A shadow creeping across your vision is an emergency. Not tomorrow. Not after the weekend. Now.

Retinal detachment occurs when the retina, the light-sensitive layer at the back of the eye, separates from the tissue beneath it. The retina needs constant contact with the retinal pigment epithelium to receive oxygen and nutrients. Once separated, retinal cells begin to die within hours. If the detachment reaches the macula, the central retina responsible for sharp detail vision, the window for a full visual recovery narrows rapidly. Retinal detachment is an ocular emergency. The outcome depends on one thing above all others: how quickly it is treated.

What You Need to Know About Retinal Detachment

Retinal detachment is a medical emergency. Any shadow, curtain, or sudden dramatic change in vision requires same-day assessment at an emergency eye unit
The most common cause is a retinal tear that allows fluid from the vitreous to seep beneath the retina and lift it away
Risk factors include high myopia, previous PVD, eye trauma, previous eye surgery, and a family history of retinal detachment
Surgery reattaches the retina successfully in around 85 to 90 percent of cases after a single procedure
If the macula has not yet detached, full visual recovery is possible. Once the macula is involved, central vision recovery is less predictable
The other eye carries an elevated lifetime risk and requires regular monitoring

Surgery success 85-90% Of cases reattach successfully after a single procedure

Key factor Macula on Macula-on detachments have much better visual outcomes

Fellow eye risk 10-15% Lifetime risk of retinal detachment in the fellow eye

What Actually Happens

The retina is a thin, delicate sheet of neural tissue lining the back of the eye. Behind it sits the retinal pigment epithelium (RPE), a layer of cells that support and nourish the retinal photoreceptors. In a healthy eye the two are in close contact. In a retinal detachment, fluid accumulates between them and the retina lifts away from its support layer like wallpaper peeling from a damp wall.

Side-by-side cross-section illustration comparing a normal eye with the retina fully attached on the left, versus a retinal detachment on the right showing retinal tissue separated from the RPE with subretinal fluid and a visible retinal tear at the point of origin — Left: retina in full contact with the RPE. Right: retinal detachment with fluid beneath the separated retina and a tear at the point where fluid entered.

Without contact with the RPE, photoreceptors stop receiving the nutrients and oxygen they need and begin to deteriorate. Peripheral retinal cells are resilient for longer than macular cells. A detachment confined to the far periphery may cause only a small shadow for days. Once it reaches the macula, central vision drops rapidly. This is not a condition that can be watched and waited on.

Types of Retinal Detachment

Rhegmatogenous retinal detachment

By far the most common type. Rhegmatogenous means “arising from a break.” A tear or hole in the retina, usually caused by the pulling force of a posterior vitreous detachment, allows liquid vitreous to pass through the break and accumulate beneath the retina. Once fluid is flowing under the retina, the detachment expands. It is progressive, not self-limiting. Surgery is needed to close the break and drain the fluid.

Tractional retinal detachment

Fibrovascular scar tissue on the surface of the retina, usually from proliferative diabetic retinopathy or a previous penetrating injury, contracts over time and physically pulls the retina away from the RPE without any break in the retinal tissue itself. The detachment tends to be more localised and progresses more slowly than a rhegmatogenous detachment, but it is no less serious when it threatens or involves the macula.

Exudative retinal detachment

Fluid accumulates beneath the retina from leaking blood vessels or inflammation, without any retinal tear or traction. Usually caused by severe uveitis, tumours, or severe hypertensive retinopathy. Treatment is directed at the underlying cause rather than the detachment itself.

Who Is at Risk?

High myopia

The most significant modifiable risk factor. The highly elongated myopic eye has a thinner, more stretched retina that is more susceptible to tears, particularly in areas of lattice degeneration. High myopes should have a dilated retinal examination at least every one to two years and should act immediately on any new floaters, flashes, or visual field changes.

Posterior vitreous detachment

The single most common trigger for retinal tears that lead to detachment. Around 10 to 15 percent of symptomatic PVDs have a retinal tear at presentation. A PVD examined and found to be clean carries a much lower subsequent risk, but new symptoms after a previously clear PVD should always be re-assessed.

Previous retinal detachment in the fellow eye

Having had a retinal detachment in one eye raises the lifetime risk in the other eye to around 10 to 15 percent. Both the fellow eye and the operated eye require ongoing monitoring. Prophylactic laser treatment to areas of lattice degeneration or previous tears may be offered by your surgeon.

