Retinal detachment

About retinal detachment

Your retina is a thin layer of nerve tissue that lines the inner wall at the back of your eye. When you look at an object, light rays pass into your eye through your cornea (the clear part at the front of your eye) and lens, to your retina at the back of your eye. The light-sensitive cells in your retina then send this information via the optic nerve to your brain. Your brain interprets this as the image you see. Just to the side of the optic nerve lies a specialised part of your retina called the macula. The macula is the part of your retina that is used for seeing fine detail, for example, when reading, writing and recognising faces.

You’re more likely to get retinal detachment as you get older – usually from age 60.

Types of retinal detachment

There are three ways that your retina can detach from the back of your eye.

Rhegmatogenous retinal detachment

This is the most common type of retinal detachment. It’s caused by a tear in your retina that allows fluid in your eye to seep underneath your retina and separate it from the back wall of your eye.

Exudative retinal detachment

If the blood vessels underneath your retina start to leak fluid, this can build up underneath your retina, and may push your retina off the back of your eye. There are many possible causes for this, such as inflammation of your eye.

Tractional retinal detachment

Your retina and vitreous, which is the clear jelly-like fluid inside your eye, can become tightly stuck together. This happens as a result of an injury, inflammation or the abnormal growth of blood vessels (common in people with diabetes) in your eye. If the vitreous pulls at your retina or there is scarring on the surface, your retina may be pulled off the back of your eye. 

Symptoms of retinal detachment

The most common symptom of retinal detachment is a gradual deterioration in your vision. It’s often described as a shadow spreading across your vision of one eye.

You may get symptoms such as flashes of light, spots, or floaters appearing in your vision. You may find you have had mild symptoms such as these for some time but they suddenly get worse for no particular reason. This can be a sign of a tear in your retina, or a detachment, which means you need to seek urgent medical treatment.

However, similar symptoms are caused by posterior vitreous detachment (PVD), which is a natural part of ageing. As you get older, the jelly-like vitreous in your eye becomes more liquid in the middle and tends to shrink away from your retina. For about two in 10 people with symptoms of PVD, as the vitreous shrinks away, the attached parts can tug on your retina, causing a tear. If the tear isn’t treated, it can lead to retinal detachment. As PVD is a natural part of ageing, it doesn’t always lead to retinal detachment. Please see our frequently asked questions for more information about PVD.

If you’re having any problems with your vision, see your optometrist (a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses) or your GP.

Complications of retinal detachment

The most serious complication of retinal detachment is partial or total loss of vision.

After retinal detachment, your retina may become scarred, folded and stiff. This is usually because of your body trying to heal itself. If your retina has become stiff and folded, it can make surgery to treat retinal detachment more difficult because it’s not possible to get your retina flat up against the back of your eye to restore your vision.

Causes of retinal detachment

The exact cause of retinal detachment will depend on the type that you have. Causes include the following.

  • Age-related changes. As you get older, you’re more likely to get retinal detachment – usually over the age of 60.
  • Short-sightedness (myopia). If you’re very short-sighted, you’re likely to have a thinner retina, which can tear or break more easily.
  • Previous eye surgery. For example, a cataract operation where the jelly-like vitreous inside your eye has been disturbed.
  • Injury or trauma to your eye. This may cause retinal detachment immediately, or it can happen months or even years later.
  • Inherited conditions such as Stickler’s syndrome.
  • Inflammatory conditions such as scleritis (inflammation of the white of your eye).
  • Diabetic retinopathy. This is when an abnormal growth of blood vessels from your retina can result in bleeding, scarring and pulling on your retina.
  • Eye tumour, which can be cancerous or non-cancerous (benign).
  • Eye diseases such as glaucoma, a cataract or retinopathy of prematurity (when a baby is born prematurely before the retina has developed properly).

Diagnosis of retinal detachment

Your optometrist or GP will ask about your symptoms and examine you. He or she will carry out some tests to check your eyesight. This may involve flashing a torch in your eyes and examining them with an ophthalmoscope. An ophthalmoscope is an instrument that is used to take a closer look at the inside and back of your eyes.

