Retinal Tears and Detachments

Definition

Retinal detachment describes an emergency situation in which a critical layer of tissue (the retina) at the back of the eye pulls away from the layer of blood vessels that provides it with oxygen and nourishment.

Retinal detachment leaves the retinal cells lacking oxygen. The longer retinal detachment goes untreated, the greater your risk of permanent vision loss in the affected eye.

Fortunately, retinal detachment often has symptoms that are clear warning signs. Early diagnosis and treatment of retinal detachment can save your vision. If you suspect you may have a retinal detachment, contact an eye specialist (ophthalmologist) as soon as warning signs appear.

Symptoms

Retinal detachment itself is painless, but retinal detachment warning signs and symptoms almost always appear before it occurs or has advanced. Retinal detachment symptoms may include:

  • The sudden appearance of many floaters — small bits of debris in your field of vision that look like spots, hairs or strings and seem to float before your eyes
  • Sudden flashes of light in the affected eye
  • A shadow or curtain over a portion of your visual field that develops as the detachment progresses

When to see a doctor

Because retinal detachment is an emergency situation in which you can permanently lose your vision, you should always seek immediate medical attention if you notice any of its symptoms.

Causes

Retinal detachment can occur as a result of:

  • Shrinkage or contraction of the vitreous (VIT-ree-us) — the gel-like material that fills the inside of your eye. This can create tugging on the retina and a retinal tear, leading to a retinal detachment.
  • Injury
  • Advanced diabetes
  • An inflammatory eye disorder

How retinal detachment occurs

Retinal detachment can occur when the gel-like material (vitreous) leaks through a retinal hole or tear and collects underneath the retina.

Reasons for holes or tears include:

  • Aging or retinal disorders can cause the retina to thin. Retinal detachment due to a tear in the retina typically develops when there is a sudden collapse of the vitreous, causing tugging on the retina with enough force to create a tear.

    Fluid inside the vitreous then finds its way through the tear and collects under the retina, peeling it away from the underlying tissues. These tissues contain a layer of blood vessels called the choroid (KOR-oid). The areas where the retina is detached lose this blood supply and stop working, so you lose vision.

  • In certain inflammatory conditions or other disorders, fluid also can accumulate beneath the retina without a tear or break.

Aging-related retinal tears that lead to retinal detachment

As you age, your vitreous may change in consistency and shrink or become more liquid. Eventually, the vitreous may separate from the surface of the retina — a common condition called posterior vitreous detachment (PVD). It's also called vitreous collapse.

As the vitreous separates or peels off the retina, it may tug on the retina with enough force to create a retinal tear. Left untreated, fluid from the vitreous cavity can pass through the tear into the space behind the retina, causing the retina to become detached.

PVD can cause visual symptoms. You may see flashes of sparkling lights (photopsia) when your eyes are closed or when you're in a darkened room. New or different floaters may appear in your field of vision.

Risk factors

The following factors increase your risk of retinal detachment:

  • Aging — retinal detachment is more common in people older than age 40
  • Previous retinal detachment in one eye
  • A family history of retinal detachment
  • Extreme nearsightedness (myopia)
  • Previous eye surgery, such as cataract removal
  • Previous severe eye injury or trauma
  • Previous other eye disease or disorder