Retinal detachment: symptoms, causes, surgery and recovery

The NHS lists three main symptom groups: floaters (dots and lines) or flashes of light in your eye, a dark curtain or shadow in your vision, and changes to your eyesight such as blurred vision. The NHS does not list pain as a symptom, so a painless change in vision still needs urgent assessment.

RNIB describes how each looks. Floaters can be black dots, rings, spiders' legs or cobwebs; most people develop some as they get older, but new floaters or a change in existing ones should be checked. Flashing lights, caused in most cases by the vitreous gel tugging on the retina, are usually brief, white and vertical and occur at the edges of your vision, and are more noticeable in dim light. A retinal detachment itself appears as a solid dark shadow moving in from the edge of your vision, and it keeps moving towards the centre if more of the retina detaches.

RNIB says you may have these symptoms and not develop a retinal detachment, but there is no way to tell what is causing them unless your eye is examined.

• New floaters, or a sudden increase in floaters

• Flashes of light in one eye

• A dark curtain or shadow moving across your vision

• Sudden blurring or other changes to your eyesight

The NHS says to get help from NHS 111 if floaters suddenly appear or suddenly increase in number, you get flashes of light in your vision, you have a dark curtain or shadow moving across your vision, or your vision gets suddenly blurred.

RNIB says it is best to have these symptoms checked as soon as possible, within 24 hours of noticing any new symptoms. You can have your eyes examined urgently by an optometrist, or attend A&E or eye casualty. If you see a dark shadow moving up, down or across your vision you must attend A&E straight away. Optometrists who find, suspect or cannot rule out a tear will refer you urgently to an ophthalmologist.

The NHS adds that if symptoms come back after treatment you should get medical help as soon as possible, because you can get a detached retina more than once.

The NHS says you will be referred to hospital for surgery if tests show your retina may be detached or has started to come away (a retinal tear). Surgery will usually stop your vision getting worse. RNIB says that after examining you, the ophthalmologist decides how quickly surgery is needed, which may be within 24 hours or within a few days, and that the sooner it is done the better the results are likely to be.

The NHS says surgery is usually done under local anaesthetic, so you are awake but your eye is numbed, and you do not normally need to stay overnight. You may be asked to lie or sit in a particular position for up to 7 days afterwards so that the retina is in the correct position to heal. RNIB says around 1 in 10 people may need more than one operation, because new tears or scar tissue can pull the retina off again.

RNIB says the most common surgery used in the UK is a vitrectomy. The type of operation depends on the type and cause of the detachment and any other eye conditions, and your ophthalmologist may combine options.

The NHS says a detached retina is usually caused by changes to the jelly inside your eye that happen as you get older, called posterior vitreous detachment (PVD). It is not clear exactly why PVD leads to retinal detachment in some people, and there is nothing you can do to prevent it.

RNIB lists three causes. Holes and tears in the retina are the commonest, letting fluid leak between the layers and lift the retina. Scar tissue, for example from diabetic retinopathy, can pull on the retina. Rarely, fluid from blood vessels behind the retina leaks because of inflammation or tumours in the eye.

The NHS says it is more likely if you are short-sighted, have had an eye operation such as cataract surgery, have had an eye injury or have a family history of retinal detachment. RNIB adds that the more short-sighted you are, the greater the risk, and that diabetic retinopathy or inflammation inside the eye also raise it.

RNIB says retinal detachments are very rare in children. If your child has an eye injury, floaters or sudden vision change, take them to an urgent eye service the same day.

Recovery time varies. The NHS gives a general guide for 2 to 6 weeks: your vision may be blurry, your eye may be sore and red (take paracetamol if you need to), you may need time off work, you may not be able to drive, and you may need to avoid flying if a gas bubble has been put into your eye. Most people are eventually able to return to all their normal activities.

RNIB explains that how well your vision recovers depends on how much of the retina detached, whether the macula (the central part used for fine detail and reading) was detached, how long it was detached and whether you have another eye condition such as diabetic retinopathy. If the macula stayed attached, results are often very good. If it detached but surgery was quick, central vision can return but may be distorted.

The NHS says to call the hospital or go to A&E if pain, redness or blurriness gets worse after surgery, as you may need further treatment.

Floaters are very common and most are harmless, but RNIB says there is no way to tell what is causing new symptoms without an eye examination. The table summarises how the symptoms are described.

On the NHS, new flashes, floaters or a curtain are assessed through an optometrist, NHS 111, eye casualty or A&E, and surgery is performed by hospital eye services. Optometrists on the high street can often be seen sooner than a hospital and refer you on.

Private ophthalmology also provides retinal surgery in some areas. The key factor is speed, so use whichever route gets you examined fastest and do not delay for a routine appointment.