If your optometrist or GP suspects that your retina has become detached or that you may be at risk of this happening, he or she may urgently refer you to an ophthalmologist (a doctor who specialises in eye health, including eye surgery) for further tests. Retinal detachment is usually a medical emergency. The sooner you get treatment, the less chance there is of permanent damage to your vision.

Treatment for retinal detachment

You will usually need to have surgery to reattach your retina. There are three types of surgery used to treat a detached retina, which are described below. These treatments aim to make your retina lie flat against the inside of your eye again.

  • Scleral buckle surgery. This procedure involves putting pressure on the outside of your eye using a thin band of synthetic material that is stitched to the outer coat of your eye (the conjunctiva). One way this helps is that it causes the inside wall of your eye to indent slightly, allowing all the layers of your retina to come back together.
  • Pneumatic retinopexy. If your retinal detachment covers only a small area, you may be able to have a small gas or silicone bubble injected into your vitreous over the site of your detachment. This bubble then presses the retina back in place.
  • Vitrectomy. This involves removing the vitreous from the back of your eye and replacing it with either a gas or silicone bubble, which holds your retina in place while it heals.

After your treatment

After surgery, you will be given antibiotics and corticosteroid eye drops. These will help prevent infection and reduce any inflammation.

If you have had gas put into your eye, you may be asked to keep your head in a certain position for several days after the operation. This is sometimes called ‘posturing’. You will also be advised not to travel on an aeroplane while any gas remains in your eye. This is because the change in air pressure can affect the bubble of gas and increase pressure inside your eye. While any gas remains in your eye your vision will be blurred. The surgery can sometimes increase the pressure inside your eye – so you may be prescribed tablets or eye drops to treat this.

If your central vision has been affected, it may take up to a year or more after your operation for your vision to recover. Most of the improvement in your vision takes place during the first six months after surgery. However, for some people, their vision may never fully recover – it often depends on if and for how long the macula part of your retina was detached. Surgery is most successful when your macula hasn’t become fully detached. This is why it’s important to seek medical attention as soon as possible after noticing changes in your vision. Occasionally, it may not be possible to restore your retina to its correct position and your vision may be lost completely.

Prevention of retinal detachment

If your family has a history of retinal detachment and your doctor finds a weakness in your retina, you may be able to have preventive laser or cryotherapy treatment. However, for most people, it isn’t possible to prevent retinal detachment.

You can prevent injury to your eyes that may cause retinal detachment. Always wear eye protection if you’re doing DIY, sports, such as squash or badminton, or working with materials that could get into your eyes. Have an eye test regularly, at least every two years, to check that your eyes are healthy.

Who is most at risk of retinal detachment?

Answer

You’re at risk of retinal detachment if you have posterior vitreous detachment (PVD), cataract surgery or an eye injury, are very short-sighted or have a family history of retinal detachment.

Explanation

Retinal detachment is more likely if you have had PVD. This is when the vitreous in the middle of your eye starts to shrink away from your retina. As this happens, breaks or tears can occur in your retina where it’s attached. If a tear occurs, liquid from the vitreous can seep underneath your retina, causing it to lift away and become detached.

PVD is a natural part of the ageing process. It's rare before the age of 40. However, by the time you're 80, there is almost a nine in 10 chance of having PVD.

PVD usually results in floaters, flashing lights or spots in your vision. These symptoms may be the only signs that you have a tear in your retina, so it's important that you see an optometrist (a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses) so he or she can examine the back of your eye thoroughly.

Cataract surgery can make retinal detachment more likely as it can disturb the vitreous in your eye and result in PVD and tears in your retina. The risk is greater if any vitreous is lost from your eye during your operation.

If you’re very short-sighted, you’re more likely to develop PVD. Your retina is usually thinner so the risk of a tear in your retina is higher too.

You can be affected by retinal detachment as the result of an injury. A direct blow to your eye can cause a break in your retina (called a retinal dialysis), which may result in a retinal detachment. This usually happens very slowly.

It's also possible for retinal detachment to run in families. If you have any questions or concerns about retinal detachment, talk to your optometrist or GP.

