Rhegmatogenous
The most common type. A hole or tear in the retina allows fluid from inside the eye to seep underneath and lift the retina away from the back of the eye.
Retinal Detachment: Symptoms, Causes, and Treatment Options
Retinal detachment is a serious eye emergency that requires prompt medical attention. At The Eye Center, our visiting retina specialists serve patients across Northern Virginia with advanced diagnostic imaging and surgical care, all available at our Lansdowne retina clinic.
Watch: how the retina separates and why it is treated as an emergency.
What Is Retinal Detachment
The retina is a thin layer of nerve cells lining the back of the eye that captures light and converts it into signals the brain reads as vision. When this layer separates from the tissue supporting it, vision can be permanently affected the longer it goes untreated.
Without a functioning retina, the eye cannot send clear visual signals to the brain. Even a brief separation from its blood supply can cause lasting damage to the retinal cells, which is why retinal detachment is treated as a medical emergency.
Explore the basics
The Three Types of Detachment
Each type has a distinct cause and may require a different approach to treatment.
Tractional
Happens when scar tissue on the retinal surface contracts and pulls the retina away. This is most often associated with advanced diabetic eye disease.
Exudative
Occurs when fluid accumulates beneath the retina without any tear or hole. Inflammatory conditions, abnormal blood vessels, or tumors can cause this type.
How a Tear Leads to Detachment
The inside of the eye contains a clear gel called the vitreous. Over time, especially as we age, this gel shrinks and pulls away from the retina in a process called posterior vitreous detachment (PVD). In most cases, this separation is harmless. However, if the vitreous pulls too hard on a spot where it is firmly attached, it can tear the retina. Fluid then flows through the tear and collects underneath, lifting the retina away from its blood supply.
Proliferative vitreoretinopathy, or PVR, is a complication in which scar tissue forms on the retinal surface after a detachment or surgery. This scar tissue can contract and re-pull the retina, create new tears, or prevent the retina from lying flat during healing. PVR is the most common reason retinal detachment surgery does not succeed on the first attempt.
Urgent Warning Signs
Knowing what to look for can make a critical difference in how quickly a detachment is caught and treated. Symptoms can appear suddenly, and none of them should be ignored or waited out.
The following symptoms require immediate evaluation by a retina specialist or a visit to the emergency room. Do not wait to see if they resolve on their own.
- A sudden increase in floaters, which are dark spots, threads, or specks drifting across your vision. Some people describe seeing what looks like pepper scattered across their field of view.
- Flashes of light, especially at the outer edges of your vision. These flashes, called photopsia, happen when the vitreous tugs on the retina.
- A shadow or dark curtain spreading across part of your vision, often starting from the side and moving toward the center.
- A sudden noticeable decrease in vision clarity in one eye.
A retinal tear may first produce floaters and flashes without any obvious vision loss. As fluid begins to collect under the retina, a shadow or curtain effect may appear in the peripheral (side) vision. This shadow can remain stable or move toward the center of vision over hours or days. Once the macula, the central part of the retina responsible for sharp detail, becomes involved, central vision is affected. Speed varies, but any new floaters or flashes should be evaluated urgently to catch a tear before a full detachment develops.
Small tears or slow detachments in the far periphery of the retina may produce very mild symptoms or none at all. This is especially true in people with high myopia or lattice degeneration, where changes in the retina can develop gradually. Routine dilated eye exams can catch these problems before they cause noticeable vision loss.
Who Is at Risk
While retinal detachment can affect anyone, certain factors significantly increase the likelihood of it occurring. Understanding your personal risk can help you take the right steps toward early detection and prevention.
Age and the aging vitreous
Retinal detachment can occur at any age but becomes more common after age 40. This is largely because the vitreous gel naturally changes and becomes more likely to separate from the retina with age, increasing the chance of a tear forming in the process.
Nearsightedness
People with high myopia (severe nearsightedness) face a substantially greater risk. In highly myopic eyes, the eyeball is longer than average, which stretches and thins the retina and makes it more vulnerable to tears and detachment. Even people with moderate myopia benefit from regular dilated eye exams to monitor the peripheral retina.
Prior eye surgery or injury
Cataract surgery is a recognized risk factor for retinal detachment, and certain surgical complications can raise that risk further. Blunt trauma to the eye from sports or accidents can also cause retinal tears or trigger a detachment, sometimes weeks or months after the initial injury.
Lattice degeneration and other retinal conditions
Lattice degeneration is a condition in which areas of the peripheral retina become thin and develop small holes or weak spots. It is more common in myopic eyes and is present in a significant portion of retinal detachment cases. Retinoschisis, a splitting of the retinal layers, is another condition that can increase risk. A retina specialist can identify these changes during a dilated eye exam.
