Retinal detachment repair: urgent surgery, gas bubbles and recovery

The retina is the light-sensing layer at the back of the eye. When fluid gets under a tear, the retina peels away and stops working, producing floaters, flashes and a shadow or curtain that spreads across vision. The Norwich leaflet describes it as sight-threatening and needing urgent surgery.

Laser or freezing treatment can sometimes seal a tear before the retina lifts, which is a smaller procedure. Once the retina has detached, surgery is the only treatment, and delaying risks permanent loss of vision.

Surgery is often arranged within days, sometimes the same day. You will be asked not to eat or drink in case the operation can be done at short notice. Bring your medicines list, a means of getting home and, if possible, a plan for the first days when your vision will be poor.

Ask whether you are likely to need to position your head after surgery, because that affects what you pack and how you set up at home.

In vitrectomy the vitreous gel is removed from inside the eye, the tear sealed with laser or freezing and a bubble of gas or silicone oil put in to support the retina while it heals. Hull says local anaesthetic is standard and the procedure is usually a day case.

In a scleral buckle a band of silicone is stitched to the outside of the eye to push the wall toward the tear. Pneumatic retinopexy uses a gas bubble injected into the eye with freezing or laser. Combinations are possible.

Hull lists cataract formation as nearly universal after vitrectomy in people with a natural lens, repeat detachment needing further surgery, serious infection (endophthalmitis, rare) and raised eye pressure. Norfolk and Norwich mentions infection, bleeding and cataract and says a high proportion of first operations succeed, though some people need more than one. Silicone oil, if used, needs a second operation to remove it months later.

Ask the surgeon about your own chance of success, which depends on the size and duration of the detachment and whether the central retina is involved.

The gas bubble blurs vision at first. Hull says it is absorbed within up to eight weeks, drops are needed for four to six weeks, swelling settles within one to three weeks and vision may improve over up to six months or longer. Norwich says initial recovery takes two to four weeks, with stabilisation over about three months.

You may need to hold your head in a particular position, sometimes face-down, for days. Flying and high altitude are prohibited until the gas has completely gone, and you cannot drive while it is present.

• Increasing pain, loss of vision, increasing redness or discharge after surgery: contact the hospital immediately.

• New floaters, flashes or a shadow in the eye: urgent assessment.

• Wearing a gas bracelet or card: tell any anaesthetist or travel provider, because gas can expand dangerously with altitude or nitrous oxide.

• Which operation are you recommending and why?

• Will I need to position my head, and for how long?

• Will gas or silicone oil be used and when will I fly again?

• What is the chance the retina re-detaches?

Retinal detachment is an emergency, so care is arranged through hospital eye services. Private vitreoretinal surgery exists, but access to out-of-hours care and any repeat surgery should be clarified in advance. Unlike elective operations, time matters more than choice.