Retinal Detachment: Warning Signs and Treatment

Retinal detachment is a serious eye emergency in which the light-sensitive layer at the back of the eye separates from the tissue that supplies it with oxygen and nutrients. Without prompt treatment, the detached area can lose function and permanent sight loss may occur.

The most important warning signs are a sudden increase in floaters, flashes of light, blurred vision, loss of peripheral vision or a dark curtain or shadow moving across your sight. Retinal detachment is usually painless, so the absence of pain does not make these symptoms safe to ignore.

If you develop any of these symptoms, contact NHS 111, an emergency eye department or an urgent eye-care service immediately. Do not wait for a routine optician or GP appointment, and do not wait until the next day to see whether your vision improves.

A dark curtain, shadow, missing area of vision or sudden loss of sight requires emergency assessment. Do not drive yourself if your vision is affected.

What is retinal detachment?

The retina is a thin layer of nerve tissue lining the inside of the back of the eye. It detects light and converts it into signals that travel through the optic nerve to the brain.

In the most common type of retinal detachment, a tear or hole develops in the retina. Fluid from inside the eye passes through the break and collects underneath the retina, gradually separating it from the supporting tissues below.

This separation disrupts the retina’s oxygen and nutrient supply. The longer an important part of the retina remains detached, the greater the risk that sight will not recover fully.

The macula is the small central area of the retina responsible for detailed vision used for reading, recognising faces and seeing fine detail. Doctors may describe a detachment as:

• macula-on when the central retina is still attached;
• macula-off when the detachment has already reached the macula.

When the macula is still attached, treatment is often especially urgent because surgery may preserve central vision. A macula-off detachment also needs urgent treatment, although the timing and expected recovery depend on how long the macula has been detached and other clinical findings.

What are the warning signs?

Symptoms usually affect one eye, although retinal problems can occur in both eyes at different times.

Warning signs include:

• a sudden appearance of new floaters;
• a rapid increase in existing floaters;
• a shower of small black dots;
• flashes of light, particularly at the edge of vision;
• a cobweb, ring or large moving shape in the vision;
• sudden blurred or distorted vision;
• loss of side vision;
• a dark curtain, veil or shadow moving across the field of vision;
• a fixed missing area of sight;
• sudden reduction in central vision.

The shadow may begin at the side, top or bottom of the visual field and expand as the detachment progresses. Its position does not necessarily match where the retinal tear is located.

Some people initially notice only flashes or floaters because they have a retinal tear that has not yet progressed to a detachment. Treating a tear at this stage may prevent a much larger emergency.

Our guide to eye floaters and flashes explains how new symptoms are assessed and why a dilated examination is important.

Does retinal detachment cause pain or redness?

Retinal detachment is usually painless and does not normally make the eye red. This makes it different from several other eye emergencies.

Do not assume that an eye problem is minor simply because there is no pain. Sudden painless loss of vision can be caused by retinal detachment, bleeding inside the eye, a retinal blood-vessel blockage or another condition requiring urgent assessment.

Severe eye pain, redness, nausea or halos around lights may suggest a different emergency, such as acute angle-closure glaucoma. Our guide to urgent eye symptoms explains when pain, redness and vision changes need immediate care.

What should you do if symptoms begin?

Seek urgent help immediately if:

• floaters appear suddenly or increase sharply;
• you see new flashes of light;
• a curtain, shadow or missing area appears in your vision;
• vision suddenly becomes blurred or reduced;
• symptoms begin after an eye or head injury;
• you have previously had a retinal tear or detachment.

In the UK, you can:

• contact NHS 111 by telephone or online;
• call an emergency eye department if your local service accepts direct contact;
• attend an eye casualty or A&E department where appropriate;
• contact an urgent community eye-care or optometry service if one operates locally.

If you cannot establish where to go, NHS 111 can direct you. Tell the call handler clearly that you have sudden flashes, new floaters, a curtain or shadow, or sudden loss of vision and are concerned about retinal detachment.

Do not:

• wait for symptoms to become painful;
• wait several days for a routine appointment;
• assume that resting the eye will repair the problem;
• drive when part of your visual field is missing;
• cover one eye and continue normal activities without seeking help;
• rely on an online vision test.

The NHS advises urgent assessment for sudden floaters, flashes, blurred vision or a dark curtain or shadow. Read the NHS information on retinal detachment.

Why does retinal detachment happen?

Posterior vitreous detachment and retinal tears

The centre of the eye is filled with a transparent gel called the vitreous. As people age, this gel becomes more liquid and gradually pulls away from the retina. This is called posterior vitreous detachment, or PVD.

