Detached retina

Page last reviewed: 13/07/2011

Retinal detachmentoccurs when the thin lining at the back of your eye called the retina (see diagram, left) 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

Most people will experience warning signs that indicate that their retina is at risk of detaching before permanent loss of vision occurs. These are:

  • the sudden appearance of floaters - dark spots that float in your field of vision
  • sudden short flashes of light in one eye

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

Read more about the symptoms of retinal detachment.

Treatment

The quicker retinal detachment is treated, the less risk there is of permanent loss of some or all vision occurring in the affected eye. Most cases are successfully treated with surgery - usually by reattaching the retina with fine bands of silicone.

Read more about treating retinal detachment.

Causes

The most common cause of retinal detachment is that the retina can become thinner and more brittle with age and tear away from the underlying blood vessels.

A direct injury to the eye can be another cause, but this is less common.

Read more about the causes of retinal detachment.

Who is affected

Retinal detachment is a rare condition. It is estimated that only 1 in every 10,000 people develop a retinal detachment for the first time in any given year.

As retinal detachment is associated with ageing, most cases affect older adults aged between 50 and 75.

Retinal detachment that is caused by an injury can affect people of any age, including children.

The retina

The retina is a complex layer of tissue that lies at the back of your eye. It contains millions of nerve cells that convert the particles of light coming into the eye into nerve signals.

These nerve signals are then sent via the optic nerve to the brain, effectively allowing the brain to "see".

Without a constant supply of blood the nerve signals begin to die, which can lead to a permanent loss of vision.

Driving

If you have a retinal detachment, it could affect your ability to drive. It is important that you inform your doctor and the Road Safety Authority(RSA) about a condition which could affect your ability to drive.

Page last reviewed: 13/07/2011

Initial symptoms of retinal detachment include the sudden appearance of floaters - black dots, specks or streaks that float across your field of vision.

Some people experience a kind of cobweb effect of lots of little floaters, while others report a single large black floater that looks like a housefly.

Usually only one eye is affected by floaters.

Another common symptom is seeing flashes of light in the affected eye. These last no more than a second.

Without treatment, you will go on to experience increasing loss of vision in the affected eye. Most people report a shadow or "black curtain" spreading across their vision.

When to seek medical advice

If you experience these warning signs, contact your GP immediately for advice. If this is not possible ,contact your local GP out of hours service

Will it affect both eyes?

Retinal detachment often only occurs in one eye. If your eye is affected, there is a one in 10 chance that retinal detachment will happen in your other eye.

Page last reviewed: 13/07/2011

The most common cause of retinal detachment is when tiny holes develop inside the retina.

The holes then allow the fluid that is normally only found in between the retina and the lens of the eye to leak through underneath the retina.

If too much fluid builds up underneath the retina it can cause the retina to start pulling away from the blood vessels that supply the retina with blood. Without a constant blood supply, the nerve cells inside the retina will begin to die.

It is thought that the main reason these holes develop in the retina is that it becomes narrower and weakened with age.

People who are very short-sighted have the greatest risk of developing age-related retinal detachment (though in relative terms the risk is still very small) because they are often born with a retina that is thinner than normal in the first place.

Previous eye surgery, such as a cataract removal, may also make the retina more vulnerable to damage.

In some cases, holes can develop if the eye experiences a sudden injury such as a punch to the face or a person being accidentally hit in the eye with a flying object.

Less common causes

Described below are less common causes of retinal detachment.

  • The fluid in front of the eye becomes unusually thick and it begins to pull the retina away from the blood vessels. This can sometimes occur as a complication of poorly controlled diabetes (both type 1 and type 2), the inherited blood disorder sickle cell anaemia and in babies who are born prematurely. 
  • The retina remains unbroken but fluid from other sources gathers behind the retina. This can sometimes occur in conditions that cause inflammation and swelling inside the eye such as uveitis (which is where the middle layer of the eye becomes inflamed) and some rare types of cancer that develop inside the eye.

Page last reviewed: 13/07/2011

If your GP suspects a diagnosis of retinal detachment, it is likely that you will be referred to an eye specialist (ophthalmologist), usually on the same day.

The ophthalmologist can use a device called an ophthalmoscope, which is like a magnifying glass connected to a bright light source. This is used to study the back of your eye, check for any holes in your retina and see if the retina is out of position.

An ultrasound scan can also be used to obtain an image of your retina as well as the fluid in front of a retina. An ultrasound scan is a painless test where sound waves are used to build up an image of the inside of your eye.

If you have a condition which may affect your ability to drive you should inform your doctor and the Road Safety Authority (RSA)

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Page last reviewed: 13/07/2011

If retinal detachment has occurred, the only way of re-attaching the retina is with surgery.

Without surgery, total loss of vision is almost certain. In 90% of cases, only one operation is needed to re-attach the retina.

Surgery

Surgery for retinal detachment may be done under a general anaesthetic (where you are put to sleep) or a local anaesthetic (where drops are used to numb your eye and surrounding tissue).

You will be asked not to eat or drink anything for six hours before the operation. Afterwards, you may need to stay in hospital for one or two days, or you may be able to leave on the same day, depending on the circumstances.

Before you are given the anaesthetic, you will be given eye drops to widen your pupil.

The retina is usually re-attached in a procedure using either scleral buckling or vitrectomy. These are explained below.

Scleral buckling

Scleral buckling is the preferred way of re-attaching the retina if it has a tear or hole in it.

Fine bands of silicone rubber or sponge 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 (see the box, right), 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.

Vitrectomy

Vitrectomy 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 lies against the retina.

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 requiring general anaesthetic, you must tell your doctors about the gas bubble in your eye.

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. 

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Sealing the hole

Retinal holes or tears can be sealed using either lasers or cryotherapy (freezing treatment). These procedures can be used:

  • after scleral buckling, to seal a detached retina to the wall of the eye
  • as a treatment on its own (using local anaesthetic) to seal a small hole or tear and prevent retinal detachment from happening

Both lasers and cryotherapy work by making the eye create scar tissue that seals the hole or the gap between the detached retina and lining of the eye.

Page last reviewed: 13/07/2011

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 very 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).

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.

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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.  

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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