Other risk factors

Blunt or penetrating eye trauma, previous cataract surgery, and a positive family history all increase risk. Lattice degeneration, a common pattern of peripheral retinal thinning visible on examination, is present in around 8 percent of the general population and is a predisposing factor, though most people with lattice never develop a detachment.

Symptoms

The classic warning signs of a retinal detachment developing from a tear:

A sudden shower of new floaters, often described as a swarm, more numerous than previous floaters
Frequent large flashes of light in the peripheral vision
A dark shadow, curtain, or grey veil appearing in the peripheral visual field and advancing toward the center
A sudden drop in visual acuity if the macula has detached

Floaters and flashes alone, without a shadow, may indicate a retinal tear rather than a full detachment. That distinction matters: a tear treated with laser before detachment occurs is a brief clinic procedure. A detachment requires surgery. Both need same-day assessment. You cannot reliably distinguish a tear from a detachment at home, and trying to is not worth the time you’re losing.

Treatment

Retinal tear without detachment: laser or cryotherapy

A retinal tear caught before detachment occurs is treated with laser photocoagulation or cryotherapy, applied around the edges of the tear to create a scar that seals it. The scar takes around two weeks to fully consolidate. This prevents fluid from flowing through the tear and lifting the retina. Simple, effective, done in the clinic under local anaesthetic. The outcome in terms of preventing detachment is excellent when the tear is treated before fluid has accumulated.

Pneumatic retinopexy

A gas bubble is injected into the vitreous cavity (described on the vitreous basics page) and the patient is positioned so the bubble floats up against the tear, temporarily sealing it. Laser or cryotherapy is then applied to create a permanent seal. The gas bubble absorbs over days to weeks. Only suitable for certain tear locations and configurations. Usually performed under local anaesthetic in the clinic or minor surgery setting.

Vitrectomy

The most commonly used surgical approach for retinal detachment is vitrectomy. The vitreous gel is removed, the retina is reattached using a laser or cryotherapy to seal the tear, and the vitreous cavity is filled with gas or silicone oil to hold the retina in place while it heals.

If gas is used, patients must maintain a specific head position (usually face-down or to one side) for several days to keep the bubble against the repair site. The gas absorbs over weeks and must be fully gone before flying or receiving general anaesthetic. If silicone oil is used, it is typically removed in a second operation several months later once the retina is stable.

Scleral buckle

A silicone band or sponge is sutured to the outside of the eye, indenting the scleral wall inward toward the detached retina and reducing the traction on the tear. Often combined with vitrectomy or used alone, particularly in younger patients with simple detachments. The buckle remains permanently in place.

After Surgery: What to Expect

Vision after retinal detachment surgery is unpredictable and recovery takes time, often months. The single most important predictor of final visual outcome is whether the macula was attached or detached at the time of surgery. Macula-on repairs, where the central retina never lifted, typically recover excellent vision. Macula-off repairs, where the detachment had already reached the central retina, can recover to surprisingly good levels but are less consistent and take longer.

In the weeks after surgery, vision is often blurry and distorted, particularly if a gas bubble is in place. This is normal and expected. The eye needs time to settle, the gas needs time to absorb, and the retina needs time to re-establish its connections. Patients who had a silicone oil fill will have blurred vision until the oil is removed in a second procedure. That’s expected, not a complication. Judging the final outcome too early almost always leads to unnecessary anxiety.

Cataract formation is common after vitrectomy, particularly in patients over 50, and often occurs within one to two years of surgery. A second procedure to remove the cataract is then needed. Knowing to expect this in advance removes a lot of the surprise when it happens.

Go to an Emergency Eye Unit Immediately If You Notice

A shadow, curtain, or dark veil appearing anywhere in your visual field
A sudden shower of new floaters, far more than you have experienced before
A sudden drop in vision in one eye
Large or frequent flashes of light, especially combined with any of the above

Do not go to your GP. Do not wait until morning. Do not monitor it at home to see if it gets better. Retinal detachment does not improve without treatment, and every hour matters when the macula is threatened. Go directly to your nearest emergency eye unit and tell them you think you may have a retinal detachment.

