Retinal Detachment

What is Retinal Detachment?

Retinal detachment occurs when the retina — the light-sensitive layer at the back of the eye — separates from the underlying retinal pigment epithelium (RPE). Without urgent surgical reattachment, the detached retina loses its blood supply and photoreceptors die irreversibly. Retinal detachment is a medical emergency. Any patient experiencing a sudden onset of floaters, flashes of light, or a shadow or curtain across their vision should seek same-day ophthalmology assessment.

Symptoms

• Sudden appearance of new floaters (dark spots, cobwebs, rings)
• Flashes of light (photopsia), particularly at the edge of vision
• A dark shadow or curtain advancing across the visual field
• Sudden, painless reduction in vision
• Distorted or wavy central vision if the macula is involved

Causes

• Rhegmatogenous — a retinal tear or hole allows fluid to track beneath the retina; more common in myopia (short-sightedness) and after cataract surgery
• Tractional — fibrous membranes pull the retina away; associated with proliferative diabetic retinopathy and sickle cell disease
• Exudative — fluid accumulates beneath an intact retina due to inflammation, tumour or vascular disease

Diagnosis

Urgent dilated fundus examination. B-scan ultrasound if the view is obscured. This is an ocular emergency requiring same-day assessment.

Treatment

Retinal tears without detachment are treated prophylactically with laser retinopexy or cryotherapy. Retinal detachment requires surgery: pneumatic retinopexy (gas injection), scleral buckling, or pars plana vitrectomy. The approach depends on the extent and location of the detachment. Outcomes are significantly better when surgery is performed before the macula detaches.