Detached Retina Retinal Detachment

Overview

Your retina is a thin layer of light-sensitive tissue at the back of your eye. It works like the film in a camera, turning light into signals your brain reads as pictures. A detached retina means this layer has lifted or pulled away from the wall of the eye behind it. When that happens, the retina loses its blood supply and stops working properly. A detached retina is a medical emergency — the sooner it is treated, the better the chance of saving your sight.

It is not common. About 1 in 10,000 people develop a detached retina each year in the general population. It becomes more common with age — roughly 1 in 300 people over 40 are affected at some point. Because the numbers are small overall, most people who see flashes or floaters do not have a detachment, but it is always worth getting checked quickly, just in case.

It can happen to anyone, but it is much more likely in people who are very short-sighted (myopic), people over 50, and anyone who has had cataract surgery, an eye injury, or a detachment in the other eye. It is rare in children. Men and women are affected about equally.

Symptoms

Common symptoms

• A sudden flash of light, or repeated flashes, often at the side of your vision — like a camera flash going off inside the eye.
• A sudden new shower of floaters — small dots, threads or cobwebs that drift across your vision and do not settle.
• A dark shadow or 'curtain' coming in from one side of your vision, which may get bigger over hours or days.
• Blurring or loss of part of your field of view, so that things seem to be missing when you look straight ahead.
• Straight lines looking wavy or distorted in some cases.
• Sudden loss of vision in one eye if the central part of the retina comes away.

Symptoms in children

• Children rarely get a detached retina, and they may not be able to describe what is happening.
• Signs to watch for include a child suddenly covering one eye, squinting, or saying they cannot see well out of one eye.
• A child may rub the eye, hold objects unusually close, or seem clumsy on one side.
• In children, detachment is more often linked to eye injury, previous eye surgery, or being very short-sighted, so tell the eye doctor about any of these.
• Any sudden change in a child's vision should be checked urgently.

Symptoms in older adults

• Floaters and flashes become more common with age as the jelly inside the eye shrinks — but a sudden new burst of them still needs a same-day check.
• Older adults may put symptoms down to 'just getting older' and delay getting help, which is risky.
• People who have had cataract surgery are at higher risk, especially in the first year afterwards.
• If you have already had a detachment in one eye, you are more likely to get one in the other, so be extra alert to changes.
• Vision loss may be noticed later because the other eye is compensating — check each eye separately from time to time by covering one.

Causes

Main causes

• A tear or hole in the retina, which lets fluid get behind it and lift it away from the back of the eye. This is the most common type.
• The jelly inside the eye (the vitreous) shrinking and pulling on the retina as we age, which can cause a tear.
• Scar tissue pulling the retina away in people with long-standing diabetes or other eye disease — this is called tractional detachment.
• Fluid building up behind the retina without a tear, usually linked to inflammation, tumours, or other medical conditions — this is much rarer.

Risk factors

• Being very short-sighted (high myopia) — this is one of the strongest risk factors.
• Being over 50, as the jelly inside the eye naturally shrinks with age.
• Having had cataract surgery or other eye surgery.
• A previous detached retina in the other eye.
• A strong family history of retinal detachment.
• A direct blow to the eye or a serious eye injury.
• Thin areas or weak spots in the retina (sometimes called lattice degeneration) found by an eye doctor.
• Diabetes that has affected the eyes.
• Certain rare inherited conditions that affect the body's connective tissue.

When to see a doctor

See a doctor urgently if:

• You suddenly see new floaters, or a sudden increase in floaters.
• You see flashes of light in one or both eyes.
• A shadow, curtain, or dark area appears in your vision.
• Your vision suddenly becomes blurred in one eye, or part of your sight goes missing.
• You have an eye injury and afterwards notice changes in your vision.
• Do not wait to see if it settles. Go to an emergency eye service or call your local emergency number straight away if the shadow is spreading.

Book a routine appointment if:

• Your eye doctor has told you that you have thin or weak areas in your retina and you want to discuss monitoring.
• You are very short-sighted or have a family history of retinal detachment and want to talk about your risk.
• You have diabetes and want to check that your eyes are being screened regularly.
• You notice a slow, painless change in your vision over weeks or months with no shadow or flashes.

Diagnosis

An eye doctor can usually see a detached retina by looking carefully inside your eye. They will first put drops in your eyes to widen the pupil (the black centre). This makes your vision blurry for a few hours and makes bright light uncomfortable, so it is best not to drive yourself home. The examination is quick and does not hurt, although the bright light can feel uncomfortable.

Tests that may be done

• A dilated eye exam, where the doctor uses a bright light and special lenses to look at the whole retina.
• A slit-lamp examination to check the front of the eye and look for tears.
• An ultrasound scan of the eye (B-scan), used if blood or a cataract blocks the view of the retina.
• Optical coherence tomography (OCT), a painless scan that takes detailed pictures of the retina.
• Checking your vision and visual fields (how much you can see to the sides).
• Checking the pressure inside your eye.

