Getting treatment quickly after you notice these symptoms
can save your vision.
Retinal detachment requires care right away. Without treatment, vision loss can progress from minor to severe or even to blindness within a few hours or days.
Only surgery can repair
retinal detachment. It is usually successful and, in
many cases, restores good vision.
For more information, see Surgery.
You cannot prevent most cases of
Some eye injuries can
retina and cause detachment. You can reduce your risk
of these types of injuries if you:
Diabetes puts you at greater risk for developing
diabetic retinopathy, an eye disease that can lead to
tractional retinal detachment. If you have diabetes,
you can help control and prevent eye problems by having regular eye exams and
by keeping your blood sugar levels within a target range.
Treating a retinal tear can often prevent retinal detachment, but not all
tears need treatment. The decision to treat a tear depends on whether the tear
is likely to progress to a detachment.
You cannot treat
retinal detachment at home. Surgery is the only
After surgery to repair retinal detachment, your doctor
may give you specific instructions to help your eye recover. You may need to
rest and sleep with your head in a certain position, for example. And you may
be asked to wear an eye patch or use eyedrops.
Some types of
surgery to treat retinal detachments involve injecting a small bubble of gas
into the eye. Afterward, you may be asked to avoid air travel until your eye
has healed, because the changes in air pressure may cause pain and affect your
Surgery is the only
treatment for retinal detachment. The goals of surgery are:
Almost all retinal detachments can be repaired with
scleral buckle surgery, pneumatic retinopexy, or vitrectomy.
But even with such a high rate of success for
surgery, it is important to act quickly. The longer you wait to have surgery,
the lower the chances that good vision will be restored. When the retina loses
contact with its supporting layers, vision begins to get worse. An eye doctor
(ophthalmologist) who specializes in retinal
detachments will usually do surgery within a few days of your being
diagnosed with a detachment.
How soon you need surgery usually
depends on whether the retinal detachment has or could spread far enough to
central vision. When the
macula, the part of the retina that provides central
vision, loses contact with the layer beneath it, it quickly loses its ability
to process what the eye sees.
Your doctor will decide how soon you need surgery based
on the result of the retinal exam and the doctor's experience in treating
Treating a retinal tear
may be useful if the tear is likely to lead to detachment. Symptoms such as
flashing lights are key factors in deciding whether to
treat a tear. A tear that occurs right after a
posterior vitreous detachment (PVD) with symptoms is
usually much more dangerous and more likely to progress to a retinal detachment
than one that occurs without symptoms.
when to treat a retinal tear, your doctor will
evaluate whether the torn retina is likely to detach. If the tear is very
likely to lead to detachment, treatment can usually repair it and prevent
detachment and potential vision loss. If the tear is not likely to lead to
detachment, you may not need treatment.
Common methods of repairing a retinal detachment
Common methods of repairing a retinal tear
You have several surgical
options to repair a retinal detachment. Their success in restoring good vision
varies from case to case. The cause, location, and type of detachment usually
determine which surgery will work best. Other conditions or eye problems may
also play a role when you choose the best type of surgery.
need more than one surgery to reattach the retina if scar tissue from the first surgery grows over the surface of your retina.
Things that may make surgery more difficult
After surgery, you
may need to use antibiotic eyedrops and
corticosteroid medicines for a short time.
The American Society of Retina Specialists is a membership group for ophthalmologists who specialize in the diagnosis and treatment of retina and vitreous problems in the eye. Use the Patients tab to find a retina specialist in your area. And go to the EyeWiki link to find eye disease content written by eye doctors.
EyeCare America is a public service program of the
Foundation of the American Academy of Ophthalmology. This site aims to raise awareness about
eye diseases and eye care. It has information about eye conditions, treatments, and general eye health. You can check to see if you qualify for a free eye exam.
EyeSmart is a public information Web site provided by
the American Academy of Ophthalmology. It provides general information and
brochures on eye conditions and diseases and low-vision resources and
As part of the U.S. National Institutes of Health, the National Eye
Institute provides information on eye diseases and vision research.
Publications are available to the public at no charge. The Web site includes
links to various information resources.
Prevent Blindness America assists the visually impaired
and provides consumer information on vision problems and vision aids.
Its website has information about eye health and safety for children
and adults. Many states have local affiliates.
Other Works ConsultedAmerican Academy of Ophthalmology (2008). Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology.Fletcher EC, et al. (2008). Retina. In P Riordan-Eva, JP Whitcher, eds., General Ophthalmology, 17th ed., pp. 186–211. New York: McGraw-Hill.Greven CM (2009). Retinal breaks. In M Yanoff, JS Duker, eds., Ophthalmology, 3rd ed., pp. 716–719. Edinburgh: Mosby Elsevier.Kang HK, Luff AJ (2008). Management of retinal detachment: A guide for non-ophthalmologists. BMJ, 336(7655):1235–1240.Sebag J (2009). Vitreous anatomy and pathology. In M Yanoff, JS Duker, eds., Ophthalmology, 3rd ed., pp. 766–773. Edinburgh: Mosby Elsevier.Steel D, Fraser S (2010). Retinal detachment, search date June 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.Trobe JD (2006). Retinal detachment section of Principal ophthalmic conditions. In Physician's Guide to Eye Care, 3rd ed, pp. 124–129. San Francisco: American Academy of Ophthalmology.Wilkinson CP (2005). Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database of Systematic Reviews (1).Wilkinson CP (2009). Rhegmatogenous retinal detachment. In M Yanoff, JS Duker, eds., Ophthalmology, 3rd ed., pp. 720–726. Edinburgh: Mosby Elsevier.
August 7, 2011
Adam Husney, MD - Family Medicine & Carol L. Karp, MD - Ophthalmology
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