Introduction 

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. 

Warning signs and symptoms

Most people will experience warning signs that indicate their retina is at risk of detaching before they lose their sight. These include:


the sudden appearance of floaters – black dots, specks or streaks that float across your field of vision (usually only one eye is affected)

a cobweb effect of lots of little floaters – others report a single large black floater that looks like a housefly

sudden short flashes of light in the affected eye lasting no more than a second

blurring or distortion of your vision


Without treatment, sight in the affected eye will start to deteriorate. Most people describe this as a shadow or "black curtain" spreading across their vision.

Retinal detachment usually only occurs in one eye. If your eye is affected, there is an up to one in 10 chance that retinal detachment will happen in your other eye.

When to seek medical advice

Contact your GP immediately if you get any of these warning signs. 

Causes

The retina lies at the back of your eye and sends signals to the brain, allowing it to see. Without a blood supply, the nerve cells die which leads to a loss of sight.

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.

 

Diagnosis

If your GP suspects 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, an ultrasound scanmay also be used. 

Treatment

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 you may have reduced vision, which means you may not be able to do some of your usual activities, such as driving or flying.

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. This risk is higher the longer the detachment was left untreated.

Who is affected?

Retinal detachment is rare. Only one in every 10,000 people will develop it in any given year in the UK.

As retinal detachment is associated with ageing, most cases affect older adults aged between 60 and 70. Retinal detachment caused by an injury can affect people of any age, including children.



 




 

 


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Driving

If you have a retinal detachment, it could affect your ability to drive. It is your legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about a medical condition that could have an impact on your driving ability. 

 

Causes of retinal detachment 

The most common cause of retinal detachment is tiny breaks developing inside the retina.

The breaks allow the fluid found between the retina and the lens of the eye to leak underneath the retina.

A build-up of fluid 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 die.

These breaks are thought to develop due to:


a posterior viteous detachment (PVD) – which is a normal ageing phenomenon when the gel of the eye pulls off from the retina

thinning of the retina


Very short-sighted people have the greatest risk of developing age-related retinal detachment (though 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 cataract removal, may also make the retina more vulnerable to damage.

In some cases, a tear can develop if the eye is suddenly injured, such as by a punch to the face.

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, called diabetic retinopathy.

The retina remains unbroken, but fluid from other areas gathers behind it. This sometimes happens in conditions that cause inflammation and swelling inside the eye, such as uveitis and some rare types of eye cancer.


 

Treating retinal detachment 

Surgery is needed to reattach the retina if it becomes detached.

Without treatment, it will lead to loss of vision. In 85% of cases, only one operation is needed to reattach the retina.

Surgery

Surgery for retinal detachment may be done under a general anaesthetic or a local anaesthetic (where drops and an injection 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.

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.

Vitrectomy

Vitrectomy is the most commonly performed operation. It 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.

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

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.

Pneumatic retinopexy

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.

If you need another operation that requires general anaesthetic, you must tell your doctors about the gas bubble in your eye. 

As with vitrectomy, posturing will be necessary to ensure the bubble is in the right place. The same restrictions on flying and precautions for further surgery also apply to pneumatic retinopexy

Possible complications

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 (glaucoma)

the lens of the eye becomes cloudy (cataract)

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. 

 


Medical treatment

Sometimes retinal detachment is the result of inflammation in the eye.

In these cases, medicine may also be used to treat the underlying cause of the inflammation.



Surgery to prevent retinal detachment

If you have the symptoms of retinal detachment but examinations only find small tears or holes in your retina, surgery can stop this damage getting worse and reduce the risk of retinal detachment.

This procedure, which is carried out under local anaesthetic, uses either lasers or cryotherapy (freezing treatment) to seal the holes or tears.

Recovering from retinal detachment 

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 as paracetamol to 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.

You should ask your specialist when it will be safe to return to work and drive. If you have been asked to keep your head in a certain position for several days (posturing) this may delay your return.

Your vision may not be as good as it was before. You should discuss this with your insurer before driving to make sure you meet minimum standards required by the DVLA.

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. 

 


When to seek help

Contact your hospital immediately if you have any of the following symptoms after your operation:


a very painful eye

increasing redness in the eye

loss of vision


In a gas-filled eye you should be able to detect a moving hand. Call your doctor if your vision reduces and you can only see light.  






Detached retina