PVD is common and usually does not cause serious damage. It can produce flashes and floaters as the vitreous moves and tugs on the retina.

Occasionally, the vitreous pulls strongly enough to tear the retina or damage a small retinal blood vessel. Fluid can then pass through the tear and begin lifting the retina away from the back of the eye.

Symptoms alone cannot reliably distinguish an uncomplicated PVD from a retinal tear or early detachment. A dilated retinal examination is therefore needed when flashes or floaters appear suddenly.

Different types of retinal detachment

There are three main types:

• Rhegmatogenous retinal detachment: the most common type, caused by a tear or hole that allows fluid underneath the retina.
• Tractional retinal detachment: scar tissue pulls the retina away from the back of the eye. This may occur with advanced diabetic eye disease and certain other retinal conditions.
• Exudative retinal detachment: fluid accumulates beneath the retina without a tear. Possible causes include inflammation, abnormal blood vessels, eye tumours and other uncommon conditions.

Treatment depends on the type. Laser alone may secure a small tear, while an established detachment usually needs surgery. Tractional and exudative detachments require treatment directed at their underlying cause as well as the retinal problem.

Who has a higher risk?

Anyone can develop a detached retina, but the risk is higher if you:

• are strongly short-sighted;
• are older, because vitreous changes become more common with age;
• have previously had cataract or another eye operation;
• have had a serious injury to the eye;
• have already had a retinal tear or detachment in one eye;
• have a close family history of retinal detachment;
• have areas of thin peripheral retina known as lattice degeneration;
• have advanced diabetic retinopathy;
• have certain inflammatory or inherited eye conditions;
• were born prematurely and developed retinopathy of prematurity.

Severe short-sightedness increases risk because the eyeball is longer and the retina may be thinner and more vulnerable to tearing.

Cataract surgery can increase lifetime risk, although the absolute risk for an individual varies. Symptoms appearing months or years after surgery still require urgent assessment.

Most retinal detachments are not caused by reading, using a computer, watching television or ordinary exercise. People should not blame themselves for causing the condition through normal daily activity.

Can an injury cause detachment?

Yes. A direct blow to the eye can create a retinal tear or other damage. Symptoms may begin immediately or develop later.

Seek urgent eye assessment after an eye injury if you develop:

• flashes or floaters;
• blurred or reduced vision;
• a curtain or shadow;
• double vision;
• significant pain;
• blood visible inside the eye;
• an irregular pupil or obvious injury.

Could the symptoms have another cause?

Flashes, floaters and blurred vision do not always mean the retina has detached. Possible alternatives include:

• an uncomplicated posterior vitreous detachment;
• migraine aura;
• bleeding into the vitreous;
• inflammation inside the eye;
• changes caused by diabetes;
• a retinal blood-vessel blockage;
• debris or deposits within the vitreous.

Migraine aura often creates shimmering zigzags, coloured patterns or a growing blind spot affecting the visual field of both eyes, even if it initially seems one-sided. It commonly develops over several minutes and resolves within an hour, sometimes with a headache.

Retinal traction more typically causes brief flashes at the edge of one eye, especially in dim light or when moving the eye. However, these descriptions overlap and should not be used to diagnose yourself.

Covering one eye and then the other may help determine whether a visual effect is present in one eye or both, but it should not delay urgent assessment.

How is retinal detachment diagnosed?

An eye clinician will ask when the symptoms began, how they have changed and whether you have relevant risk factors, previous eye surgery or an injury.

Assessment may include:

• checking vision in each eye;
• examining pupil reactions;
• measuring pressure inside the eye;
• placing dilating drops in the eyes;
• examining the vitreous and retina through a slit lamp;
• examining the far edge of the retina with specialised lenses;
• retinal photography or wide-field imaging;
• optical coherence tomography, or OCT;
• an ultrasound scan if blood or another opacity blocks the view.

Dilating drops make the pupils larger so the clinician can inspect as much of the retina as possible. The drops commonly cause blurred near vision and sensitivity to light for several hours. Take sunglasses and avoid driving yourself.

OCT produces detailed cross-sectional images of the central retina and can show whether the macula is involved. It does not always replace a careful examination of the peripheral retina, where many tears occur.

If the retina cannot be seen because of a cataract, bleeding or another obstruction, an ultrasound scan can help identify a detachment.

How are retinal tears treated?

A retinal tear or hole found before the retina has significantly detached can often be sealed with laser treatment or cryotherapy.