What to expect at your appointment

You will usually be seen the same day if a detachment is suspected. The examination takes about 20 to 30 minutes. Your pupils will stay enlarged for around four to six hours, so bring sunglasses and arrange a lift home. If a detachment is found, you will usually be referred to a specialist eye hospital straight away, and surgery is often planned within a day or two.

Treatment

A detached retina almost always needs an operation to put the retina back in place. There is no medicine or eye drop that can reattach it. The aim is to close any tears and hold the retina against the back of the eye so it can start working again. The type of operation depends on where the tear is, how big it is, and your general health. The sooner surgery happens, the better the likely result.

Self-care at home

• After surgery, follow your eye doctor's instructions exactly — especially any advice about head position or lying in a certain way. This matters a lot for some types of surgery.
• Wear the eye shield or patch as instructed, including at night, to protect the eye.
• Do not rub or press on the eye.
• Avoid heavy lifting, strenuous exercise, and straining for the time your doctor advises.
• If you have a gas bubble in the eye, you must not fly or travel to high altitude until your doctor says the bubble has gone — this can be dangerous.
• Keep your follow-up appointments, even if everything feels fine.
• Use any prescribed eye drops exactly as directed, and ask your pharmacist if you are unsure how to use them.
• Wash your hands before touching the eye area, and keep soap and water out of the eye for the first days.

Medical treatments

Treatment is surgical. Common approaches include: sealing a tear with a laser or by freezing the spot (this is often done for small tears before a detachment happens); putting a small gas bubble inside the eye to push the retina back into place while the tear heals; placing a tiny band or pad around the outside of the eye (a 'buckle') to support the retina; or removing the jelly inside the eye and replacing it with clear fluid or gas (vitrectomy). Sometimes more than one approach is combined. Your surgeon will explain which is best for you and why.

When is surgery considered?

Surgery is needed urgently whenever the retina has come away, and also for certain retinal tears that are very likely to lead to detachment. It is usually done within a day or two of diagnosis. If the central part of your vision (the macula) is still attached, surgery is treated as an emergency to protect it. If the macula has already come away, surgery is still done promptly, but the timing is slightly less critical.

Living with this condition

Recovery takes time. Your vision may be blurry or changeable for weeks or even months, and it can improve slowly over a year or more. If a gas bubble was used, you may notice a dark line in your vision that moves — this is normal and goes as the bubble shrinks. You may need new glasses once your eye has settled, but usually not until your doctor says the eye has healed. Many people need help with driving, reading, or work for a while, so plan for some support in the first few weeks.

Lifestyle tips

• Give yourself time off work as advised — heavy or physical jobs usually need longer.
• Ask someone to help with household tasks and lifting in the early weeks.
• Protect your eyes with safety glasses if you do DIY, gardening, or sports.
• Check each eye separately now and then by covering one, so you notice changes early.
• Keep up regular eye checks, especially if you are very short-sighted or have had a detachment before.
• If you have diabetes, keep your blood sugar well managed and go to your eye screening appointments.

Diet and exercise

There is no special diet that fixes or prevents a detached retina. Eating a healthy, balanced diet with plenty of fruit and vegetables supports general eye and blood vessel health. Gentle walking is usually fine soon after surgery, but your surgeon will tell you when you can return to more vigorous exercise, swimming, or contact sports. If you have a gas bubble, avoid strenuous activity and altitude changes as advised.

Mental health and emotional wellbeing

It is very normal to feel frightened or anxious when your sight is affected. Many people worry about losing vision in the other eye, or feel frustrated by slow recovery. Talk to your care team about your worries — they hear this often. If low mood, worry, or sleep problems are affecting your daily life, tell your doctor. Support is available, and you do not have to cope alone.

Prevention

You cannot always prevent a detached retina, especially when it is linked to age or being short-sighted. But you can lower your risk and catch problems early: get sudden flashes, floaters, or shadows checked the same day; wear protective eyewear for DIY, sport, and work; keep diabetes well controlled and attend diabetic eye screening; and go for regular eye tests if you are at higher risk. Sometimes an eye doctor will treat a high-risk retinal tear with a laser before it turns into a detachment — this can prevent vision loss.

Screening programmes

There is no national screening programme for retinal detachment. Instead, regular eye tests (usually every two years, or more often if advised) can pick up weak areas in the retina. People with diabetes should attend their annual diabetic eye screening. If you are very short-sighted, have a family history, or have had a detachment in one eye, ask your optometrist how often you should be checked.

Complications

If left untreated

• Permanent loss of vision in the affected eye — this can happen within days if the detachment is not treated.
• Scarring and permanent damage to the retina, which cannot be reversed.
• A higher risk of the other eye being affected later.
• Ongoing distortion or a missing area in your field of vision, even after successful surgery.

Long-term outlook

The outlook is much better with quick treatment. Most people who are treated promptly keep useful vision, and many recover a good level of sight. If the central part of the retina was still attached when you had surgery, the chances of reading-level vision are good. If it had already come away, vision may stay reduced, but surgery still gives the best chance of saving what can be saved. Recovery is often slow, and some people need more than one operation. Try to take it a day at a time, keep your follow-up appointments, and ask your eye team what to expect for your particular case.

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