New flashes, a sudden increase in floaters, or a shadow or curtain can each signal a retinal tear or detachment. Follow the urgent assessment advice above even if you have only one symptom.
None of these changes should wait.
Retinal tears
and detachment
A retinal tear is a break in the retina; a detachment is the retina lifting away from the wall of the eye. New flashes, a shower of floaters or a spreading shadow need same-day assessment. Tears can often be sealed with laser; a detachment needs an operation.
Which symptoms need same-day attention?
A sudden shower of new floaters, new flashes of light, or a shadow or curtain spreading across your vision may mean a retinal tear or detachment.
Phone Vision Eye Institute the same day so the team can arrange prompt assessment. Do not wait for a routine appointment or a web form. If the clinic is closed or the change is severe and sudden, attend your nearest emergency department.
Call 02 9424 9999A tear can often be sealed with laser in the clinic. Once the retina detaches, an operation is needed, and timing matters, especially before the centre of the retina, the macula, is involved.
Further reading
Why does myopia increase the risk of retinal detachment and myopic macular degeneration?
What are a retinal tear and a retinal detachment?
The retina is the thin light-sensing layer lining the back of the eye. The vitreous, the clear gel that fills the eye, sits against it.
With age the vitreous gel shrinks and separates from the retina, a normal event called posterior vitreous detachment. Usually it causes some floaters and settles. Occasionally the gel pulls hard enough to tear the retina. Fluid can then pass through the tear and lift the retina away from the wall of the eye: a retinal detachment. A detached retina cannot work, so vision is lost in the area affected, and the detachment tends to spread.
Short-sighted eyes, eyes that have had cataract surgery or an injury, and people with a family history of detachment are at higher risk, but it can happen to anyone.
The vitreous gel can pull away from the retina and cause floaters. Occasionally this pulling causes a retinal tear.
The retina lies against the wall of the eye.
1. Gel pulls on the retina. 2. A tear opens. 3. Fluid lifts the retina.
When the retina lifts away. A tear can allow fluid to pass beneath the retina. This simplified diagram compares an attached retina with a retinal detachment.
- A tear is a small break; a detachment is the retina lifting away
- Tears can often be sealed with laser in the clinic
- A detachment needs an operation
- Same-day contact for new flashes, a shower of floaters or a shadow
- Higher risk with short-sightedness, previous surgery or injury
What are the symptoms of a retinal detachment?
ClearWith detachment
A shadow or curtain
A dark shadow that starts at one edge and spreads across the vision, like a curtain being drawn, is the classic sign of a detachment.
ClearWith flashes
Flashes of light
In a dark room a brief arc of light sweeps down the far edge of vision, with a few sparkles on it, like a camera flash or distant lightning. It comes from the gel tugging on the retina and is most noticeable at night or when the eye moves.
ClearWith floaters
A shower of floaters
A sudden burst of many new floaters, sometimes with a haze like smoke or cobwebs, can mean a tear has bled. A single long-standing floater is different from a sudden shower.
How is a retinal tear found?
The whole retina is examined through a dilated pupil, out to its far edge.
After drops to enlarge the pupil, the retina is examined with bright lights and lenses, sometimes with gentle pressure on the eyelid to bring the far edge into view. An ultrasound scan is used if bleeding hides the view, and an OCT scan (optical coherence tomography, a light-based scan of the retina) shows whether the macula is still attached. The examination takes time and can feel bright, but it is not painful.
Dr Chen decides on the spot whether laser in the clinic will do, or whether surgery needs to be arranged.
What should I bring?
- Someone to drive you home
- Sunglasses for afterwards
- Ask the clinic whether to eat or drink before you arrive, in case surgery follows the same day
- A list of medications, including blood thinners
How are retinal tears and detachments treated?
Laser for a tear
If the retina has torn but not detached, laser spots are placed around the tear in the clinic to seal it to the wall of the eye. The eye is numbed with drops; it takes minutes and you go home afterwards. Freezing treatment (cryotherapy) is an alternative for some tears.
Laser spots are placed around a retinal tear while the retina is still attached.
Freezing treatment is an alternative for some retinal tears.
Vitrectomy for a detachment
The most common operation for a detached retina. Vitrectomy means removing the vitreous gel: through tiny openings, the gel is removed, the retina is flattened, the tear is sealed with laser, and the eye is filled with a gas bubble or, in some cases, silicone oil to hold the retina in place while it heals. Dr Chen performs this surgery under local or general anaesthetic, usually as day surgery.
What other operations are used?
For some detachments a scleral buckle, a silicone band placed around the outside of the eye, or a gas bubble injected in the clinic (pneumatic retinopexy) is more suitable. The choice depends on the type of detachment, the eye and the person, and is explained before surgery.
What technology is used to repair a retinal detachment?
Dr Chen repairs retinal detachments with the Alcon UNITY Vitreoretinal Cataract System (VCS) through tiny self-sealing openings. ZEISS RESIGHT wide-angle viewing lets him find and seal every tear, including those at the far edge of the retina.
How quickly can retinal detachment surgery be arranged?
Often quickly: Dr Chen’s clinic (level 3) and the day surgery (level 4) are in the same building, so surgery can sometimes happen on the day of assessment when a theatre, anaesthetist and nursing team are available. This cannot be guaranteed.
About the technology in Dr Chen’s practiceWhat is recovery like after retinal detachment surgery?
Recovery is measured in weeks, and a gas bubble changes what you can do for a while.
