In short: a retinal detachment is when the retina, the layer at the back of the eye that senses light, lifts away from the wall of the eye. It needs checking the same day, and it usually needs surgery to put the retina back in place.
This article explains the warning signs, what to do, and the operations used to repair a detachment. To read about how a detachment happens and the risks of surgery, see the retinal detachment and tears page.
The warning signs
Look out for:
- new floaters, or a sudden shower of them, which can look like dots, lines or cobwebs
- flashes of light, often at the edge of your vision
- a dark shadow or curtain across part of your sight, often starting from the side
- blurred vision
The shadow may stay still or spread towards the centre of your vision. A detachment does not usually cause pain, so do not wait for pain before you get help.
What to do
Get your eye checked the same day. Do not wait to see whether it clears.
Call the clinic at +65 6694 0400. Outside clinic hours, call the 24-hour answering service at +65 6535 8833, or go to a hospital A&E with eye services. Do not drive yourself if your sight is affected.
Why it is urgent
The retina needs the blood supply from the wall of the eye to work. When it lifts away, it stops working properly.
The centre of the retina, the macula, gives you sharp vision for reading and recognising faces. If the macula is still attached, surgery aims to keep it that way, so treatment is arranged quickly. If the macula has already lifted away, some sight may not come back, even after the retina is back in place.
The examination
Drops widen your pupils so that Dr Chin can examine the whole retina. This shows where the breaks are, how much of the retina has lifted away, and whether the macula is involved. These findings decide which operation suits you.
The three operations
Pneumatic retinopexy
A small gas bubble is injected into the eye. The bubble presses the retina back against the wall of the eye, and the break is sealed with laser or freezing treatment. Dr Chin does this in the operating theatre.
Afterwards, you keep your head in a set position for 7 days, so that the bubble presses on the right spot. This operation suits only some detachments, usually small ones.
Scleral buckle
A soft silicone band is stitched to the outside wall of the eye. It pushes the wall of the eye inwards, against the break, and the break is sealed with freezing or laser treatment. The band usually stays in place for good. This operation is done under general anaesthesia, so you are asleep.
Vitrectomy
Three small openings are made in the white of the eye. Fine instruments remove the vitreous gel, so that it stops pulling on the retina. The retina is flattened, the breaks are sealed with laser or freezing, and the eye is filled with a gas bubble or silicone oil. This holds the retina in place while it heals.
The gas slowly disappears over the following weeks. Silicone oil does not, so it usually needs a second operation to remove it later.
Which one is used
Sometimes a buckle and a vitrectomy are combined. Which operation suits you depends on where the breaks are and the state of your eye. Most retinal surgery is day surgery. A vitrectomy is usually done under local anaesthesia, and general anaesthesia can be used where needed.
After surgery
Your sight will be blurred at first, often for two to six weeks. If a gas bubble was used, you may need to keep your head in a set position for 7 days, so that the bubble presses on the right spot.
If you have a gas bubble in your eye:
- Do not fly, or travel to high places such as mountains, until Dr Chin confirms the gas has gone. This can take several weeks.
- Tell any doctor or anaesthetist that you have gas in your eye, because an anaesthetic gas called nitrous oxide must not be used.
Flying is safe with silicone oil in the eye.
You may not be able to drive for a while. Plan to take about a month off work after detachment surgery. Avoid heavy lifting and strenuous exercise until Dr Chin says you can. Use your eye drops as you are told, and keep your follow-up appointments.
When to call after surgery
Call straight away if:
- your sight gets worse
- you have a lot of pain or swelling
- you notice new floaters, flashes or a shadow
Call the clinic at +65 6694 0400. Outside clinic hours, call the 24-hour answering service at +65 6535 8833, or go to a hospital A&E with eye services.
Related reading
- Retinal detachment and tears: how a detachment happens, and the risks of surgery
- Retinal tears and laser treatment
- Floaters and flashes: when should I be worried?