Personal and family history
If you have experienced a retinal detachment in one eye, the other eye carries a higher risk of detachment as well. A family history of retinal detachment also raises your likelihood. Regular dilated exams with a retina specialist are especially important if either applies to you.
How It Is Diagnosed
Accurate diagnosis requires a thorough examination and, in some cases, specialized imaging. Our retina specialists use a comprehensive approach to confirm the diagnosis and determine the best treatment plan.
Dilated Eye Examination
The retina specialist begins with a dilated eye exam. Special eye drops are used to widen the pupil, giving the doctor a clear view of the entire retina, including its outer edges. The specialist checks for tears, holes, thinning, and any areas where the retina may have lifted away from the back of the eye.
Imaging and Ultrasound
When blood or debris inside the eye limits the view of the retina, ultrasound imaging can be used. This painless test uses sound waves to show whether the retina is attached or detached. Optical coherence tomography (OCT), which creates detailed cross-sectional images of the retina, may also be used to assess the macula and guide treatment decisions. Our retina clinic also offers fluorescein and ICG angiography, color fundus photography, and B-scan echography to support a thorough evaluation.
Why Timing Matters
A retinal tear found before the retina has detached can often be treated in the office with a laser or freezing procedure, avoiding the need for surgery. Once the retina has detached, surgical repair is necessary. If the macula remains attached, repair is typically performed within 24 to 48 hours. If the macula has already detached, surgery remains essential but may be scheduled within a few days. In either case, prompt evaluation is critical to protect as much vision as possible.
Treatment Options
Treatment depends on the type of detachment, the location of the tear, and whether the macula is involved. Our retina specialists will recommend the approach best suited to your specific situation.
Laser photocoagulation and cryopexy for retinal tears
When a retinal tear is identified before the retina has fully detached, it can often be sealed in the office. Laser photocoagulation uses a focused beam of light to create small areas of controlled scarring around the tear, bonding the retina to the underlying tissue and preventing fluid from passing through. Cryopexy uses a freezing probe applied to the outside of the eye to achieve the same effect. Both procedures are performed in the office and are highly effective at preventing a tear from progressing to a full detachment.
Pneumatic retinopexy
In pneumatic retinopexy, the retina specialist injects a small gas bubble into the vitreous cavity of the eye. The bubble rises and gently presses against the retinal tear, pushing the retina back into contact with the wall of the eye. The patient must maintain a specific head position for several days to keep the bubble over the repaired area while it heals. Laser or cryopexy is then applied to permanently seal the tear. This approach works best for detachments caused by tears in the upper portion of the retina.
Scleral buckle surgery
A scleral buckle is a small band of silicone material that the retina specialist places around the outside of the eye. The buckle gently indents the eye wall inward, bringing it closer to the detached retina and helping it reattach. Cryopexy or laser is used to seal the tear. The buckle remains on the eye permanently in most cases but is not visible from the outside. This approach is often preferred for younger patients or for certain types of detachments.
Vitrectomy surgery
Vitrectomy is the most common surgical procedure for retinal detachment. Through very small incisions, the retina specialist removes the vitreous gel from inside the eye. This eliminates any traction pulling on the retina and allows the surgeon to directly repair tears and flatten the retina. A gas bubble or silicone oil is then placed inside the eye to hold the retina in position during healing. Gas bubbles dissolve on their own over a period of weeks. Silicone oil may need to be removed in a separate procedure months later.
Combining surgical approaches
For complex detachments or cases involving PVR, the retina specialist may combine vitrectomy with a scleral buckle. Long-acting gas bubbles or silicone oil are commonly used in these situations to provide support during healing. The appropriate combination of techniques is determined based on the specific characteristics of each case.
Recovery and What to Expect
Recovery after retinal detachment treatment varies depending on the procedure performed and the extent of the detachment. Understanding what to expect can help you prepare and follow your retina specialist's instructions carefully.
Most retinal detachment surgeries are performed on an urgent basis. Your retina specialist will explain which procedure is recommended and why. You will receive instructions about eating, drinking, and medications before surgery. The procedure is typically performed under local anesthesia, so you will be awake but your eye will be numbed so you do not feel pain.
After pneumatic retinopexy or vitrectomy with a gas bubble, you will need to hold your head in a specific position for a period of time directed by your retina specialist. This keeps the gas bubble pressing against the repaired area of the retina during healing. Your retina specialist will give you clear instructions about how many hours per day and for how long this positioning is required. Not every procedure requires face-down positioning.
If a gas bubble was placed inside your eye, you must not fly in an airplane or travel to high-altitude locations until the bubble has completely dissolved. Changes in cabin pressure can cause the gas to expand, which may dangerously increase the pressure inside the eye. Your retina specialist will monitor the bubble and let you know when it is safe to fly. This restriction typically lasts several weeks but depends on the type of gas used.