- Posturing. When gas is used you may be asked to hold a particular head position for much of the day for several days, so the bubble presses on the right part of the retina. The team explains the position and for how long.
- Vision with a bubble. Vision is very poor while the bubble is present and clears as the gas absorbs over weeks.
- No flying or altitude. Gas in the eye expands with altitude and can raise the pressure dangerously. Tell any anaesthetist about the gas before other surgery.
- Drops and care. Drops for several weeks; avoid rubbing the eye, swimming and heavy lifting for the period advised.
- Cataract. A cataract commonly develops or advances after vitrectomy, and is planned for as part of the whole-eye view.
What are the risks of retinal detachment surgery?
The retina can re-detach and further surgery is sometimes needed. How much vision returns depends on how much of the retina, and particularly the macula, was affected and for how long; some distortion or a blind area can remain. These points are discussed candidly before surgery.
What should I ask Dr Chen about retinal detachment?
- Is this a tear or a detachment, and is the macula involved?
- Which treatment do you recommend for my eye, and why that one?
- What will my vision be like while the gas bubble is present, and for how long?
- What head position do I need to keep, and for how many days?
- When can I fly, drive and return to work?
- What are the warning signs that the retina has detached again?
- What does this mean for my other eye?
Questions about retinal tears and detachment
Recognising a problem
I have had floaters for years. Is that a detachment?
Long-standing, stable floaters are usually harmless. The concern is change: a sudden shower of new floaters, new flashes, or a shadow. Those need same-day contact.
How urgent is urgent?
Seek assessment the same day. A tear may be treatable with laser before the retina detaches. Most detachments caused by a retinal break need an operation, with timing guided by the examination. Phone rather than wait for a routine appointment.
Can a retinal detachment happen without pain?
Yes. Retinal detachment is usually painless. A new curtain, shadow, shower of floaters or sudden loss of vision needs urgent assessment even when the eye feels comfortable. Call for same-day advice rather than waiting for a routine appointment.
Retinal tears and laser treatment
What is the difference between a retinal tear and a detachment?
A tear is a break in the retina. A detachment occurs when the retina lifts away from the tissue beneath it, often after fluid passes through a tear. Treating a tear while the retina is still attached can reduce the risk of a detachment.
Does every retinal tear need treatment?
A new tear associated with flashes or floaters often needs prompt treatment. Some longstanding tears or small retinal holes have a lower risk and can be monitored. Dr Chen makes this decision after examining the retina; do not wait for symptoms to settle before seeking assessment.
What does laser treatment for a retinal tear feel like?
Numbing drops are used, and you will see bright flashes of light. Some people feel brief sharp sensations, an ache or pressure. Tell Dr Chen if you are uncomfortable so the treatment can be paused or adjusted. Freezing treatment is another option for some tears.
What should I expect after laser treatment?
Vision can be dazzled or blurred for several hours, so arrange transport home and do not drive that day. Dr Chen will advise when to resume exercise and other activities. A follow-up examination checks the treated area; occasionally more laser is needed.
Will laser treatment remove my floaters?
No. Laser around a retinal tear is intended to reduce the risk of detachment; it does not remove the floaters in the vitreous gel. A sudden increase in floaters, new flashes or a shadow still needs urgent assessment, even after treatment.
Can another tear develop after successful treatment?
Yes. Laser treats the identified break, but it cannot prevent a separate tear elsewhere. Attend the recommended reviews and seek same-day advice for new warning symptoms. The other eye is also checked because it may share similar risk factors.
Retinal detachment and recovery
Does a retinal detachment always require surgery?
Most detachments caused by a retinal break need an operation to reattach the retina. A small, localised detachment can sometimes be contained with laser. Other forms, caused by scarring or leaking fluid, need treatment directed at the cause. Dr Chen will explain the approach appropriate to your eye.
Does a retinal detachment mean I will lose my sight?
Not necessarily. Prompt treatment can preserve useful vision. Recovery depends particularly on whether the macula — the centre used for reading and fine detail — has detached, and for how long. Even when the retina is successfully reattached, vision may not return completely to its previous level.
Can the retina detach again after surgery?
Yes. A new break or scar tissue can cause another detachment, and some eyes need more than one operation. Keep your follow-up appointments and contact the clinic promptly if vision worsens or a new shadow develops.
Will I need a general anaesthetic?
Many retinal operations are done under local anaesthetic with sedation. A general anaesthetic is used when it suits the person or the operation. The choice is made with you and the anaesthetist.
How long is the recovery?
Vision is poor while a gas bubble is present and clears over weeks as the gas absorbs. Most people need time off work, longer for physical jobs. Head positioning, drops and reviews are explained before you go home.
Can it happen in the other eye?
The other eye is at higher risk, so it is examined too and any weak areas may be treated with laser. Knowing the warning signs matters for both eyes.
Independent patient information: ASRS: retinal tears · National Eye Institute: retinal detachment.
Where can I read more?
Longer articles by Dr Chen go into these questions in more detail, including what the research shows.
How do I make an appointment with Dr Chen to discuss a retinal tear or detachment?
Appointments and enquiries are made through Vision Eye Institute Chatswood.
Level 3, 270 Victoria Avenue, Chatswood NSW 2067For referrers
Optometrists, GPs and ophthalmologists can refer through Oculo or with the PDF referral form.
Vision Eye Institute confirms your appointment after you submit your request. The request form is not for emergencies. A referral is not strictly essential to request an appointment, but you need a valid one to claim a Medicare rebate for your consultation.