Laser retinopexy

Laser burns are placed around the tear. As they heal, they form a scar that attaches the retina more firmly to the tissue underneath and creates a barrier around the break.

The procedure is commonly performed using local anaesthetic drops in an outpatient clinic. A contact lens is placed on the eye to focus the laser. Patients may see bright flashes and feel mild discomfort.

The laser seal is not instantaneous. It develops over the following days, so you should continue monitoring for a new shadow, worsening floaters or reduced vision.

Cryotherapy

Cryotherapy uses a freezing probe against the outside of the eye to produce a scar around the retinal tear. Local anaesthetic is used, and the eye can be sore or swollen afterwards.

Neither treatment removes existing floaters. Their purpose is to stop fluid passing through the tear and reduce the chance of a full retinal detachment.

Laser or freezing treatment cannot always prevent detachment, particularly if another tear develops. Attend all follow-up appointments and seek help again if symptoms change.

How is a detached retina repaired?

Once fluid has collected under the retina and created a significant detachment, an operation is usually required. The surgeon chooses the procedure according to the tear’s position, the size and duration of the detachment, whether the macula is affected, the condition of the vitreous and whether previous eye surgery has taken place.

Vitrectomy

During a vitrectomy, the surgeon removes the vitreous gel that is pulling on the retina. Fluid under the retina may be drained, and laser or cryotherapy is used to seal the retinal breaks.

The eye is then filled with a temporary gas bubble or, in some cases, silicone oil. This holds the retina in position while it heals.

A gas bubble gradually dissolves and is replaced by the eye’s natural fluid. Silicone oil may remain for longer and can require another operation for removal.

Scleral buckle

A scleral buckle is a small silicone band or sponge secured around the outside of the eye. It gently indents the eye wall, bringing it closer to the retinal tear and reducing vitreous traction.

The buckle usually remains permanently unless it causes a problem. This method may be used alone or combined with vitrectomy.

Pneumatic retinopexy

For selected detachments, the surgeon may inject a gas bubble into the eye without performing a full vitrectomy. The bubble pushes the retinal break against the wall of the eye while laser or cryotherapy creates a seal.

This approach is suitable only for particular tear locations and requires strict head positioning. If it does not work, another operation may be needed.

Anaesthetic and hospital stay

Retinal surgery may be performed under local or general anaesthetic. Many patients return home on the same day, although an overnight stay may sometimes be required.

Surgery usually succeeds in reattaching the retina, but some eyes need more than one operation. Successful anatomical repair does not always restore all the vision that was lost before treatment.

What happens after surgery?

The eye may initially feel gritty, swollen or sore, and vision is commonly blurred. Eyedrops are usually prescribed to reduce inflammation and prevent infection.

Recovery instructions depend on the operation, but may include:

• wearing an eye shield at night;
• using prescribed drops exactly as directed;
• avoiding rubbing or pressing the eye;
• avoiding heavy lifting and strenuous exercise temporarily;
• keeping water, shampoo and dirt out of the eye;
• taking time away from work;
• not driving until the clinical team confirms that it is safe;
• attending follow-up appointments.

Posturing after a gas bubble

You may be asked to keep your head in a particular position for several days so that the gas bubble presses against the retinal tear. This may involve lying on one side or spending periods face down.

Follow the prescribed position rather than choosing one yourself. The correct position depends on where the retinal break is located.

Flying and anaesthesia with a gas bubble

Do not fly or travel to high altitude while a gas bubble remains in your eye. Lower atmospheric pressure can make the bubble expand, dangerously increasing pressure inside the eye and causing permanent damage.

You must also tell every doctor, dentist, paramedic and anaesthetist that you have an intraocular gas bubble. Nitrous oxide—sometimes called gas and air or laughing gas—can rapidly expand the bubble and must not be used while it remains present.

Your hospital should tell you which gas was used and approximately how long it may remain. Do not assume it has disappeared solely because vision has begun improving.

When to contact the hospital after surgery

Contact the eye department urgently if you develop:

• increasing rather than improving pain;
• worsening redness or swelling;
• sudden deterioration in vision;
• a new curtain, shadow, flashes or floaters;
• discharge from the eye;
• nausea, vomiting or severe headache with eye pain;
• an injury to the operated eye.

The NHS advises contacting the hospital or attending A&E if pain, redness or blurred vision becomes worse after retinal surgery.

Will vision return after treatment?

The outlook depends on:

• whether the macula was still attached before surgery;
• how long the retina had been detached;
• the size and location of the detachment;
• the presence of scar tissue;
• other eye conditions;
• whether the retina remains attached after surgery.

