The retina is a thin, light-sensitive layer lining the inside of the eye — roughly the thickness of a piece of cling film. When it tears and fluid seeps underneath, lifting it away from the supporting tissue beneath, the result is a retinal detachment. Without prompt surgical repair, the detached retina loses its blood supply and photoreceptors begin to die — irreversibly. This is why retinal detachment is classified as a surgical emergency and not a condition that can safely wait for a routine appointment.
The good news is that modern vitreoretinal surgery achieves anatomical success — reattachment of the retina — in over 95% of cases. Visual outcomes depend primarily on whether the central retina (the macula) was involved before surgery, and how quickly the patient received treatment.
Three Warning Signs You Must Not Ignore
Retinal detachment does not cause pain. Instead, it announces itself through visual phenomena that are distinctive once you know what to look for. Any one of these three symptoms — especially in combination — warrants emergency assessment on the same day.
Emergency — seek same-day assessment
- A sudden shower of new floaters — dozens of spots, cobwebs, or a cloud of dark specks appearing at once, especially if unlike floaters you have had before
- Flashing lights (photopsia) — repeated flickers or arcs of light, typically at the peripheral vision, often worse in a dark room or when moving the eye
- A shadow, curtain, or dark veil — a dark area obscuring part of the visual field, often described as a curtain being drawn across from the side. This is the retinal detachment itself advancing
Floaters and flashes alone — without the curtain — are often caused by a posterior vitreous detachment (PVD), which is usually benign. But because a PVD can cause a retinal tear in around 10–15% of cases, and a tear can rapidly progress to detachment, these symptoms always warrant prompt dilated examination within 24 hours.
"The shadow or curtain of a retinal detachment moves towards central vision. Once the macula detaches, the prognosis for sharp central sight is permanently diminished — even with successful surgery. Speed is not optional."
— Dr. Chee Wai WongWho Is at Risk
Rhegmatogenous retinal detachment — the most common type, caused by a break or tear in the retina — does not discriminate, but certain groups face substantially higher risk.
- Age 50–70 — posterior vitreous detachment becomes near-universal in this age group, and PVD is the mechanism behind most retinal tears
- High myopia (above 500°, or –5.00 dioptres) — myopic eyes are longer, with thinner, more stretched retinas that are more prone to tears, particularly at the periphery
- Previous cataract surgery — the risk of retinal detachment increases modestly after uncomplicated phacoemulsification, and more substantially after complicated surgery
- Family history — a first-degree relative with retinal detachment increases personal risk two- to three-fold
- Previous retinal detachment in the fellow eye — approximately 10–15% of patients with a unilateral detachment will eventually develop one in the other eye
- Trauma — blunt ocular trauma can cause dialysis (peripheral tear at the vitreous base) or direct retinal breaks
- Lattice degeneration — a thinning of the peripheral retina present in around 8–10% of the population; most cases are asymptomatic but this predisposes to tears
>95%
Anatomical reattachment success rate with modern vitreoretinal surgery
Visual outcome depends critically on whether the macula detached before repair
Three Surgical Options
The choice of surgical approach depends on the location and number of breaks, the extent of detachment, the presence of vitreoretinal proliferation, the patient's lens status, and the surgeon's experience. All three techniques aim to seal the retinal break and allow the retina to reattach.
Scleral Buckling
A silicone band or sponge is sutured to the outside of the eye, indenting the scleral wall to relieve vitreoretinal traction at the site of the break and bring the wall of the eye into contact with the detached retina. Cryotherapy is applied to the tear to create a permanent adhesion. This technique has been used for decades and achieves primary reattachment in 85–90% of appropriately selected cases. It avoids entering the eye and preserves the crystalline lens in young patients — an important consideration in those under 40. It is particularly well suited to simple inferior detachments with a single peripheral break.
