Symptoms — when to call us
Sudden flashes of light, a shower of new floaters, or a curtain or shadow moving across part of your vision can be symptoms of a retinal tear or detachment.
Urgent evaluation
We see urgent retinal detachment referrals as soon as possible. Call our scheduling line — let them know you have flashes, floaters, or a curtain in your vision.
How a retina detaches
The retina is the thin layer of tissue that lines the back wall of the eye. It works like the film in a camera — it captures the light coming through the lens and sends the signal to the brain. For the retina to function, it has to stay in close contact with the wall of the eye.
In front of the retina, filling most of the eye, is the vitreous — a clear gel that gives the eye its shape. As we age, the vitreous gradually liquefies and shrinks, and at some point it pulls away from the retina. This is called a posterior vitreous detachment, and it is common — most people experience it eventually. Usually it's harmless.
Sometimes, however, as the vitreous pulls away, it tugs hard enough on the retina to tear it. Once a tear is present, fluid from inside the eye can pass through the tear and get behind the retina, lifting it off the wall of the eye like wallpaper peeling away from a wall. That is a retinal detachment.
A detached retina cannot function. The portion that has lifted off loses its blood supply and stops sending signals to the brain. This is why a detachment causes vision loss — and why prompt evaluation matters.
Risk factors
Anyone can have a retinal detachment, but the risk is higher in patients who are very nearsighted (high myopia), have had cataract surgery or eye injury, have lattice degeneration, or have a family history of retinal detachment. A detachment in one eye increases the risk in the other. If you fall into one of these categories, any new flashes or floaters should be evaluated promptly.
Tears vs. detachment
A retinal tear is a small break in the retina, usually in the periphery (side). It is not yet a detachment. Tears can often be sealed in the office with laser or freezing treatment, preventing them from progressing.
A retinal detachment has already begun — fluid has gotten behind the retina and is lifting it off. Detachments are typically repaired with surgery, though in select cases laser may be used to seal it off without operating.
This is why prompt evaluation matters. A tear caught early can sometimes be treated in 15 minutes in the office. The same tear, if it goes on to detach the retina, requires surgery in an operating room and a longer recovery. Same problem, very different treatment, depending on when we see it.
How we diagnose it
A complete evaluation includes a careful dilated examination of the entire retina, often with scleral depression (gentle pressure on the outside of the eye to bring the far peripheral retina into view). When the view is limited — for example, by a vitreous hemorrhage — we use ocular ultrasound to see through the blood and confirm whether a detachment is present.
Surgical options
There are several techniques for repairing a retinal detachment, sometimes used in combination. These include pneumatic retinopexy (an in-office gas bubble procedure), scleral buckle, and vitrectomy. Which one is right depends on the type, location, and extent of the detachment, as well as factors specific to your eye. Your retina specialist will discuss the recommended approach with you.
After surgery
Recovery depends on the technique used and the type of detachment, but most patients can expect:
- A gas bubble in the eye for several days to several weeks. Vision is blurred while the bubble is present and clears as it absorbs.
- Head positioning instructions. For some surgeries, you'll be asked to keep your head in a specific position — sometimes face-down — for several days. We will give you clear instructions.
- No air travel until the gas bubble is gone. Cabin pressure changes can cause a gas bubble to expand dangerously.
- Restrictions on heavy lifting, bending, and strenuous activity for one to two weeks.
- Visual recovery is gradual — often weeks to months — and depends heavily on whether the macula was detached and for how long.