What retinal detachment is
The retina is the light-sensing layer lining the inside of the eye, like film in a camera. It works only while it is in contact with the wall of the eye, which supplies it with oxygen and nutrients. A detachment is when that contact is lost.
Most detachments begin with a tear or hole in the retina. Fluid from inside the eye passes through the break and collects underneath, lifting the retina away progressively. The longer the retina stays detached, the more the light-sensing cells deteriorate — and beyond a point, that loss does not recover even after successful surgery.
This is why retinal detachment is treated as urgent. The surgery is not difficult to arrange; the vision lost while waiting is what cannot be recovered.
Symptoms that should bring you in immediately
- A sudden shower or increase in floaters — specks, threads or cobwebs drifting across your vision
- Flashes of light, often at the edge of vision, particularly noticeable in a dark room
- A dark curtain, shadow or veil spreading across part of your field of vision
- Sudden blurring or loss of a section of your vision
Floaters and flashes on their own do not always mean a detachment — they are often caused by the vitreous gel separating from the retina, which is common with age. But the two cannot be told apart without a dilated examination, and the consequence of guessing wrongly is permanent. If you have these symptoms, get examined the same day.
Who is at higher risk
- High myopia (strong short-sightedness)
- Previous retinal detachment in the other eye
- A family history of detachment
- Previous eye surgery, including cataract surgery
- Blunt injury to the eye
- Lattice degeneration or other known retinal thinning
- Diabetes, which can cause a different, tractional form of detachment
How it is diagnosed
The examination is a dilated indirect ophthalmoscopy — the pupil is widened with drops and the surgeon examines the whole retina, including the far periphery where breaks usually sit. The extent of the detachment, whether the macula is involved, and the location of every break determine which operation is appropriate.
Where the view into the eye is obscured, for example by bleeding into the vitreous, ultrasound is used to assess the retina indirectly. OCT scanning helps to establish precisely whether the macula is attached, which is the single most important factor in predicting the visual outcome.
How it is treated
There is no medicine for retinal detachment. Treatment is surgical, and the choice depends on the type of detachment, where the breaks are, and the state of the vitreous.
Laser or cryotherapy may be enough for a retinal tear or a very small detachment caught early, sealing the break before fluid gets underneath.
Vitrectomy removes the vitreous gel, drains the fluid under the retina, treats the breaks, and fills the eye with gas or silicone oil to hold the retina in place while it heals. See our page on vitrectomy surgery for how the operation itself works.
Scleral buckling places a silicone band around the outside of the eye to indent the wall inwards, relieving the traction pulling on the retina.
More than one technique is sometimes combined, and more than one operation is occasionally needed.
Recovery and posturing
If a gas bubble has been used, you will be asked to hold a specific head position for a period each day. This is genuinely uncomfortable and genuinely important — the bubble floats upward, and posturing is what keeps it pressed against the part of the retina that needs support.
You must not fly, and must avoid high-altitude travel, while a gas bubble remains in the eye, because the bubble expands at altitude and can raise pressure dangerously. Your surgeon will tell you when the bubble has absorbed and the restriction lifts.
Vision returns gradually and can keep improving for months. How much returns depends largely on the state of the macula before surgery.
Why this matters locally
Sampada VR was set up as the first centre in the Malabar region dedicated to vitreoretinal disease, because retinal emergencies were routinely being referred long distances from Tirur and the surrounding area — and distance costs time that the retina does not have. Having assessment and surgery available within the district is the main argument for the centre existing.