Frequently Asked Questions About Retinal Detachment

Will I get my vision back after surgery?
That depends largely on whether the macula was attached or detached when you had surgery. Macula-on detachments, caught before the central retina lifted, usually recover excellent vision. Macula-off detachments can recover well, but it varies: some patients get back to near-normal, others are left with some permanent central vision loss. Honesty about this before surgery is important, because the uncertainty is real. The sooner the surgery, the better the chance. If you’re reading this because you have symptoms right now, stop reading and go to an emergency eye unit.
How long is recovery after retinal detachment surgery?
Longer than most people expect. Initial recovery takes weeks, but full visual stabilisation often takes three to six months, sometimes longer. If a gas bubble was used, specific head positioning is required for several days to a week, which is uncomfortable and disruptive. If silicone oil was used, a second operation to remove it comes several months later. Plan for time off work, limitations on activity, and a protracted rather than a quick recovery.
Can I fly after retinal detachment surgery?
Not if a gas bubble was used. The reduced air pressure at altitude causes gas to expand, which can cause a dangerous rise in intraocular pressure. Flying is contraindicated until the gas has fully absorbed, which takes days to weeks depending on the gas used. Your surgeon will tell you exactly when it is safe. Carry a letter stating you have had intraocular gas if you are travelling during the recovery period. General anaesthesia with nitrous oxide must also be avoided until the gas is completely absorbed. Your anaesthetist needs to know.
What are the chances the detachment comes back?
Around 85 to 90 percent of retinal detachments are successfully repaired with a single operation. A proportion, around 10 to 15 percent, require a second or further procedure. Reoperation rates are higher in complex detachments, long-standing detachments, and those associated with proliferative vitreoretinopathy (PVR), a complication where scar tissue forms on the retinal surface. After successful repair, long-term follow-up continues because the fellow eye also carries risk.
My other eye is also at risk. What should I do?
Tell your ophthalmologist you’ve had a retinal detachment. The fellow eye should be examined carefully for predisposing factors such as lattice degeneration, previous tears, or areas of thinning. Prophylactic laser to high-risk areas may be recommended. More importantly, know the warning signs and act on them immediately if they appear. The other eye will be watched carefully, but your own prompt action if symptoms develop is the most important protection. Specialist care is provided by the retina team.
Can retinal detachment be prevented?
Not completely, but risk can be reduced. If you are highly myopic, regular dilated retinal examinations allow high-risk areas to be identified and treated before a detachment occurs. Retinal tears found during examination for PVD can be sealed with laser before they detach. Wearing appropriate eye protection during sports or activities with a risk of eye trauma removes one modifiable risk factor. Beyond this, knowing your risk and acting immediately on warning symptoms is the most effective prevention available.

If you would like to learn more, the National Eye Institute’s retinal detachment page offers a clear patient-friendly overview of symptoms, risk factors, causes, diagnosis, and treatment, including the warning signs that need urgent care right away.

Retinal detachment (RD) is the separation of the neurosensory retina from the retinal pigment epithelium (RPE), interrupting the metabolic support on which photoreceptors depend. Untreated, it causes progressive and permanent photoreceptor loss. Three pathological mechanisms produce distinct types: rhegmatogenous RD (RRD), the most common, caused by a full-thickness retinal break allowing fluid vitreous to pass beneath the retina; tractional RD (TRD), caused by fibrovascular membranes pulling the retina off the RPE without a break; and exudative RD, caused by fluid accumulation beneath an intact retina from choroidal or systemic disease. RRD is a surgical emergency when the macula is not yet detached , primary success rates for macula-on RRD exceed 90% with prompt repair, with excellent visual outcomes. Macula-off RRD carries a guarded visual prognosis even with successful anatomical reattachment.

Clinical Overview: Retinal Detachment

Classify on presentation: Macula-on vs macula-off (OCT or slit-lamp biomicroscopy). Macula-on: emergency surgery within 24 hours. Macula-off: urgent but not emergency.
Break location determines surgical approach: Superior breaks (10 o’clock to 2 o’clock) treated with gas tamponade and posturing. Inferior breaks (4-8 o’clock) have lower success with gas/PPV; scleral buckle or silicone oil may be preferred.
Three surgical options for RRD: Pneumatic retinopexy (PR), scleral buckle (SB), pars plana vitrectomy (PPV). PPV most widely used; scleral buckle preferred for phakic patients under 50 with superior breaks. Pneumatic retinopexy for selected phakic cases.
Gas tamponade: C3F8 (14-20% concentration) lasts 6-8 weeks; SF6 (18-25%) lasts 10-14 days. Patient must maintain strict posturing (face-down for posterior breaks). No flying until gas absorbed.
Silicone oil: Used for complex RD (inferior breaks, PVR, fellow eye at extreme risk). Requires planned removal at 3-6 months.
PVR (proliferative vitreoretinopathy): Develops in approximately 8% of RRD; the main cause of surgical failure. Risk factors: large breaks, VH, inflammation, delayed presentation.

