Retinal Detachment
Urgent specialist treatment to reattach the retina and protect vision
What is retinal detachment?
The retina is the thin light-sensitive lining on the inside back wall of the eye. It has no blood supply of its own at its outer layer and depends on being pressed flat against the wall behind it. A detachment is the retina lifting away from that wall.
Most detachments start with a small tear. The vitreous, the clear gel filling the eye, liquefies and shrinks with age and pulls away from the retina. Where it is stuck firmly, the pull tears the retina, fluid tracks through the tear, and the retina peels off progressively like wallpaper. Strong short sight, previous eye surgery, a blow to the eye, a detachment in the other eye and a family history all raise the chance of this happening.
A detached retina starves. The part of it that has lifted stops working within hours to days, and the longer it stays off the less function returns after it is put back. This is one of the few eye problems where the same week genuinely changes the outcome, and same-day assessment is the right response to a new curtain or shadow across your vision.
What you might notice
- Floaters and flashes of light
- Sudden loss of vision
How it is diagnosed
The examination is done with your pupils dilated, which takes about thirty minutes to take effect and leaves you light-sensitive and unable to drive for several hours. Bring someone with you.
Your eye doctor examines the whole retina out to its far edge with a bright light and a hand-held lens, often pressing gently on the outside of the eye through the lid to bring the extreme periphery into view. They are establishing three things: how much of the retina is off, whether the central area responsible for reading and faces is still attached, and exactly where every tear is. The answer to the second decides how urgently you go to theatre, and the answer to the third decides what is done.
Where blood in the vitreous blocks the view, an ultrasound probe on the closed lid shows the shape of the retina behind it. The other eye is examined as carefully as the affected one, because weak areas there can be treated before they tear.
Recovery
Repair is arranged within days, and often the next available list. You go home the same day or after one night.
If a gas bubble is placed in the eye to hold the retina flat, your surgeon will tell you which position to keep your head in and for how long, commonly most of each hour for five to seven days. Vision through the bubble is very poor and improves in stages as the gas absorbs over two to eight weeks. You must not fly, travel over a high mountain pass or have a general anaesthetic with certain gases while the bubble is there, because it expands with altitude and the pressure in the eye can rise dangerously.
Plan two to six weeks away from work, at the longer end for physical jobs. Driving waits until vision has been measured at a review and the bubble has gone. Sight keeps improving for six months to a year, and the final level depends mostly on whether the central retina was still attached when you were operated on.
If it is left untreated
A detachment that is not repaired almost always extends until the whole retina is off. Once the central area lifts, reading and recognising faces go with it, and the eye loses useful sight permanently.
An eye with a long-standing detachment does not simply stop seeing and stay that way. Scar tissue grows across the surface and contracts, the retina becomes stiff and folded, the pressure in the eye falls, and the eye can become painful and shrink over months to years. Repair after that point is much harder and much less likely to restore vision.
The warning signs come before the loss. A sudden shower of new floaters, flashes of light in the dark, or a shadow moving in from one side of your vision all mean the retina should be examined that day. A tear found before the retina has lifted can often be sealed in the clinic in minutes.
Questions about retinal detachment
Will my sight go back to how it was?
The retina is successfully reattached in the large majority of cases, sometimes needing more than one operation. How much sight returns depends mostly on one thing, which is whether the central part of the retina was still attached when you were operated on. If it was, most people keep vision close to their previous level. If the centre had already lifted, useful vision usually returns but is often a line or two worse on the chart, with some distortion of straight lines and altered size perception that the brain adapts to over months. Improvement continues for six months to a year.
Why can I not fly with a gas bubble in my eye?
Gas expands as the surrounding air pressure falls. In a cabin at altitude, or driving over a high pass, the bubble in your eye expands with it, and because the eye cannot stretch, the pressure inside rises sharply. That can cut off the blood supply to the optic nerve within minutes and cause permanent loss of sight in that eye. The restriction lasts until the bubble has completely absorbed, which takes two to eight weeks depending on the gas used. Your surgeon will check the eye and tell you when it has gone. Tell any anaesthetist about the bubble as well.
Is my other eye at risk?
It is at higher risk than average, since whatever predisposed the first eye, most often strong short sight or the way the vitreous gel is attached, usually applies to both. Your surgeon will examine the other eye carefully at the same visit, and weak areas or a tear found there can often be sealed in the clinic in a few minutes before anything lifts. After that, know the warning signs and act on them the same day: a sudden shower of new floaters, flashes of light in the dark, or a shadow moving across your vision. A tear treated early is a very small matter.
Other ophthalmology treatments
Removal of a cloudy natural lens and replacement with an artificial lens to improve vision
Day CareLaser vision correction that reshapes the cornea to reduce dependence on glasses or contact lenses
Day CareTalk to a care coordinator about retinal detachment
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one