Vitrectomy (Pars Plana Vitrectomy)
The vitreous gel is removed through three small ports in the sclera, the subretinal fluid is drained internally, and the break is treated with laser photocoagulation. The eye is then filled with a gas bubble (or silicone oil for complex cases) that acts as a tamponade, pushing the retina flat against the wall of the eye while the laser adhesion heals. Vitrectomy offers direct visualisation of the retina and can address multiple breaks, posterior tears, and proliferative vitreoretinopathy (PVR) — a complication of long-standing or complex detachments. It has become the dominant surgical approach at most specialist centres.
Combined Scleral Buckle and Vitrectomy
For complex detachments — particularly those with inferior breaks, PVR, or extensive detachment — combining both techniques provides maximal anatomical support. The buckle provides permanent peripheral support while the vitrectomy addresses posterior pathology. This approach is also used for cases where recurrent detachment has occurred after a primary repair attempt.
Gas bubble and flying
If a gas bubble is used during surgery, patients must not travel by air until the bubble has fully absorbed — typically 6–10 weeks for long-acting gases (C3F8). The bubble expands at altitude, causing a dangerous pressure rise inside the eye. Before any air travel post-operatively, patients must confirm the bubble has cleared with their surgeon.
Outcomes: Macula-On vs Macula-Off
The most important determinant of visual outcome is whether the macula — the central retina responsible for reading vision and fine detail — was involved in the detachment before surgery.
On
Macula-on detachment
Central retina intact at time of surgery. Visual outcomes are excellent — most patients return to pre-detachment acuity. Surgery within 24 hours is ideal to prevent progression to macula-off.
Off
Macula-off detachment
Central retina has detached. Visual recovery is unpredictable and often incomplete. Duration of macular detachment is critical — the longer it has been off, the less recovery is possible even after successful reattachment.
PVR
Proliferative vitreoretinopathy
Scar tissue forming on the retinal surface, causing rigid folds. The most common cause of failed retinal detachment repair. Requires complex revision surgery, often with silicone oil.
>95%
Primary success rate
Overall anatomical reattachment with a single operation at specialist centres. A small proportion require a second procedure to achieve final reattachment.
Other factors affecting visual prognosis include the patient's pre-operative visual acuity, the duration of detachment (particularly macular detachment), the height of the detachment, and the presence of PVR. Age plays a role in photoreceptor recovery — younger patients tend to recover better from macular detachment.
Recovery: What to Expect
Recovery after retinal detachment surgery is more demanding than many elective eye procedures, particularly when a gas bubble is used for tamponade.
Positioning requirement (gas bubble cases)
Patients must maintain a specified head position — typically face-down or to one side — for 5–14 days after surgery. The position keeps the gas bubble pressing against the treated area. This is the most challenging aspect of recovery and requires practical preparation in advance.
Initial vision
Vision is very poor immediately after surgery due to the gas bubble filling the visual field. As the bubble gradually absorbs over several weeks, a watery interface appears and eventually clears. Do not judge the visual outcome until the bubble has fully gone.
Eye drops
Antibiotic and anti-inflammatory drops are typically used for 4–6 weeks post-operatively. In some cases, pressure-lowering drops are also prescribed if intraocular pressure rises after gas injection.
Activity restrictions
Strenuous exercise and heavy lifting should be avoided for 4–6 weeks. No air travel until the gas bubble has fully resolved. Driving restrictions apply until visual acuity meets legal requirements and the surgeon has confirmed it is safe.
Spectacle update
Refraction changes substantially after vitrectomy and scleral buckling. A new spectacle prescription should be sought 6–8 weeks after surgery, once the eye has stabilised.
Post-operative red flags — return immediately
- Sudden increase in pain not controlled by paracetamol
- Vision deteriorating rapidly after initial improvement
- Increasing redness, discharge, or photophobia
- New shadow or curtain appearing in the visual field
Frequently Asked Questions
Can a retinal detachment fix itself without surgery?
No. A true rhegmatogenous retinal detachment (caused by a tear) will not resolve spontaneously. The only exceptions are certain limited tractional or exudative detachments which may be managed non-surgically, but these are distinct from the common tear-related variety. If you have been told you have a retinal detachment, surgery is required.
How long can I wait before having surgery?
