Retinal Detachment: Symptoms & Treatment

Written by Vasileios Skouteris MD, FEBO, Ophthalmic Surgeon

Page contents

1. What is retinal detachment?
2. Causes and risk factors
3. Symptoms: flashes, floaters and a shadow
4. How is it diagnosed?
5. Treatment: how retinal detachment is repaired
6. What happens after surgery?
7. When to see an ophthalmologist urgently
8. The three types of retinal detachment
9. Posterior vitreous detachment: the first step
10. Retinal tear: causes, symptoms and treatment
11. Why time is so critical
12. The gas bubble and head positioning
13. Recovery and vision after surgery
14. Prevention: can retinal detachment be avoided?
15. Who is at higher risk of retinal detachment?
16. Retinal detachment in children
17. Driving, work and daily life after repair
18. Myths and facts about retinal detachment
19. Questions worth asking your ophthalmologist
20. Frequently Asked Questions about Retinal Detachment

Retinal detachment is the separation of the retina, the light-sensitive layer at the back of the eye, from the underlying tissue that nourishes it. It is an emergency: without prompt treatment it can lead to permanent loss of sight. Warning signs are new floaters, flashes of light and a shadow in your field of vision.

What is retinal detachment?

The retina works like the sensor of a camera. It converts light into nerve signals that reach the brain through the optic nerve. To function, it must lie against the layers beneath it, which supply it with oxygen and nutrients. When it separates, the light-sensing cells begin to suffer and, the longer the detachment lasts, the greater the risk of permanent damage.

There are three main types:

• Rhegmatogenous detachment: the most common form. It starts from a retinal tear, through which fluid from the vitreous cavity passes and “lifts” the retina.
• Tractional detachment: caused by fibrous membranes that pull on the retina, as happens in advanced diabetic retinopathy.
• Exudative detachment: fluid collects under the retina without a tear, because of inflammation, a tumour or a vascular condition.

Causes and risk factors

The vitreous is the clear gel that fills the inside of the eye. With age it becomes more liquid and at some point separates from the retina, a process called posterior vitreous detachment. It is a normal process and in most cases causes no problems. In a small percentage of people, however, the vitreous pulls on the retina so strongly that a tear forms, and a detachment can start from there.

The risk is higher in people who have:

• high myopia, because the longer eye has a thinner retina in the periphery,
• had previous eye surgery, most commonly cataract surgery,
• had an injury to the eye or head,
• had a retinal detachment in the other eye, or a family history of it,
• areas of thinning in the retinal periphery, such as lattice degeneration,
• advanced diabetic retinopathy.

Symptoms: flashes, floaters and a shadow

Retinal detachment is painless. This is why visual symptoms are the only warning sign and must not be ignored:

• A sudden increase in floaters: many small dots, threads or a “cloud” that moves as you move your eyes.
• Flashes of light: brief flickers, usually at the edge of your vision, more noticeable in the dark.
• A shadow or “curtain”: a dark area that starts in the periphery and moves towards the centre.
• Blurred or distorted vision: when the detachment reaches the macula, central vision is affected.

A few stable floaters that have been there for years are usually harmless. The difference between harmless and worrying floaters is explained in detail on the page what are eye floaters. Any new, sudden change, however, needs an examination the same day.

How is it diagnosed?

The diagnosis is made with a detailed dilated fundus examination. The ophthalmologist examines the entire retina out to the far periphery, looking for tears, areas of thinning and fluid under the retina. Gentle pressure is often applied to the eyelid so that the most distant areas can be seen.

Depending on the case, the examination is supplemented with:

• fundus photography, to record the findings and compare them at follow-up visits,
• optical coherence tomography (OCT), to see whether the macula has been affected,
• ocular ultrasound, when a haemorrhage or a cloudy lens prevents a clear view of the fundus.

Treatment: how retinal detachment is repaired

The choice of treatment depends on whether there is only a tear or already a detachment, on its size and location, on whether the macula has been affected and on whether the eye has had cataract surgery. Time is critical: the sooner it is treated, the better the chances of preserving vision.

Laser photocoagulation for a retinal tear

When a tear is found before a detachment develops, small laser burns are applied around it. These create a scar that “seals” the retina and stops fluid from passing underneath. The treatment is carried out at the practice with anaesthetic eye drops and takes a few minutes. In certain locations, cryotherapy, freezing applied from the outside of the eye, is used instead.

