Retinal detachment — where the retina tears or separates from its underlying tissue — is one of the most critical ophthalmic emergencies that can lead to blindness. Because it causes almost no pain, patients often dismiss it as simple "floaters" and delay treatment, potentially losing the window for vision recovery.
Retinal detachment is primarily caused by age-related changes in the vitreous body, but it can also occur at a relatively young age in people with high myopia, atopic dermatitis, or a history of eye trauma. If floater-like spots suddenly multiply, vision becomes obscured as if a curtain has been drawn, or flashing lights appear, patients should visit an ophthalmologist without delay.
On the Seoul Economy TV program "Right Now, Top Doctors" airing at 9:25 p.m. on the 28th, Lee Kyung-min, chief of the Retina Center at Hangil Eye Hospital and a leading specialist in retinal detachment, will discuss the causes, symptoms, treatment, and prevention of retinal detachment.
◇ A Condition Where the Retina Separates — Tears Constitute an Emergency
Retinal detachment is literally a condition in which the retina separates from the position where it should remain attached. However, not all retinal detachments are the same. Serous retinal detachment, where fluid accumulates beneath the retina due to inflammation, can improve when the underlying condition is treated and is not necessarily an emergency.
In contrast, retinal detachment caused by a hole or tear in the retina constitutes an emergency. This is especially urgent when the macula — the central area responsible for sharp vision — has not yet been affected. Missing this window allows the detachment to progress to the macula, drastically worsening the visual prognosis.
The most common cause is aging. As people age, the vitreous — a gel-like substance inside the eye — gradually liquefies. During the process of separating from the retina, it can pull on and tear the retinal tissue.
However, younger individuals are not immune. High myopia elongates the eyeball and thins the retina, making it prone to tears. Patients with atopic dermatitis who frequently rub their eyes also face elevated risk. Trauma such as being struck in the head by a soccer ball can also trigger the condition, meaning athletes are susceptible as well. While smartphone use itself does not directly cause retinal detachment, it can lead to dry eyes and irritation that prompts frequent eye rubbing — a harmful habit.
◇ Lack of Pain Can Delay Diagnosis
One of the most frightening aspects of retinal detachment is that it is painless. When detachment begins in the upper retina, gravity causes it to progress rapidly within two to three days, producing noticeable visual field loss. But detachment starting from the lower retina may show no clear symptoms until it reaches the central area.
Symptoms of retinal detachment include: △ a sudden, dramatic increase in floaters; △ the sensation of thousands of tiny fly-like spots drifting before the eye; △ frequent flashing lights; △ part of the visual field appearing blocked as if by a curtain; and △ portions of objects appearing invisible or blacked out when viewed with one eye.
"If existing floaters have only increased slightly, it may be a simple change. But if symptoms suddenly worsen, a fundus examination is essential — not only to rule out retinal detachment but also hemorrhage, inflammation, and other conditions," Lee said.
The most critical diagnostic tool for retinal detachment is a fundus examination performed after mydriasis — dilating the pupil with medication — to directly inspect the peripheral retina. Optical coherence tomography (OCT), commonly known as an eye CT scan, is useful for checking whether the macula is affected, but it alone is insufficient because retinal detachment typically begins in the periphery. Wide-angle fundus photography equipment that captures a broader view has also become helpful, but the most accurate method remains a post-dilation examination using a lens to inspect the full 360 degrees directly.
◇ Retinal Detachment Before Macular Involvement Is an Emergency
The single most important criterion in retinal detachment is whether the macula has been affected. The macula is the central part of the retina and is responsible for the majority of visual acuity.
When detachment is discovered before it reaches the macula, surgery or laser treatment can preserve a significant portion of existing vision. Once the macula has detached, however, vision may not return to its previous level even after the retina is reattached. This is why ophthalmologists regard macula-sparing retinal detachment as a quintessential emergency.
◇ Laser for Small Tears, Surgery for Advanced Detachment
