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
Treatment varies depending on the condition's severity. If the retinal tear is small or the area of detachment is limited, laser photocoagulation can be applied around the tear to prevent further progression. However, the laser does not create an immediate bond; full adhesion typically takes two weeks to one month.
When detachment has progressed, surgery is required. There are two main surgical procedures.
The first is scleral buckling. In this procedure, silicone bands or sponge-like material is placed on the outer sclera to push inward, helping the detached retina reattach. It is most commonly performed on younger patients.
The second is vitrectomy. This involves removing the vitreous from inside the eye, draining fluid from beneath the retina, applying laser to the torn area, and then pressing the retina back into place using gas or silicone oil. Advances in instrument design have made the tools much thinner, reducing complications and discomfort compared to the past.
◇ Retinal Detachment Surgery Success Rate: 80–90%
The success of retinal detachment surgery is judged not by vision recovery but by whether the retina reattaches properly. "Generally, the probability of the retina reattaching with a single surgery is around 80 to 90 percent," Lee said. "However, in cases left untreated for a long time, inflammatory material or fibrous tissue can form beneath the retina, making surgery more complex. It may not be completed in a single procedure, and in fact, 10 to 20 percent of cases experience recurrence requiring reoperation."
Vision recovery depends heavily on whether the macula was affected. When the macula was not involved, patients generally have a high chance of recovering their previous vision. When the macula has detached, some degree of vision loss may remain or recovery may be limited.
After vitrectomy in which gas or silicone oil is inserted, patients must maintain a face-down position for a certain period to ensure the retina is properly pressed into place. This posture is particularly important during the first day or two after surgery; subsequent positioning may vary depending on the location of the tear.
Pain is also a significant factor. Scleral buckling involves pulling on the eye muscles, which can cause considerable pain. Vitrectomy can also cause discomfort due to elevated intraocular pressure or irritation at the surgical site. The stabilization period after surgery is generally considered to be about three months.
The most important measures for preventing retinal detachment are avoiding eye rubbing and protecting the eyes from trauma. Those with severe atopic dermatitis, those who play ball sports, and those with high myopia should be particularly careful.
Developing the habit of alternately covering each eye to check for visual field abnormalities is also helpful. Even when both eyes are open and no problem is apparent, if covering one eye reveals a blind spot or a curtain-like dark area, patients should visit a hospital immediately.
"If you are 50 or older, get a fundus examination once a year," Lee said. "A standard fundus photograph alone can miss peripheral lesions, so when necessary, it is advisable to also undergo wide-angle fundus photography or a dilated examination."
