Symptoms

Retinal detachment is painless, but retinal detachment symptoms almost always appear before it occurs. Retinal detachment symptoms may include:

• The sudden appearance of many floaters — small bits of debris in your field of vision that look like spots, hairs or strings and seem to float before your eyes
• Sudden flashes of light in one or both eyes
• A shadow or curtain over a portion of your visual field

When to see a doctor
Seek immediate medical attention if you suddenly notice retinal detachment symptoms, such as new floaters or flashes of light in your visual field or if it seems as if a dark curtain has fallen across your visual field.

Causes

Retinal detachment can occur as a result of:

• Sagging or shrinkage of the jelly-like vitreous that fills the inside of your eye
• Trauma
• Advanced diabetes
• An inflammatory disorder

How retinal detachment occurs
Retinal detachment can occur when vitreous liquid (vitreous humor) leaks through a retinal hole or tear and accumulates underneath the retina. Small retinal holes or tears can develop where the retina has thinned due to aging or with other retinal disorders. Retinal detachment due to a tear in the retina typically develops when there is a sudden separation of the vitreous from the retina. Less commonly, fluid can leak directly underneath the retina, without a tear or break.

As liquid collects underneath it, the retina can peel away from the underlying layer of blood vessels (choroid). The areas where the retina is detached lose their blood supply and stop functioning, so you lose vision.

Aging-related retinal tears that lead to retinal detachment
As you age, your vitreous humor may change in consistency and shrink or become more liquid. Eventually, the vitreous may sag and separate from the surface of the retina — a common condition called posterior vitreous detachment (PVD), or vitreous collapse.

As the vitreous separates or peels off the retina, it may tug on the retina with enough force to create a retinal tear. Left untreated, the tear can progress to a retinal detachment.

PVD can cause visual symptoms. You may see flashes of sparkling lights (photopsia) when your eyes are closed or when you're in a darkened room. New or different floaters may appear in your field of vision.

Risk factors

The following factors increase your risk of retinal detachment:

• Aging — retinal detachment is more common in people older than age 40
• Previous retinal detachment in one eye
• A family history of retinal detachment
• Extreme nearsightedness (myopia)
• Previous eye surgery, such as cataract removal
• Previous severe eye injury or trauma

Preparing for your appointment

Make an appointment with your eye doctor if you have any changes in your vision that worry you. If you're thought to have a retinal tear or retinal detachment, you'll likely be referred to a doctor who specializes in diagnosing and treating eye diseases (ophthalmologist). You may be referred to an ophthalmologist who is also a retinal specialist.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared. Here's some information to help you get ready, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For retinal detachment, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What kinds of tests do I need?
• Is my vision loss likely temporary or chronic?
• What is the best course of action?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see another specialist? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What websites do you recommend?
• What will determine whether I should plan for a follow-up visit?
• If I need surgery, how long will recovery take?
• Will I be able to travel after surgery? Will it be safe to travel by plane?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover points you want to address. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or occasional?
• How severe are your symptoms?
• Have you had any symptoms in your other eye?
• Have you ever had an eye injury?
• Have you ever experienced eye inflammation?
• Have you ever had eye surgery?
• Do you have any other medical conditions, such as diabetes?
• Have any of your family members ever had a retinal detachment?

Tests and diagnosis

Tests and procedures used to diagnose retinal detachment include:

• Using a bright light and special lens to see inside your eye. An ophthalmologist may be able to see a retinal hole, tear or detachment by looking at your retina with an ophthalmoscope — an instrument with a bright light and powerful lens that allows your doctor to view the inside of your eyes in great detail and in three dimensions.
• Creating a picture of your eye using sound waves. If blood in your vitreous cavity blocks the view of your retina, ultrasound examination may be useful. Ultrasonography is a painless test that sends sound waves through your eye to bounce off the retina. The returning sound waves create an image of your retina and other eye structures on a video monitor. This test usually provides the information your doctor needs to determine whether your retina is detached.

Treatment and drugs

Surgery is used to repair a retinal tear, hole or detachment. Your ophthalmologist can tell you about the various risks and benefits of your treatment options. Together you can determine what treatment is best for you.

