Retinal detachment refers to separation of the inner layers of the retina from the underlying retinal pigment epithelium (RPE, choroid). Next to central retinal artery occlusion, chemical burns to the eye, and endophthalmitis, it is one of the most time-critical eye emergencies encountered in the emergency setting.
The annual incidence is approximately one in 10,000 or about 1 in 300 over a lifetime. Other sources suggest that the age-adjusted incidence of idiopathic retinal detachments is approximately 12.5 cases per 100,000 per year, or about 28,000 cases per year in the US.
Retinal detachment describes an emergency situation in which a thin layer of tissue (the retina) at the back of the eye pulls away from its normal position.
Retinal detachment separates the retinal cells from the layer of blood vessels that provides oxygen and nourishment. The longer retinal detachment goes untreated, the greater your risk of permanent vision loss in the affected eye.
Warning signs of retinal detachment may include one or all of the following: the sudden appearance of floaters and flashes and reduced vision. Contacting an eye specialist (ophthalmologist) right away can help save your vision.
Symptoms
Retinal detachment itself is painless. But warning signs almost always appear before it occurs or has advanced, such as:
The sudden appearance of many floaters — tiny specks that seem to drift through your field of vision
Flashes of light in one or both eyes (photopsia)
Blurred vision
Gradually reduced side (peripheral) vision
A curtain-like shadow over your visual field
Seek immediate medical attention if you are experiencing the signs or symptoms of retinal detachment. Retinal detachment is a medical emergency in which you can permanently lose your vision.
Types and Causes of Retinal Detachment
Retinal detachment happens when your retina (a light-sensitive layer of tissue at the back of your eye) is pulled away from its normal position.
Learn more about retinal detachment
There are 3 types of retinal detachment:
Rhegmatogenous (“reg-ma-TAH-juh-nus”)
Tractional
Exudative
Any type of retinal detachment is a medical emergency. If you have symptoms of a detached retina, go to the eye doctor or the emergency room right away. Early treatment can help prevent permanent vision loss.
Rhegmatogenous retinal detachment
Rhegmatogenous retinal detachment is the most common type of retinal detachment. It can happen if you have a small tear or break in your retina.
When your retina has a tear or break, the gel-like fluid in the center of your eye (called vitreous) can get behind your retina. The vitreous then pushes your retina away from the back of your eye, causing it to detach.
What causes rhegmatogenous retinal detachment?
Aging is the most common cause of rhegmatogenous retinal detachment. As you get older, the vitreous in your eye may change in texture and may shrink. Sometimes, as it shrinks, the vitreous can pull on your retina and tear it.
Other things that can increase your risk of rhegmatogenous retinal detachment are eye injuries, eye surgery, and nearsightedness.
Tractional retinal detachment
Tractional retinal detachment happens if scar tissue on your retina pulls your retina away from the back of your eye.
What causes tractional retinal detachment?
The most common cause of tractional retinal detachment is diabetic retinopathy — an eye condition in people with diabetes. Diabetic retinopathy damages blood vessels in the retina and can scar your retina. As the scars get bigger, they can pull on your retina and detach it from the back of your eye.
If you have diabetes, it’s important to get a comprehensive dilated eye exam at least once a year. Managing your diabetes — by staying physically active, eating healthy foods, and taking your medicine — can also help you prevent or delay vision loss.
Other causes of tractional retinal detachment include eye diseases, eye infections, and swelling in the eye.
Exudative retinal detachment
Exudative retinal detachment happens when fluid builds up behind your retina, but there aren’t any tears or breaks in your retina. If enough fluid gets trapped behind your retina, it can push your retina away from the back of your eye and cause it to detach.
What causes exudative retinal detachment?
The most common causes of exudative retinal detachment are leaking blood vessels or swelling in the back of the eye.
There are several things that can cause leaking blood vessels or swelling in your eye:
Injury or trauma to your eye
Tumors in your eye
Diseases that cause inflammation inside the eye
Coats disease, a rare eye disorder
The outlook for a person with retinal detachment will depend on the reason for the detachment, the type of detachment, the extent of the damage, and whether or not the macula remains attached.
If the macula remains attached, some statistics suggest that 83% of people will have 20/40 vision or better after treatment. If it does not, figures show that 37% of people will recover 20/50 vision as long as they have surgery within the first week.
In around 8–10% of cases, the repair will not be successful due to proliferative retinopathy. This is scarring that happens as additional cells form and develop unwanted membranes as the body attempts to save the retina. The membranes can contract, causing the retina to shrink and pull away again from the back of the eye.
