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Retinal detachment (detachment)
Last reviewed: 05.07.2025
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Retinal detachment is the separation of the rod and cone layer (neuroepithelium) from the retinal pigment epithelium, which is caused by the accumulation of subretinal fluid between them. Retinal detachment is accompanied by a disruption in the nutrition of the outer layers of the retina, leading to rapid vision loss.
Retinal detachment is caused by the structural features of this structure. Dystrophic processes in the retina and traction actions from the vitreous body play an important role in retinal detachment.
Symptoms of retinal detachment include loss of peripheral and central vision, often described as "blindness in the eyes." Associated symptoms include painless visual disturbances including photopsies and multiple floaters. Diagnosis is by indirect ophthalmoscopy; ultrasonography can determine the extent of retinal detachment. Immediate treatment is indicated when central vision is at risk to restore the integrity of the retinal layers. Treatment of retinal detachment includes systemic glucocorticoids, laser photocoagulation around retinal breaks, diathermy or cryotherapy of retinal breaks; scleral buckling, transconjunctival cryopexy; photocoagulation, pneumatic retinopexy; intravitreal surgery, and enucleation, depending on the cause and location of the lesion. Vision loss is reversible in the early stages of the disease; treatment is less successful with macular detachment and decreased vision.
[ What causes retinal detachment?
The following types of retinal detachment are distinguished: dystrophic, traumatic and secondary retinal detachment.
Dystrophic retinal detachment, also called primary, idiopathic, rhegmatogenous (from the Greek rhegma - rupture, breakage), occurs due to a retinal rupture, as a result of which subretinal fluid from the vitreous body penetrates under it. Rhegmatogenous retinal detachment occurs secondarily in response to a deep defect in the sensory retina, which increases the access of subretinal fluid from the liquefied vitreous body to the subregional space.
Traumatic retinal detachment develops as a result of direct trauma to the eyeball - contusion or penetrating injury.
Secondary retinal detachment is a consequence of various eye diseases: neoplasms of the choroid and retina, uveitis and retinitis, cysticercosis, vascular lesions, hemorrhages, diabetic and renal retinopathy, thrombosis of the central retinal vein and its branches, retinopathy of prematurity and sickle cell anemia, von Hippel-Lindau angiomatosis, Coats retinitis, etc.
Nonrhegmatogenous retinal detachment (detachment without break) may be caused by vitreoretinal traction (as in proliferative retinopathy of diabetes mellitus or sickle cell anemia) or by transudation of fluid into the subretinal space (eg, severe uveitis, especially in Vogt-Koyanagi-Harada syndrome or in primary or metastatic choroidal tumors).
Non-rhegmatogenous retinal detachment can be:
- traction, when the sensory retina is torn away from the pigment epithelium due to tension of the vitreoretinal membranes; the source of the subretinal fluid is unknown. The main causes include proliferative diabetic retinopathy, retinopathy of prematurity, sickle cell anemia, penetrating trauma of the posterior segment;
- exudative (serous, secondary), in which subretinal fluid from the choriocapillaries increases access to the subretinal space through damaged pigment epithelium. The main causes include choroidal tumors, exophytic retinoblastoma, Harada disease, posterior scleritis, subretinal neovascularization, and severe arterial hypertension.
The main pathogenetic factor in the development of dystrophic and traumatic retinal detachment is retinal rupture.
The causes of retinal breaks have not been fully established. However, dystrophic changes in the retina and choroid, traction effects of the vitreous body, and weakening of the connections between the photoreceptor layer of the retina and the pigment epithelium undoubtedly play a role in the pathogenesis of retinal breaks and detachment.
Among the peripheral vitreochorioretinal dystrophies, the most common forms can be conditionally identified.
According to localization, it is necessary to distinguish between equatorial, paraoral (at the dentate line) and mixed forms of peripheral vitreochorioretinal dystrophies, which are detected in 4-12% of eyes in the general population. Lattice dystrophy is considered the most dangerous in terms of the occurrence of retinal tears and detachment.
Lattice dystrophy of the retina is usually located equatorially or anterior to the equator of the eyeball. Its characteristic feature is a network of intertwined white lines (obliterated retinal vessels), between which areas of thinning, retinal tears and vitreoretinal adhesions are detected. As lattice dystrophy progresses, not only perforated but also valvular and large atypical breaks can form along the entire length of the affected area ("giant" breaks). The favorite localization is the upper outer quadrant of the fundus, but circular variants of lattice dystrophy are also encountered.
Rhegmatogenous retinal detachment refers to the presence of a retinal tear. It most often occurs in myopia, after cataract surgery, or after eye trauma.
Symptoms of Retinal Detachment
Retinal detachment is painless. Early symptoms of retinal detachment may include dark or irregular floaters in the vitreous, photopsia, and blurred vision. As the detachment progresses, the patient notices a "curtain" or "veil" in front of the vision. If the macula is involved, central vision is significantly reduced.
Diagnosis of retinal detachment
Direct ophthalmoscopy may demonstrate an irregular retinal surface and a bleb-like elevation with darkened retinal vessels. Retinal detachment is suggested by symptoms and ophthalmoscopy findings. Indirect ophthalmoscopy with scleral indentation is used to detect peripheral tears and detachment.
If vitreous hemorrhage from a retinal break prevents visualization of the retina, retinal detachment should be suspected and scanning ultrasonography should be performed.
What do need to examine?
How to examine?
Treatment of retinal detachment
In the presence of retinal tears, retinal detachments may spread without treatment, involving the entire retina. Any patient with suspected or confirmed retinal detachment should be promptly evaluated by an ophthalmologist.
Rhegmatogenous retinal detachment is treated by laser, cryocoagulation, or diathermocoagulation of the tear. Scleral buckling may be performed, during which fluid is drained from the subretinal space. Anterior retinal tears without detachment may be blocked by transconjunctival cryopexy; posterior tears by photocoagulation. More than 90% of rhegmatogenous detachments can be treated surgically with achievement of their adhesion. If the tears occur in the superior 2/3 of the eye, simple detachments may be treated by pneumatic retinopexy (an outpatient procedure).
Nonrhegmatogenous retinal detachments due to vitreoretinal traction may be treated with vitrectomy; transudative detachments in uveitis may respond to systemic glucocorticoids. Primary choroidal tumors (malignant melanomas) may require enucleation, although radiation therapy and local resection are sometimes used; choroidal hemangiomas may respond to local photocoagulation. Metastatic choroidal tumors, most commonly from the breast, lung, or gastrointestinal tract, may respond well to radiation therapy.