Surgery for retinal tears
When a retinal tear or hole hasn't yet progressed to detachment, your eye surgeon may suggest an outpatient procedure, which can usually prevent retinal detachment and preserve almost all vision. Options include:

• Laser surgery (photocoagulation). During photocoagulation your surgeon directs a laser beam through a contact lens or ophthalmoscope designed for this procedure. The laser makes burns around the retinal tear, and the scarring that results usually "welds" the retina to the underlying tissue.
• Freezing (cryopexy). During cryopexy, your surgeon uses intense cold to freeze the retina around the retinal tear. After a local anesthetic numbs your eye, your surgeon applies a freezing probe to the outer surface of the eye directly over the retinal defect. This freezes the area around the hole, leaving a delicate scar that helps secure the retina to the eye wall.

After your procedure you'll need to remain relatively still for the next two weeks or so, as the bonds created by your procedure strengthen.

Surgery for retinal detachment
Doctors also use surgical procedures to repair retinal detachments. These procedures may be done in conjunction with photocoagulation or cryopexy. The type, size and location of the retinal detachment will determine which surgical approach your eye surgeon recommends. In general, these surgeries can successfully treat most cases of retinal detachment, although a second treatment is sometimes necessary.

Procedures include:

• Injecting air or gas into your eye. A procedure called pneumatic retinopexy involves injecting a bubble of air or gas into the vitreous. Over the next several days, the gas bubble expands, sealing the retinal tear by pushing against it and the detached area that surrounds the tear. With no new fluid passing through the retinal tear, fluid that had previously collected under the retina is absorbed, and the retina is able to reattach itself to the back wall of your eye. Depending on where the retinal detachment is located in your eye, you may need to hold your head in a certain position for several hours in order to keep the bubble in place.
• Indenting the surface of your eye. A procedure called scleral buckling involves suturing a piece of silicone rubber or sponge to the white of your eye (sclera) over the affected area. The silicone material indents the wall of the eye, relieving the tugging of the vitreous on the retina. When you have several tears or holes or an extensive detachment, your surgeon may create an encircling scleral buckle that goes around the entire circumference of your eye like a belt. The buckle usually remains in place for the rest of your life.
• Draining and replacing the fluid in the eye. A vitrectomy is a procedure to remove the gel-like fluid in the center of the eye, along with any tissue that is tugging on the retina. Air, gas or liquids are injected into the vitreous cavity to reattach the retina. A vitrectomy is often combined with a scleral buckling procedure.

Surgery isn't always successful in reattaching the retina. Also, a reattached retina doesn't guarantee normal vision. How well you see after surgery depends in part on whether the central part of the retina (macula) was affected by the detachment before surgery, and if it was, for how long. Your vision may take many months to improve after repair of a retinal detachment. Some people don't recover any lost vision.

Coping and support

Unless you undergo prompt surgery, retinal detachment will cause you to lose vision in the portion of your field of vision that corresponds to the detached part of the retina. Losing part of your vision can greatly change your lifestyle — affecting your ability to drive, read and do many other things you're accustomed to doing. Yet there are ways to cope with impaired vision:

• Check into transportation. Investigate vans and shuttles, volunteer driving networks, or ride shares available in your area for people with impaired vision.
• Get special glasses. Optimize the vision you have with glasses that are specifically prescribed for the effects of retinal detachment. Keep an extra pair of glasses in the car.
• Brighten your home. Have proper light in your home for reading and other activities.
• Make your home safer. Eliminate throw rugs and other tripping hazards within your home.
• Enlist the help of others. Tell friends and family members about your vision problems so that they can help you.
• Talk to others with impaired vision. Take advantage of online networks, support groups and resources for people with impaired vision.

Prevention

There's no way to prevent retinal detachment. However, being aware of the warning signs of a detached retina — floaters, bright flashes of light, or a shadow or curtain that seems to fall across your visual field — could help save your vision. If you notice any of the warning signs of retinal detachment, particularly if you're over age 40, you or a family member has had a detached retina, or you're extremely nearsighted, contact your ophthalmologist immediately.