Pneumatic retinopexy

In selected detachments with a single small tear in the upper part of the eye, a small bubble of special gas is injected into the eye. The patient keeps their head in a specific position for a few days so that the bubble presses against the tear, which is then sealed with laser or cryotherapy.

Scleral buckling

A thin, flexible piece of material is stitched to the outer wall of the eye, the sclera, and indents it slightly inwards so that it comes into contact with the tear. The material usually stays in place permanently and is not visible. It is used more often in younger patients who have not had cataract surgery.

Vitrectomy

Using microsurgical instruments, the vitreous that is pulling on the retina is removed, the retina is put back in place and the tears are sealed with laser. At the end, the eye is filled with gas or silicone oil, which holds the retina in position while it heals. It is the most common operation for complex detachments and for eyes that have already had cataract surgery.

What happens after surgery?

Recovery varies depending on the method. After surgery with gas, a specific head position is needed for a number of days, and flying or travelling to high altitude is not allowed until the bubble has been fully absorbed, because the change in pressure can make it expand dangerously. If silicone oil is used, a second operation is usually needed to remove it after a few months.

Vision improves gradually, over weeks or months. The final result depends mainly on whether the macula had detached and for how long. After vitrectomy, a cataract often develops or gets worse. In a proportion of patients the detachment recurs and further surgery is needed, which is why follow-up visits are essential.

When to see an ophthalmologist urgently

Contact an ophthalmologist the same day, without waiting to see whether it passes, if you notice:

• a sudden appearance of many new floaters,
• flashes of light, especially if they are new or keep recurring,
• a shadow, curtain or “veil” anywhere in your field of vision,
• sudden blurring or distortion of your vision.

If you are in a higher-risk group, such as people with high myopia or a history of detachment in the other eye, regular dilated fundus examinations help to find tears before they cause a detachment.

For a retinal examination at the practice in Neo Psychiko, book an appointment.

The three types of retinal detachment

• Rhegmatogenous detachment: the most common form. A tear or hole forms in the retina, through which fluid from inside the eye passes and lifts it away from the underlying layers.
• Tractional detachment: fibrous tissue on the surface of the retina “pulls” it inwards. It occurs mainly in advanced diabetic retinopathy.
• Exudative detachment: fluid collects under the retina without a tear, because of inflammation, a tumour or a vascular condition. Treatment targets the underlying cause.

Posterior vitreous detachment: the first step

The vitreous is the clear gel that fills the inside of the eye. With age it becomes more liquid and at some point separates from the retina. This posterior vitreous detachment is normal and happens in most people after the age of 50 to 60, earlier in people with myopia. It usually causes a sudden appearance of floaters or a large floating ring, and sometimes flashes.

In most cases it causes no damage. In a small percentage, however, where the vitreous is firmly attached, it pulls on the retina and creates a tear. This is why any new floaters or flashes need a dilated fundus examination within a few days, even if nothing worrying is found in the end.

Retinal tear: causes, symptoms and treatment

A retinal tear is often the forerunner of a detachment. The most common causes are traction from posterior vitreous detachment, thin degenerative areas in the retinal periphery, which are particularly common in people with myopia, and blows to the eye. The symptoms are the same as those of posterior vitreous detachment: flashes and new floaters, sometimes like a “cloud” of small dots, caused by a small haemorrhage.

When a tear is found before the retina detaches, treatment is simple: laser photocoagulation creates small “welds” around the tear that seal it. The treatment is carried out at the practice, takes a few minutes and in most cases prevents a detachment. This is why early examination is so important.

Why time is so critical

The visual outcome after a detachment depends mainly on whether the macula, the centre of vision, has detached. When the detachment is diagnosed while the macula is still attached, surgery is performed urgently to protect it, and final vision is usually very good. When the macula has already detached, surgery reattaches the retina, but central vision may not fully recover. This is why a shadow “rising” in your field of vision is an emergency.

The gas bubble and head positioning

In many retinal detachment operations, a gas bubble is placed in the eye at the end. The bubble presses the retina into place while the tears heal and is gradually absorbed over a few weeks. For it to work properly, the patient often needs to keep their head in a specific position for several hours a day during the first days. The position depends on where the tear is and is set by the surgeon.

While there is a gas bubble in the eye:

• air travel and travelling to high altitude are not allowed, because the gas expands and the eye pressure can rise dangerously
• you must inform any anaesthetist, because certain anaesthetic gases are contraindicated
• vision is very blurred and improves as the bubble gets smaller

In more complex cases silicone oil is used, which is not absorbed and is removed with a second operation after a few months.