If the macula remains attached and treatment is successful, useful central vision may be preserved. When the macula has detached, vision often improves after surgery but may not return to its previous level.

Recovery can continue for several months. Vision may initially appear distorted, objects may seem smaller or larger, and depth perception can feel different if the two eyes no longer see equally well.

A cataract commonly develops or progresses after vitrectomy, especially in older adults. This may later require cataract surgery. Our guide to cataract symptoms and surgery options explains what treatment involves.

Other possible complications include:

• another retinal detachment;
• scar tissue that pulls on the retina;
• raised or reduced eye pressure;
• infection;
• bleeding inside the eye;
• double vision;
• distortion or permanent loss of part of the visual field.

If vision remains reduced, low-vision services and an eye clinic liaison officer may help with lighting, magnification, work, benefits, registration and emotional support.

Can retinal detachment be prevented?

Most age-related retinal detachments cannot be completely prevented. The most effective protection is recognising symptoms and obtaining an urgent examination while a tear may still be treatable.

You can reduce avoidable risk by:

• using appropriate eye protection for hazardous work and sport;
• attending diabetic eye screening if eligible;
• managing diabetes according to your clinical plan;
• attending retinal follow-up when advised;
• reporting new symptoms even if a previous examination was normal;
• making close relatives aware if your clinician identifies an inherited risk.

Routine eye examinations are useful, but a recent normal test does not rule out a new tear. Retinal changes can develop suddenly between appointments.

If NHS assessment is not readily accessible and you are considering private care, our guide to private ophthalmologist costs in the UK explains consultation, OCT, scan and follow-up fees. However, do not delay emergency NHS care while comparing prices or waiting for a convenient private appointment.

Frequently asked questions

Is retinal detachment always an emergency?

Yes. A suspected retinal tear or detachment requires urgent specialist assessment. The exact timing of treatment is decided by the ophthalmologist, but patients should seek help immediately when warning symptoms appear.

Can a detached retina heal by itself?

No. An established rhegmatogenous retinal detachment does not normally reattach permanently without treatment. Delaying assessment can allow the detached area to expand.

Can a retinal tear be treated without surgery?

A tear may sometimes be sealed with outpatient laser treatment or cryotherapy before a significant detachment develops. This is still an eye procedure and requires follow-up.

Are occasional longstanding floaters dangerous?

Stable floaters that have remained unchanged for a long time are often harmless. A sudden shower of floaters, rapid increase, new flashes, blurred vision or a shadow requires urgent assessment.

Can retinal detachment cause a headache?

Retinal detachment itself is usually painless and does not typically cause headache. A headache with visual patterns may suggest migraine, but sudden new visual symptoms should not automatically be attributed to migraine without appropriate assessment.

Can retinal detachment affect both eyes?

It normally occurs in one eye at a time, but people who have experienced a detachment in one eye have a higher risk in the other. Any new symptoms in either eye need prompt assessment.

Can cataract surgery cause retinal detachment?

Cataract surgery is associated with an increased risk, although most people never develop a detachment. Flashes, new floaters or a shadow after surgery require urgent assessment even if the operation was months or years ago.

Can rubbing your eyes detach the retina?

Ordinary gentle rubbing is not a typical cause. A major direct injury can cause a tear, and people with particular retinal conditions may receive individual advice about avoiding trauma.

Does screen use cause retinal detachment?

No evidence shows that ordinary computer, phone or television use causes retinal detachment. Screen use can contribute to eye strain or dryness but does not pull the retina away from the back of the eye.

Can exercise cause retinal detachment?

Normal activity does not usually cause detachment. People with a recent tear, retinal surgery or a specific high-risk condition should follow their ophthalmologist’s advice about lifting, impact sports and exercise.

How quickly does a retinal detachment progress?

Progression varies. Some detachments spread rapidly over hours, while others move more slowly. There is no safe way to predict this from symptoms at home, so urgent assessment is required.

What does the curtain symptom look like?

People describe a grey, black or dark shadow, veil or curtain blocking part of their vision. It may begin in the peripheral field and gradually spread. Any new missing area of vision should be treated as an emergency.

Will surgery restore normal vision?

Surgery can reattach the retina and often prevents further deterioration, but it cannot guarantee full restoration. Recovery is generally better when the macula remains attached and treatment occurs before extensive damage.

Can retinal detachment happen again?

Yes. The same retina can detach again, and the other eye may also be at increased risk. Seek immediate help if flashes, floaters, a shadow or sudden blurred vision returns.