Retinal Tears and Detachment

A retinal detachment is the retina, the light-sensing layer at the back of the eye, coming away from the wall of the eye. A detached retina cannot work, and without repair the eye usually loses its vision. It is an emergency. It almost always begins with a retinal tear, and a tear caught before the retina detaches can be sealed in the office in a few minutes.

Choose "A detachment" or "A tear caught early" and press Play.

Warning signs

• A sudden shower of new floaters
• Flashes of light at the edge of vision
• A dark curtain, shadow or veil moving in from one side, above or below
• Blurring or loss of central vision, if the detachment reaches the macula

It is painless. Call the same day if you have any of these; see When to Call the Same Day. The vision loss simulator shows what the curtain looks like.

How it happens

The gel that fills the eye shrinks with age and pulls away from the retina. This is described on Flashes and Floaters. Usually it separates cleanly. Where it is stuck firmly, it can tear the retina. Fluid then passes through the tear and spreads underneath, peeling the retina off the wall like wallpaper.

Who is at higher risk

• People who are very nearsighted
• After cataract surgery or a serious eye injury
• A previous detachment in the other eye, or a family history
• Thin patches at the edge of the retina (lattice degeneration), which your doctor may point out at a dilated exam

Sealing a tear

If a tear is found before the retina has detached, it is treated in the office, usually the same day.

• Laser. After numbing drops, laser spots are placed in a ring around the tear. Each spot forms a small scar that welds the retina to the wall over the next week or two.
• Freezing (cryotherapy) does the same job from the outside of the eye when laser cannot reach the tear.

You can go home afterward. For a week or two you may be asked to avoid heavy exertion while the seal strengthens. New symptoms should still be reported, because new tears can form.

Repairing a detachment

A detachment is repaired by a retina surgeon, usually within days, and sooner if the macula is still attached. The method depends on the detachment.

• Vitrectomy. The gel is removed through tiny openings, the retina is flattened, the tear is sealed with laser, and the eye is filled with a gas bubble (or occasionally silicone oil) that holds the retina in place while it heals.
• Scleral buckle. A soft silicone band is stitched around the outside of the eye, under the muscles, to press the wall in against the tear. It stays permanently and is not visible.
• Gas bubble in the office (pneumatic retinopexy). For some detachments a gas bubble is injected and the tear is sealed with laser or freezing, without an operating room.

After surgery

• Head positioning. With a gas bubble you may need to keep your head in a particular position, sometimes face down, for several days so the bubble presses on the right spot. This matters for the result.
• Flying and high altitude. If a gas bubble is used, there is often a period afterward when you should not fly or travel to high altitude, because the bubble expands as air pressure falls. Your surgeon will tell you how long. Tell any anesthetist that you have gas in your eye.
• Vision through a gas bubble is very poor. It returns from the top down as the bubble shrinks.
• Drops are used for several weeks.

Results

Most detachments are repaired with one operation, and nearly all with a second if needed. How much vision returns depends mainly on whether the macula was detached and for how long, which is why speed matters. A cataract commonly develops within a year or two after a vitrectomy.

If you have glaucoma

Eye pressure is watched closely after retinal surgery, because gas, oil and steroid drops can all raise it. Tell your retina surgeon about your glaucoma and keep using your drops unless told otherwise.

Questions worth asking

• Is the macula attached?
• Which repair do you recommend for my detachment, and why?
• Will I need to position my head, and for how long?
• When can I fly, drive and return to work?