Retinal detachment occurs when the thin lining at the back of your eye called the retina begins to pull away from the blood vessels that supply it with oxygen and nutrients.
Without prompt treatment, it will lead to blindness in the affected eye.
Most people will experience warning signs that indicate their retina is at risk of detaching before they lose their sight. These are:
- the sudden appearance of – dark spots that float in your field of vision
- sudden short flashes of light in one eye
- blurred or distorted vision
Contact your doctor immediately if you get any of these warning signs.
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Retinal detachment is most often the result of the retina becoming thinner and more brittle with age and pulling away from the underlying blood vessels.
It can also be caused by a direct injury to the eye, but this is less common.
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If your doctor suspects a diagnosis of retinal detachment, it is likely you will be referred to an eye specialist (ophthalmologist), usually on the same day.
The ophthalmologist will study the back of your eye with an ophthalmoscope (a magnifying glass connected to a light) and a slit lamp (a microscope that magnifies the eye while you rest your head on a chin rest). If there is a poor view of the retina, anmay also be used.
The quicker retinal detachment is treated, the less risk there is of permanently losing some or all of your vision in the affected eye.
Most detached retinas can be successfully reattached with surgery. There are a number of different types of surgery available, depending on the individual.
It can take months to fully recover from surgery on your eye. During this period your vision may be reduced, which means you may not be able to do some of your usual activities, such as driving or flying.
Unfortunately, some people's eyesight does not fully return after surgery and they have permanently reduced peripheral (side) or central vision. This can happen even if the retina is reattached successfully. The risk of this is higher the longer the detachment was left untreated.
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Who is affected?
Retinal detachment is a rare condition.
As retinal detachment is associated with ageing, most cases affect older adults aged between 50 and 75.
Retinal detachment caused by an injury can affect people of any age, including children.
Initial symptoms of retinal detachment include the sudden appearance of– black dots, specks or streaks that float across your field of vision.
Some people experience a kind of cobweb effect of lots of little floaters, while others report a single large black floater that looks like a housefly.
Usually only one eye is affected by floaters.
Another common symptom is seeing flashes of light in the affected eye. These last no more than a second.
You may also experience some blurring or distortion of your vision.
Without treatment, you will go on to experience increasing loss of vision in the affected eye. Most people describe this as a shadow or "black curtain" spreading across their vision.
When to seek medical advice
If you experience these warning signs, contact your doctor immediately for advice. If this is not possible, or your local out-of-hours service.
The most common cause of retinal detachment is when tiny holes develop inside the retina.
The holes allow the fluid found between the retina and the lens of the eye to leak underneath the retina.
If too much fluid builds up underneath the retina it can cause the retina to pull away from the blood vessels that supply it with blood. Without a constant blood supply, the nerve cells inside the retina will begin to die.
The main reason for these holes developing is thought to be because the retina becomes narrower and weakened with age.
People who are veryhave the greatest risk of developing age-related retinal detachment (though in relative terms the risk is still very small) because they are often born with a thinner than normal retina in the first place.
Previous eye surgery, such as, may also make the retina more vulnerable to damage.
In some cases, holes can develop if the eye is suddenly injured, such as by a punch to the face or being accidentally hit in the eye with a flying object.
Less common causes
Less common causes of retinal detachment include:
- Damage to the blood vessels in your eye causes scar tissue to form, which can pull the retina out of position. This is usually the result of a complication of diabetes](/diabetes/#diabetes), called [diabetic retinopathy.
- The retina remains unbroken but fluid from other sources gathers behind the retina. This can sometimes occur in conditions that cause inflammation and swelling inside the eye, such as and some rare types of cancer that develop inside the eye.
If retinal detachment has occurred, surgery is required to reattach the retina.
Without treatment, total loss of vision is almost certain. In 90% of cases, only one operation is needed to reattach the retina.
Surgery for retinal detachment may be done under a(where you are put to sleep) or a (where drops are used to numb your eye and the surrounding tissue).
You will be asked not to eat or drink anything for six hours before the operation. Afterwards, you may need to stay in hospital for one or two days, or you may be able to leave on the same day, depending on the circumstances.
Before you are given the anaesthetic, you will be given eye drops to widen your pupil.
The different surgical treatments for a detached retina are explained below.
If the detachment is relatively small and uncomplicated, a procedure called pneumatic retinopexy may be used. This involves injecting a small bubble of gas into the eye, which presses the retina back into place.
Laser or freezing treatment is often then used to create scar tissue that keeps the retina in the correct place. The bubble is slowly absorbed into the eye over the following weeks.
After the procedure, you will be asked to keep your head in a certain position for a while, known as "posturing", so the bubble settles in the correct position.
If you have had a gas bubble put in your eye, you will not be able to travel by air for a while. Your doctor will tell you when it is safe to fly again.
If you need another operation that requires general anaesthetic, you must tell your doctors about the gas bubble in your eye.
Scleral buckling involves fine bands of silicone rubber or sponge that are stitched onto the outside white of the eye (the sclera) in the area where the retina has detached. The bands act like a buckle and press the sclera in towards the middle of the eye, so the torn retina can lie against the wall of the eye.
Laser or freezing treatment is used to scar the tissue around the retina, which creates a seal between the retina and the wall of the eye and closes up the tear or hole.
The bands can be left on the eye and should not be noticeable after the operation.
Vitrectomy works by removing the fluid from the inside of the eye and replacing it with either a gas or silicone bubble. This holds the retina in position from the inside.
A vitrectomy may be recommended if the fluid in front of the eye is unusually thick and dense and is pulling the retina away from the underlying blood vessels.
Tiny dissolving stitches are used to close the wound. It is also possible to perform such surgery without the use of stitches, using smaller instruments. While this may lead to less discomfort, it is not known whether it is more effective.
As with a pneumatic retinopexy, posturing will be necessary to ensure the bubble is in the right place. The same restrictions on flying and precautions for further surgery that apply to pneumatic retinopexy also apply to vitrectomy.
There is a small chance of developing complications during or after surgery, including:
- bleeding inside the eye
- more holes in the retina
- bruising around the eye
- high pressure or swelling inside the eye ( )
- the lens of the eye becomes cloudy ( )
- double vision
- allergy to the medicine used
- infection in the eye (this is very rare)
These complications are not common and can usually be treated. Sometimes you may need more than one operation to fix the retina.
After the operation, your eyelids may feel itchy and sticky, and some fluid may leak from your eye.
There may be some bruising around the eye. These symptoms are perfectly normal and any discomfort should go away after a couple of days. You can take a simple painkiller such asto relieve the discomfort.
A day after the operation, your doctor will give you some eye drops to reduce the swelling and prevent infection. It is important not to rub the eye while it heals, which will usually take two to six weeks.
If you have had a gas bubble in your eye, your vision will be blurry for a while. This is only temporary.
It can take many months for vision to improve after surgery and in some cases you may experience some degree of permanent vision loss, but not complete blindness. Your ophthalmologist can advise you about any activities you may need to avoid while you recover.
The amount of vision that can be successfully restored depends, for the most part, on how much of the retina was detached and for how long.
The Royal National Institute for the Blind (RNIB) website has a section called Living with sight loss, which provides useful resources for people who have recently lost some of their vision.
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