Annual incidence ~10-15 Per 100,000 population per year

Primary success rate (PPV) 85-95% Single operation for uncomplicated RRD

Macula-on final VA >6/12 Majority of macula-on RRD achieve this

Pathophysiology and Classification

Rhegmatogenous RD (RRD) begins with a posterior vitreous detachment (PVD), which occurs as the vitreous collagen liquefies with age or in myopia. When vitreoretinal adhesions are abnormally strong (at lattice degeneration, meridional folds, encircling chorioretinal scars), a PVD can tear the retina rather than separate cleanly. The tear allows liquefied vitreous to enter the subretinal space, progressively separating the retina from the RPE. The risk is maximal where the retina is thinned by lattice degeneration , which occurs in approximately 8% of the population and confers a lifetime RD risk of approximately 1%.

Cross-section comparing normal retina with rhegmatogenous retinal detachment — RRD cross-section: subretinal fluid separating the neurosensory retina from the RPE through a full-thickness break.

Tractional RD (TRD) occurs when fibrovascular proliferative membranes contract and mechanically pull the retina off the RPE. The retina remains intact but cannot reattach without surgical membrane removal. TRD is most commonly seen in advanced proliferative diabetic retinopathy, and occasionally in sickle cell retinopathy and ROP. Unlike RRD, TRD does not extend to the ora serrata and tends to be more concave in configuration. Immediate surgery is required when the macula becomes involved.

Exudative RD occurs without breaks or traction, caused by fluid accumulation from choroidal inflammation, malignant hypertension, central serous chorioretinopathy, or uveal melanoma. The fluid shifts with patient positioning (shifting fluid sign). Treatment targets the underlying cause.

Diagnosis

Presenting symptoms and urgency triage: New onset of floaters and photopsia strongly suggests acute PVD, which may precede RD by days to weeks. Any new floaters require slit-lamp examination with scleral depression to detect peripheral breaks. A field defect or “shadow” in the vision indicates retinal detachment has already occurred. A central shadow indicates macula-off RD.

Examination: Dilated fundus examination with indirect ophthalmoscopy and scleral depression is mandatory to examine the peripheral retina. Slit-lamp biomicroscopy with a Volk lens confirms macular status. B-scan ultrasound when media opacity prevents fundal view (VH, corneal oedema). OCT of the macula , if the macula is “threatened” but not fully detached, this determines urgency.

Surgical Management

Pars plana vitrectomy (PPV): The dominant technique in most centers for primary RRD. Advantages: visualisation of all breaks, efficient use of gas tamponade, simultaneous treatment of vitreous pathology, no restriction on break location. 25G and 27G transconjunctival sutureless systems have reduced recovery time. Primary success approximately 85-95% for uncomplicated RRD.

Medical illustration of pars plana vitrectomy for retinal detachment repair — PPV for RRD: 25G transconjunctival instruments for vitrectomy, PVD induction, break sealing, and gas tamponade.

Scleral buckle (SB): An encircling or segmental explant indents the sclera to oppose the break to the RPE, while cryotherapy creates a chorioretinal adhesion. No intraocular entry. Advantages in phakic young patients: avoids induction of cataract, preserves accommodation, no lens-related complications. Better long-term results for inferior breaks in phakic patients in some series (PIVOT trial: SB vs PPV non-inferior overall, with SB better for phakic patients). Higher myopia induction than PPV.

Pneumatic retinopexy (PR): Office procedure. Intravitreal gas injection followed by cryotherapy or laser to seal the break. Requires single superior break within a 1-clock-hour arc, phakic or pseudophakic, clear media. Primary success approximately 70-80% (lower than PPV/SB). Advantage: outpatient procedure, rapid recovery, lower cataract risk. Failure requires subsequent PPV/SB , overall visual outcomes comparable in properly selected cases (PIVOT trial).

Prognosis Determinants

The single most important prognostic factor is macula status at presentation. Macula-on RRD treated within 24 hours: more than 90% achieve VA above 6/12. Macula-off RRD: final VA depends on duration of detachment. Detachment less than 24 hours: good prognosis. More than 1 week: significantly worse. After 2 weeks, photoreceptor loss is largely irreversible even with successful reattachment. Visual recovery continues for months after surgery but the ceiling is set by the duration of macular detachment.

PVR is the main cause of failure. It develops from RPE and glial cell proliferation forming contractile membranes on both retinal surfaces. PVR-C is the highest grade. Management requires repeat vitrectomy with membrane peeling, relaxing retinotomies if needed, and silicone oil tamponade. Fellow eye RD risk approximately 10% lifetime in patients with spontaneous RRD.