Recovery and vision after surgery

• First few days: discomfort, swelling and redness. Antibiotic and anti-inflammatory eye drops, as instructed.
• First few weeks: avoid strenuous physical activity, bending over and lifting heavy objects. Office work is usually possible after one to two weeks, depending on the operation.
• First few months: vision improves gradually. New glasses may be needed, especially after scleral buckling, which changes the shape of the eye.
• Long term: regular check-ups of both eyes, because the risk of detachment in the other eye is increased.

Prevention: can retinal detachment be avoided?

We cannot prevent the normal separation of the vitreous, but we can significantly reduce the risk of retinal detachment:

• with an annual fundus examination for people with high myopia or a personal or family history of detachment
• with preventive laser treatment of selected degenerative areas or high-risk tears
• with protective eyewear for ball sports, martial arts and work with a risk of eye injury
• with an immediate examination whenever new flashes or floaters appear

Dr. Vasileios Skouteris, who completed specialist training in retinal diseases in Oxford, sees patients with flashes and floaters urgently at his practice in Neo Psychiko. To book an appointment, call 210 677 0007.

Who is at higher risk of retinal detachment?

Retinal detachment can happen to anyone, but some groups of people are affected much more often. If you belong to one of them, it is worth knowing the warning signs and having regular fundus examinations, even if your vision seems normal.

High myopia

In myopia the eyeball is longer than normal and the retina is stretched, becomes thinner and more often develops areas of degeneration in the periphery. People with more than 6 dioptres of myopia have a risk several times higher than the general population. For this reason, a short-sighted person who has eye tests only for glasses is missing the most important part: a dilated fundus examination.

After cataract surgery

Modern cataract surgery is very safe, but it slightly increases the risk of detachment in the following years, mainly in people with myopia and in younger patients. If new floaters or flashes suddenly appear after surgery, this is not “normal after the operation”: you need an examination the same day.

Eye injury

A blow from a ball, an elbow or an object can cause a tear, even if the eye looks intact from the outside. A detachment after trauma does not always appear immediately; it can develop weeks or months later. This is why a fundus examination is essential after a hard blow to the eye.

Personal and family history

Anyone who has had a detachment in one eye is at increased risk in the other, so the “healthy” eye needs close monitoring. A family history of detachment, as well as advanced diabetic retinopathy, also increases the risk.

Retinal detachment in children

In children, retinal detachment is rare but is often diagnosed late, because a young child will not say they “see a shadow”. Parents may notice that the child has a squint, bumps into things on one side or that the pupil looks whitish in photographs. Common causes are high myopia, injury and certain inherited syndromes. Regular check-ups in paediatric ophthalmology identify early the children who need monitoring.

Driving, work and daily life after repair

Returning to daily life depends on the type of operation and on whether a gas bubble or silicone oil has been used. For driving, the criterion is not how many days have passed but your vision: you must meet the visual acuity and visual field standards, and the gas must have been fully absorbed. Most people return to office work within 2 to 4 weeks, while for manual jobs involving lifting, the return takes longer. Swimming, the gym and contact sports should only be resumed with your doctor’s approval.

Myths and facts about retinal detachment

• “It doesn’t hurt, so it isn’t urgent.” Wrong. A detachment is painless, and that is exactly why many people delay dangerously.
• “Floaters are always harmless.” Old, stable floaters usually are. Sudden, numerous new floaters, especially with flashes, need an examination within 24 hours.
• “Bending over or lifting heavy objects causes a detachment.” Not in a healthy eye. The risk is mainly related to the vitreous, myopia and your medical history.
• “After surgery, vision goes back to how it was before.” It depends. If the macula had not detached, the chances of very good vision are high; if it had, improvement is gradual and sometimes incomplete.

Questions worth asking your ophthalmologist

At your appointment, it helps to have written down what you want to know. Ask whether the macula is affected, which method is recommended in your case and why, whether you will need a special head position and for how many days, when you can fly or drive, and how often you will need follow-up visits. Also ask whether preventive laser treatment is needed in the other eye.

If you have flashes, new floaters or a shadow in your field of vision, do not wait. Call 210 677 0007 for an urgent fundus examination.

Frequently Asked Questions about Retinal Detachment

Medically reviewed by: Dr. Vasileios Skouteris MD, FEBO