What Are Retinal Tear and Retinal Detachment?

A retinal tear is a small tear in the retinal tissue; retinal detachment happens when fluid leaking through that tear separates the retina from the tissue beneath it and lifts it out of place. Left untreated, it can cause permanent vision loss. Sudden eye floaters, flashes of light, or a curtain-like shadow spreading across your vision are the typical warning signs.

A retinal tear and retinal detachment can occur at any age, though the risk is higher with high myopia, previous eye trauma, and older age. A tear caught early can often be controlled with a limited laser procedure; once detachment has developed, surgery becomes necessary. This is a genuine emergency — any delay increases the risk of vision loss. Even without symptoms, people in a higher-risk group benefit from regular eye examinations, including a fundus (dilated eye) examination of the peripheral retina, which can help a tear be caught before it causes symptoms.

The retina lies close to the eye's jelly-like filling, the vitreous. At birth the vitreous is firmly attached to the retina, but with age the gel liquefies and gradually separates from it — a process called posterior vitreous detachment. Where the vitreous remains attached during this separation, traction can build up and create a small tear in the retina. If fluid leaks through the tear and gets beneath the retina, between it and the supporting tissue underneath (the retinal pigment epithelium), the retina lifts away — this is retinal detachment. Detachment usually starts near the edge of the retina and, untreated, tends to spread towards the centre (the macula); treatment before the macula is affected generally offers a better chance of preserving vision than treatment given afterwards, and vision loss in the affected area can become permanent as detachment progresses. This page covers rhegmatogenous retinal detachment, the type most often seen in practice; forms following injury or vitreous traction are less common, though both need the same urgent assessment.

The most typical symptoms are a sudden onset of eye floaters, flashes of light, and a curtain-like shadow starting at one edge of your vision and spreading. These usually appear suddenly and can worsen over time, so they need urgent assessment as soon as they're noticed. Retinal detachment is usually free of pain, so the absence of pain doesn't mean the situation is mild. Some patients describe it as 'a dirty, moving shadow in front of my eye' or 'part of my vision looks blacked out'. Whether one eye or both are affected, when symptoms started, and whether they're progressing all help the doctor judge urgency.

The most common cause is the vitreous separation that develops with age. High myopia, eye trauma, previous eye surgery (such as cataract surgery), and a family history of retinal detachment also raise the risk; in some cases there is no clear cause. Anyone with one of these risk factors can benefit from regular eye examinations, even without symptoms, so a possible tear is caught early. The chart below ranks these risk factors by roughly how often they appear in practice — it shows order of frequency only, not a percentage.

If you notice a sudden increase in floaters, new flashes of light, or a shadow or curtain spreading across your vision, see an ophthalmologist without delay. Retinal detachment is time-sensitive, and how early it's treated directly affects the chances of preserving vision. A few long-standing floaters that haven't increased are not usually a warning sign; a sudden increase, new flashes, or a spreading shadow always should be assessed. Even outside normal clinic hours, these symptoms should not be put off.

Diagnosis is made through a detailed retinal examination with the pupil dilated, checking the peripheral retina as well as central areas for any tear or detached area. This is a more detailed extension of the fundus (dilated eye) examination done during a standard eye examination: the doctor first asks when symptoms began and how they've progressed, then dilates the pupil with eye drops so the retina's edges can be examined closely with a special lens. If bleeding inside the vitreous blocks a direct view, ultrasound scanning may help assess whether detachment is present and roughly how extensive it is.

A limited tear caught early can often be treated with laser photocoagulation, which can prevent detachment developing. Once detachment has occurred, surgery is necessary; left untreated, vision loss in the affected area becomes permanent. Laser photocoagulation is usually a short outpatient, day-case procedure, while surgical cases may involve some restrictions afterwards and regular follow-up. When and how treatment starts depends on the detachment's size, location and duration, and varies from patient to patient — every case is assessed individually after a detailed examination.

For a retinal tear, laser photocoagulation seals the area around it, preventing fluid passing beneath the retina; it's usually a short outpatient procedure. Where detachment has developed, surgical options include vitrectomy (removing the vitreous gel) or scleral buckling (placing external support on the eye wall); some cases use pneumatic retinopexy, a gas injection that helps settle the retina back into place. Which method is used depends on the detachment's size, location and duration. After scleral buckling, patients may follow certain physical restrictions for a period; after vitrectomy, a particular head or body position (face-down, for example) may be needed until gas or silicone oil inside the eye clears. Some patients develop macular oedema after surgery, in which case intravitreal injection may be added to the treatment plan. The exact method is decided once detailed examination and imaging findings are assessed together.

Eye floaters are closely related to retinal tears; diabetic retinopathy and macular degeneration are two other retinal conditions in this same family. Intravitreal injection (anti-VEGF injections) treats some retinal conditions, such as diabetic retinopathy and macular degeneration; it isn't the primary treatment for retinal tear and detachment but may be added if an accompanying finding is present. Anyone with a retina-related concern is advised to have a detailed fundus examination as part of a routine eye examination, so both retinal tears and other retinal conditions can be caught early.

If you're experiencing a sudden increase in floaters or new flashes of light, book an appointment for a retina assessment without delay — acting quickly can help prevent possible vision loss.