Prophylaxis and Fellow Eye Management

Prophylactic laser: Indicated for symptomatic retinal tears (horseshoe tears with overlying VH or subretinal fluid at the edge). Lattice degeneration alone, without tears, does not routinely require prophylactic treatment in phakic eyes. Pre-operative cataract surgery breaks: treatment of symptomatic breaks or any break in a highly myopic or monocular patient is reasonable. The evidence base for prophylaxis in asymptomatic lattice is weak , discuss rather than treat routinely.

Fellow eye examination: after RRD, examine the fellow eye carefully for breaks, lattice with vitreous traction, or early RD. In familial cases or high myopia, increased surveillance is appropriate. Discuss flying restrictions with gas tamponade: expanding gas causes acute IOP rise at altitude and patients must not fly until the gas has fully absorbed. The restriction is absolute with C3F8 (6-8 weeks), partial with SF6 (10-14 days).

Clinical Decision Points

Macula-on RRD with superior break: Emergency same-day surgery. Brief strict face-down posturing pre-operatively may slow inferior progression while arranging theatre. Every hour matters.
Macula-off RRD, duration uncertain: Proceed to surgery , even chronic macula-off RD of 3-4 weeks can achieve useful vision after successful reattachment, and the alternative is guaranteed progressive photoreceptor loss.
Inferior RRD, phakic patient: Scleral buckle is favoured over PPV by many vitreoretinal surgeons for inferior breaks in young phakic eyes , inferior gas tamponade is less effective and the lens complications of PPV matter more in younger patients. Discuss with the operating surgeon.
Bilateral RD or second eye presentation: Ask about family history (Stickler syndrome, Marfan syndrome, X-linked retinoschisis). Systemic connective tissue disease affects surgical planning and fellow eye management.
Failed primary repair, PVR developing: Pre-emptive macular sparing approach. 5-fluorouracil and LMWH infusion at time of repeat PPV reduces PVR recurrence (RT Hammersmith PISCES trial data).

Ophthalmological Emergencies

New floaters + visual field defect + photopsia , same-day slit-lamp and indirect ophthalmoscopy mandatory. This is retinal detachment until proven otherwise.
Confirmed macula-on RRD , do not discharge home. Same-day vitreoretinal referral or emergency theatre.
Known RD post-op: sudden pain, severe vision loss, hypotony , suspect choroidal hemorrhage or endophthalmitis. Emergency assessment.

Patients flying with undisclosed intraocular gas (C3F8 or SF6): the expanding gas causes acute angle-closure glaucoma at altitude. Every vitreoretinal patient requires explicit written instruction not to fly until gas has resolved, and should carry documentation for medical emergencies requiring anaesthesia (nitrous oxide is also contraindicated with intraocular gas).

Clinical Pearls: Retinal Detachment

Scleral indentation is not optional in new floaters. It will find breaks the slit-lamp misses.
Peripheral retinal breaks beyond the equator are invisible without scleral depression. Examining only to the equator with a Volk lens misses the majority of horseshoe tears responsible for RRD. Every patient presenting with new floaters requires a fully dilated 360-degree peripheral retinal examination with indirect ophthalmoscopy and scleral depression. This is a time-constrained skill that requires practice , but missing a break means missing the window to prevent detachment.
The PIVOT trial settled the PPV vs scleral buckle debate , for now, and with nuance.
PIVOT (2021) showed non-inferiority of scleral buckle versus PPV overall for primary uncomplicated RRD, with scleral buckle showing an advantage in phakic eyes and PPV in pseudophakic eyes. The study was underpowered for subgroups and excluded inferior RRD. In practice, most UK vitreoretinal units have moved to predominantly PPV, accepting the cataract risk in phakic adults in exchange for technical control and flexibility. Scleral buckle remains the technique of choice for many pediatric RDs, inferior RDs, and highly myopic young phakic patients at experienced centres.
C3F8 gas does not disappear in 2 weeks. Patients and anaesthetists both need to know this.
SF6 gas resolves in approximately 10-14 days. C3F8 (perfluoropropane) persists for 6-8 weeks. Death under general anaesthesia has occurred when nitrous oxide was used in a patient with residual intraocular gas , nitrous oxide rapidly diffuses into and expands gas bubbles, causing acute IOP rise and central retinal artery occlusion. All vitreoretinal patients should carry a written medical alert card stating the date of surgery, gas type used, and contraindication to nitrous oxide anaesthesia.

Further reading: Royal College of Ophthalmologists , Retinal Detachment Guidelines. For related vitreoretinal pathology, see posterior vitreous detachment, vitreomacular traction, and the retina subspecialty page.