Retinal detachment is one of the most serious ocular conditions, occurring when the neurosensory retina—a tissue essential for vision—separates from the underlying retinal pigment epithelium, with which it is normally in close anatomical contact. This represents a major ophthalmic emergency. In such cases, the retina is unable to function properly, leading to blurred or distorted vision. If left untreated, retinal detachment can result in permanent vision loss in the affected eye.
The pathological process underlying retinal detachment is often related to changes in the vitreous—the transparent gel that fills the eyeball. With age, the vitreous tends to become more liquefied and may shift across the retinal surface without causing issues. However, in some cases, it can exert traction strong enough to tear the retina. Through this tear, vitreous fluid may seep beneath the retina, lifting it and causing the detachment.
Initial symptoms of retinal detachment are often characteristic and easily recognizable. The most common warning signs include flashes of light (photopsia), perceived as sudden flashes or flickers, especially in peripheral vision and more noticeable in dim lighting. Another frequent symptom is the sudden appearance of floaters (myodesopsias)—small black dots, specks, or threads that seem to drift across the visual field. In some cases, patients describe a shadow or “curtain” moving across their field of vision, starting from one side and gradually spreading. These symptoms may be accompanied by peripheral vision loss (often described as “tunnel vision”) or blurry vision, as if looking through a hazy filter.
The causes of retinal detachment are varied. Risk factors include high myopia, ocular trauma, inflammatory diseases such as scleritis or chorioretinitis, vascular conditions that cause fluid accumulation beneath the retina, and, less commonly, ocular tumors such as choroidal melanoma.
Rhegmatogenous retinal detachment is the most common form, caused by a retinal tear through which fluid enters the subretinal space. Tractional retinal detachment occurs when fibrovascular membranes exert traction on the retina, typically seen in proliferative diabetic retinopathy or following inflammatory processes. Finally, exudative (or serous) retinal detachment results from fluid accumulation under the retina without any retinal break, usually caused by inflammatory, vascular, or neoplastic conditions.
Retinal tears are treated with retinal laser photocoagulation, which seals the area around the break and reduces the risk of detachment. When a rhegmatogenous or tractional detachment is already present, surgical intervention is required. Surgical options vary depending on the type and extent of the detachment.