Retinal Detachment

Get help the same day if you suddenly have:

• A lot of new floaters: dots, cobwebs or squiggly lines floating across your vision [1][2]
• Flashes of light, like lightning streaks at the side of your vision, especially in the dark
• A dark shadow or curtain coming in from the side, top or bottom of your vision
• Sudden blurred vision in one eye

Cover each eye in turn to check. The good eye can hide the problem in the other eye.

If you have had retinal surgery before and these signs come back, go to Emergency the same day too. A retina can detach again [2].

The retina is a thin layer of nerve tissue lining the back of the eye. It works like the film in a camera: it picks up light and sends pictures to the brain.

In a retinal detachment, the retina lifts away from the wall of the eye. A detached retina cannot work properly, so the part of your vision it controls goes dark. Without treatment, the whole retina can come off and the eye can go blind.

Image to add

Simple diagram of the eye showing a tear in the retina and fluid going underneath it, lifting the retina away from the back wall of the eye. Alt text: "Diagram of the eye showing a retinal tear with fluid passing through it and lifting the retina off the back of the eye."

Floaters and flashes are not always a detachment. Many people get floaters as they get older, when the clear jelly inside the eye (the vitreous) shrinks and pulls away from the retina. This is called a posterior vitreous detachment (PVD) and is usually harmless. But sometimes the jelly tugs hard enough to tear the retina [3]. Only an eye examination can tell the difference, so new symptoms always need a check.

What causes it?

The most common type starts with a tear or hole in the retina. Fluid from inside the eye passes through the tear and gets underneath the retina, lifting it off, like wallpaper peeling off a damp wall. Tears usually happen when the vitreous jelly pulls on the retina as it shrinks with age [3].

Less common types are caused by scar tissue pulling on the retina (for example, in advanced diabetic eye disease), or by fluid leaking under the retina from inflammation or a tumour [1].

Anyone can get a retinal detachment, but your risk is higher if you:

• are short-sighted (myopia), especially if it is strong [1][2]
• are older, usually over 50, when the jelly in the eye starts to pull away (PVD) [3]
• have had eye surgery before, such as cataract surgery [2]
• have had an eye injury, such as a blow to the eye [1][2]
• have a family history of retinal detachment [1][2]
• have had a retinal detachment in your other eye before [1]
• have thin, weak areas in the retina (such as lattice degeneration) found at an eye check [1][3]
• have advanced diabetic eye disease [1]

You cannot tell for sure at home. The doctor will:

• check your vision
• put in eye drops to make your pupils big (dilate them). These can blur your vision for a few hours, so do not drive yourself home
• look at the whole retina with a bright light and a special lens
• sometimes do an ultrasound scan of the eye, if blood or a cataract is blocking the view

The check is not painful, though the light is bright.

What can happen?

• If treated early, most retinas can be put back in place with surgery.
• The macula is the small centre of the retina used for reading, faces and fine detail. If the macula is still attached ("macula-on"), treatment is very urgent, to stop it coming off. The chance of keeping good central vision is better.
• If the macula has already come off ("macula-off"), surgery is still needed soon, but central vision may not fully come back, even when the operation works.
• Without treatment, the eye can go permanently blind.

This is why we say: the sooner, the better.

Treatment depends on what is found [2][3].

A retinal tear (retina not yet detached)

• Laser or freezing treatment (cryotherapy) around the tear makes a scar that "spot-welds" the retina in place. This is usually quick, done in the clinic, and can stop a detachment from happening [3].

A retinal detachment needs an operation, usually within days, and sooner if the macula is still attached. The main types are:

1. Pneumatic retinopexy: a small gas bubble is injected into the eye to push the retina back, together with laser or freezing treatment to seal the tear.
2. Scleral buckle: a soft band is stitched onto the outside wall of the eye to push it in against the tear. It usually stays in for life and cannot be seen.
3. Vitrectomy: the jelly inside the eye is removed and replaced with a gas bubble or silicone oil that holds the retina in place while it heals. Silicone oil needs a second operation later to remove it.

Sometimes more than one operation is needed.

If you have a gas bubble in your eye

• Posturing: you may need to keep your head in a certain position (for example, face down) for several days, so the bubble presses on the right spot [2].
• Do not fly, and avoid high places such as mountain travel, until your eye doctor says the bubble has gone. The bubble can expand and raise the eye pressure dangerously [2][4].
• No nitrous oxide ("laughing gas", Entonox), including during other operations or in labour. It can make the bubble expand quickly and cause permanent loss of sight [4]. Tell any doctor, dentist or midwife that you have gas in your eye, and keep any warning card or wristband you are given.
• Your vision will be very blurry until the gas slowly goes away, often over a few weeks. You must not drive during this time.

Not all retinal detachments can be prevented, but you can prevent loss of sight by acting fast:

• Know the warning signs (new floaters, flashes, a shadow or curtain, sudden blur) and go to Emergency the same day.
• If you are very short-sighted, have had eye surgery, or have a family history, have regular eye checks and know the signs.
• After a PVD, go back for a check if you get new symptoms, even if your first check was normal [3].
• Protect your eyes with goggles during sports, DIY and work with tools.
• If you have diabetes, keep it under control and attend your eye screening.

Where to get help in Brunei

For sudden floaters, flashes, a shadow or sudden blur, go to the hospital Emergency Department now. Do not wait for a clinic appointment.

For less urgent eye problems, you can walk in to a Community Eye Clinic at your health centre. No referral is needed.