How much vision recovers depends on whether the macula was involved and how long the detachment was present before repair. When the macula remains attached, vision outcomes are generally more favorable. When the macula was detached, some degree of vision improvement is usually possible, but full recovery to pre-detachment levels cannot be guaranteed. Vision may continue to improve gradually over weeks to months. Surgery successfully reattaches the retina in the large majority of cases, though some patients require more than one procedure.
As with any surgery, retinal detachment repair carries risks. These can include elevated eye pressure, bleeding inside the eye, infection, cataract development, and recurrent detachment. PVR is the most common cause of surgical failure. Your retina specialist will monitor you closely after surgery and address any concerns that arise during recovery.
Protecting Your Vision After Treatment
Once your retina has been repaired, ongoing care and awareness are essential to protecting your vision long term. This includes monitoring the treated eye and taking steps to reduce risk in the other eye.
Having a retinal detachment in one eye increases the risk in the other eye. Your retina specialist may recommend more frequent dilated exams, especially if you also have high myopia, lattice degeneration, or a family history of detachment. Regular monitoring allows any new tears or thinning to be caught and treated early.
After successful reattachment surgery, many people regain useful vision. Some patients notice that colors appear slightly different in the treated eye, or that fine detail is not quite as sharp as before. These changes can be related to how long the retina was detached. Over time, the brain adapts. Low-vision aids and rehabilitation services are available for those who experience lasting changes, and your retina specialist can guide you toward appropriate resources.
Wearing protective eyewear during sports and activities that could result in eye injury is an important precaution, especially if you have already experienced a detachment. Keep all follow-up appointments with your retina specialist and report any new floaters, flashes, or changes in vision immediately, even months or years after your repair.
Frequently Asked Questions
Here are answers to common questions about retinal detachment that go beyond what is covered above, including practical guidance to help you make informed decisions.
Can a retinal tear heal on its own without treatment?
Retinal tears do not heal on their own. Without treatment, fluid can seep through the tear and cause a detachment. This is why any identified tear requires prompt attention from a retina specialist. The good news is that a tear caught before detachment occurs can usually be sealed with an in-office laser or cryopexy procedure, which is far less involved than surgery. Delaying evaluation significantly increases the likelihood that the tear will progress.
How do I know if I need emergency care or can wait for an appointment?
Any sudden onset of new floaters, flashes of light, a curtain or shadow crossing your vision, or a noticeable drop in vision in one eye should be treated as urgent, meaning you should seek evaluation that same day. These symptoms do not always mean detachment has occurred, but they cannot be safely assessed without examination by a retina specialist. When in doubt, seek care right away rather than waiting for a routine appointment slot.
What happens if retinal detachment surgery does not work the first time?
When the retina does not fully reattach after the first procedure, or when PVR causes the retina to re-detach, a second surgery may be needed. The retina specialist will evaluate the situation and determine the most appropriate next step, which may involve a different surgical technique, a longer-acting gas bubble, or silicone oil to provide extended support. While additional surgery adds complexity, many patients who require more than one procedure still achieve meaningful vision recovery.
Is there anything I can do to lower my risk if I am highly nearsighted?
Regular dilated eye exams are the most important step for people with high myopia. A retina specialist can identify thinning, lattice degeneration, or small tears before they cause problems. Wearing protective eyewear during contact sports is also advisable. There is no guaranteed way to prevent detachment, but early detection and preventive treatment when a tear is found significantly reduce the risk of a full detachment occurring.
Will I need glasses or contacts differently after retinal detachment surgery?
It is common for your vision prescription to change after retinal detachment surgery, particularly after scleral buckle procedures, which can shift the curvature of the eye. Your retina specialist will advise you on when it is appropriate to have your prescription re-evaluated. Updating your glasses or contact lens prescription after the eye has fully healed can help optimize your functional vision.
Are floaters after surgery something to worry about?
Some floaters are normal and expected during the recovery period, especially as a gas bubble slowly dissolves. However, a sudden new increase in floaters or flashes after surgery should be reported to your retina specialist promptly, as it may signal a new tear or a recurrent detachment. During your follow-up appointments, your retina specialist will examine the retina to ensure healing is progressing properly. Never dismiss a significant change in floaters as a routine part of recovery without first checking with your care team.
Retinal Care at The Eye Center
Our visiting retina specialists bring fellowship-trained expertise in vitreoretinal surgery, medical retina, and uveitis to patients throughout Northern Virginia. Whether you are experiencing urgent symptoms or seeking a comprehensive retinal evaluation, our team is here to provide thorough, personalized care using advanced imaging and proven surgical techniques. We are committed to helping you protect your vision at every stage of your care.