If the macula is still attached (macula-on detachment), the priority is extreme urgency — ideally within 24 hours to prevent the detachment from advancing into the macula. If the macula is already off, the situation remains urgent because ongoing photoreceptor loss occurs the longer the detachment persists, but the absolute emergency is somewhat less acute. Either way, the answer is: do not wait. Contact your vitreoretinal surgeon immediately.
Will my vision return to normal after surgery?
For macula-on detachments repaired promptly, the majority of patients return to near pre-operative visual acuity. For macula-off detachments, recovery is variable and often incomplete. Most improvement occurs within the first 3–6 months, with some continuing up to 12 months. It is important to set realistic expectations — the goal of surgery is to prevent further permanent loss, and any meaningful visual recovery is a bonus.
What is the risk to my other eye?
The fellow eye should be examined by a vitreoretinal specialist following any retinal detachment. Peripheral retinal tears, lattice degeneration, or other predisposing lesions can be prophylactically treated with laser to reduce the risk of a second detachment. The fellow eye risk varies from approximately 5–15% depending on the underlying aetiology.
Can retinal tears be treated before they cause a detachment?
Yes — and this is one of the most important preventive interventions in ophthalmology. Symptomatic retinal tears (those causing floaters and flashes) are treated with laser photocoagulation or cryotherapy to create a chorioretinal adhesion around the break, preventing fluid from tracking underneath and causing a detachment. Treatment is straightforward, performed in clinic without anaesthetic, and highly effective at preventing detachment in symptomatic tears.
Is retinal detachment surgery painful?
Retinal detachment surgery is performed under local or general anaesthesia, so you should not feel pain during the procedure. After surgery, you may experience mild discomfort, soreness, and sensitivity to light, which typically improves within a few days with prescribed eye drops and simple pain relief.
How long does it take to recover from retinal detachment surgery?
Recovery time varies depending on the type of surgery. After scleral buckling, most patients return to light activities within one to two weeks. After vitrectomy with a gas bubble, full visual recovery typically takes three to six months, and you may need to maintain specific head positioning for one to two weeks.
Can retinal detachment happen again after surgery?
Yes, recurrence is possible, though not common. The overall success rate for retinal reattachment is over 95% across all procedures. The most common reason for re-detachment is proliferative vitreoretinopathy (PVR), where scar tissue forms on the retinal surface. If re-detachment occurs, further surgery can usually be performed.
What is the success rate of retinal detachment surgery?
The retina can be successfully reattached in over 95–97% of cases when all procedures are considered. For straightforward cases treated with scleral buckling, the primary success rate is about 88–89% with a single operation. If the initial surgery does not succeed, additional procedures almost always achieve reattachment.
Can I fly after retinal detachment surgery?
If a gas bubble was used during your vitrectomy, you must not fly or travel to high altitudes until the gas has fully absorbed. This typically takes two to eight weeks depending on the type of gas used. Flying with a gas bubble in your eye can cause dangerous increases in eye pressure. Your surgeon will confirm when it is safe to fly.
Does retinal detachment cause permanent vision loss?
Visual outcomes depend largely on whether the macula was detached at the time of surgery. If the macula was still attached ("macula on"), visual outcomes are generally excellent. If the macula was detached, some degree of permanent vision reduction is expected, though surgery can still preserve and improve peripheral vision and prevent complete blindness.
Research by Dr. Wong
Selected peer-reviewed publications by Dr. Wong on retinal detachment surgery and outcomes.
- 25-year trends in surgical outcomes of giant retinal tear–associated rhegmatogenous retinal detachment · Scientific Reports · 2020
- Pediatric retinal detachment in an Asian population with high myopia: clinical characteristics, surgical outcomes, and prognostic factors · Retina · 2019
- Scleral buckling versus vitrectomy for macula-off primary rhegmatogenous retinal detachment: a comparison of visual outcomes · Retina · 2015
- Trends and factors related to outcomes for primary rhegmatogenous retinal detachment surgery in a large Asian tertiary eye centre · Retina · 2014