What is posterior vitreous detachment?

Answer

Posterior vitreous detachment (PVD) is a condition that affects your vitreous, a jelly-like fluid in the centre of your eye. As you get older, your vitreous in your eye becomes more liquid than jelly-like in the middle and tends to shrink away from your retina. PVD is a natural part of the ageing process.

Explanation

The space inside your eye is filled with a clear jelly-like fluid called the vitreous. It's completely transparent so that light can pass through it to reach your retina. The vitreous isn't essential for maintaining the shape of your eye and it's possible to see perfectly well if it’s removed.

By the time you're in your 80s, you have an almost nine in 10 chance of having PVD, compared with a one in 10 chance when you’re less than 60 years of age.

As you get older, the vitreous begins to lose its shape and consistency, and can start to pull away from the back of your eye. PVD may occur suddenly (over a matter of days) and may pass without any noticeable changes. However, it may cause new floaters, flashing lights or spots in your vision. No treatment is needed for PVD itself and you’re likely to gradually get used to any new floaters in your vision.

These symptoms are similar to those if you have a retinal detachment. They may be the only signs that you have a tear (or tears) in your retina, so it's important to visit an ophthalmologist (a doctor who specialises in eye health, including eye surgery) who will examine the back of your eye thoroughly and treat any tears promptly.

If you have any questions or concerns about PVD, talk to your ophthalmologist or GP.

Will my vision be permanently affected by a retinal detachment?

Answer

You may lose sight permanently in your affected eye. Whether you experience long-term damage to your vision, and the severity of this damage, mainly depends on whether your macula is affected in the detachment and for how long your retina is detached.

Explanation

When your retina becomes detached from the back wall of your eye, your vision will be affected straight away in some way. It’s often described as a shadow spreading across the vision of one of your eyes.

In nine out of 10 people, the retina can be reattached. Usually only one operation is needed to do this. If the operation is carried out soon enough, you may feel your vision is as good as it was before. Retinal detachment is considered a medical emergency because the longer your retina is detached, the less likely it is that your vision will fully recover. Prompt treatment is vital in saving your sight.

There is a risk of a cataract developing as a result of surgery. However, cataract surgery is usually successful in restoring your vision if this happens, although there is a risk of your retina detaching again.

The greatest risk of permanent damage to your vision is if your macula becomes detached. The macula is the part of your retina that you use to read and recognise faces. When your retina comes away from the back wall of your eye, the inner layers bring their own blood supply with them, so it can continue to function. However, your macula is more sensitive than the rest of your retina to changes in its oxygen supply, so can be permanently damaged and your vision may never fully recover.

If you think you have a retinal detachment, see your optometrist or GP immediately. If they aren't available, go to the accident and emergency department of your local hospital.

How long before I can go back to work if I’ve had retinal detachment?

Answer

This will depend on the type of retinal detachment you had, how successful your treatment has been and the type of work you do.

Explanation

For a few days after retinal reattachment surgery, your eye may feel bruised and your eyelids may be sticky. You’ll be given eye drops to help prevent infection and inflammation.

After your retinal reattachment surgery, your surgeon may recommend that you hold your head in a certain position for about 50 minutes in every hour, for up to 10 days after your operation. This is to help your retina to heal. This treatment is known as posturing and may delay your return to work, but it’s an important part of your recovery.

If you usually drive to work or drive as part of your job, you may not be able to return to full duties straight away because your vision may not be as good as it was before. It may take some time for your sight to return to the accuracy it was before surgery. Speak to your insurance company before you drive so that you’re aware of their recommendations. Also, the Driver and Vehicle Licensing Agency (DVLA) has medical standards of fitness to drive that you will need to adhere to.

You may find that you require up to two or three follow-up appointments with your ophthalmologist. Although these won’t affect your ability to return to work, you may need to speak to your employer to ensure you can attend these.

If the changes to your vision as a result of retinal detachment mean you’re unable to see as well as you used to, you may require some adaptations at work, such as magnifiers or access to larger print. There are services available for people with poor vision that your GP can refer you to if you feel you need further support.