Retinal detachment
At a glance
Separation of the neurosensory retina from the retinal pigment epithelium. Identify rhegmatogenous, tractional or exudative mechanism and establish whether the macula is attached. Suspected acute detachment needs same-day retinal assessment.
CAVE
- Good central acuity does not exclude a macula-on detachment.
- Ask about onset and progression.
Clinical presentation
- Flashes, floaters, a peripheral curtain or field defect; central acuity falls when the macula is involved.
| Finding | Action | Timing / detail |
|---|---|---|
| Rhegmatogenous: full-thickness retinal break with subretinal fluid | Map breaks, extent and macular status; contact vitreoretinal service immediately | Macula-on threatens central vision; macula-off remains urgent, particularly with recent central loss |
| Tractional: contracting membranes elevate the retina | Assess diabetic/proliferative disease, macular threat and associated breaks | A combined tractional-rhegmatogenous detachment requires a different surgical plan |
| Exudative: fluid without a causative retinal break or traction | Investigate inflammation, vascular disease or tumour; treat the underlying cause | Do not apply routine break-directed surgery to every serous detachment |
Diagnosis & investigations
- Record acuity, RAPD, visual field symptoms, onset of central loss, lens status, prior surgery/trauma and fellow-eye history. Dilate both eyes; document break location, extent, proliferative vitreoretinopathy and macular status. OCT can resolve uncertain foveal involvement; ultrasound helps when the fundus is obscured.
- Send these findings directly to the retinal team, including whether the patient is monocular and any limitations on examination. Do not let extra imaging postpone the referral.
Differential diagnosis
- Retinoschisis, exudative or tractional detachment, choroidal detachment and vitreous opacities.
Treatment
- Agree surgical timing directly with the vitreoretinal surgeon. Macula-on versus macula-off guides priority but does not authorise routine delayed referral of macula-off cases. Buckle, vitrectomy or pneumatic retinopexy are selected by break pattern, lens, extent and ability to posture.
- Before transfer, follow the receiving team’s instructions on positioning and fasting; advise against driving with impaired vision. Treat tractional and exudative mechanisms according to their cause rather than applying a single operation to all detachments.
Follow-up
- After repair, monitor retinal attachment, IOP and complications.
- With intraocular gas, give explicit instructions about positioning, avoiding air travel and avoiding nitrous oxide until the gas has fully absorbed. The operating team determines clearance.
Risk factors & context
- Myopia, retinal breaks, trauma, previous intraocular surgery and fellow-eye detachment affect risk.
- Examine both eyes when feasible.
Complications
- Proliferative vitreoretinopathy and recurrent detachment can require further surgery.
- Final visual recovery depends in part on macular involvement and its duration.
When to refer
- Same-day retinal assessment.
- Do not delay referral to obtain nonessential tests.
References 3
- AAO · Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern ↗2025 · Initial evaluation; management; follow-up
- Royal College of Ophthalmologists · Intraocular gas and nitrous oxide safety alert ↗2018 · Intraocular gas precautions
- ASRS · Retinal Detachment ↗Patient education factsheet · accessed 20 September 2026 · Rhegmatogenous, tractional and exudative mechanisms
Adapt to the patient, local pathways and authorised product information.