Retinal detachment

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 26 Jun 2025

Last updated: 24 Jul 2025

Retinal detachment (RD) is an acute or progressive condition in which the neuroretina separates from the retinal pigment epithelium, subretinal fluid accumulates, and retinal function is lost.

Presents as primary rhegmatogenous RD, secondary to traction, or exudative in nature.

In rhegmatogenous RD, retinal discontinuity promotes detachment.

Diagnosis usually relies on indirect ophthalmoscopy or slit-lamp exam, with B-scan ultrasonography reserved for cases with media opacity.

Left untreated, rhegmatogenous RD typically results in blindness.

Surgical treatment aims to prevent fluid accessing the subretinal space through the break and to eliminate the traction that caused the break.

If treated promptly, prognosis is generally good. Failure occurs in cases with scarring due to proliferative vitreoretinopathy (PVR).

Definition

RD is typically a progressive condition in which the neuroretina detaches from the retinal pigment epithelium. Subretinal fluid accumulates, causing temporary loss of retinal function.

In rhegmatogenous RD, the separation results from a retinal discontinuity (break, tear).[1]

Tractional RD occurs due to proliferative membranes on, or less commonly underneath, the retinal surface (subretinal strands). This usually occurs without a retinal break, although one may develop to cause a combined rhegmatogenous/tractional RD. Similarly, rhegmatogenous RD may develop a secondary tractional element.

Exudative RD develops due to the subretinal accumulation of fluid, other than that originating in the vitreous cavity. Leaking retinal blood vessels or discontinuities in the retinal pigment epithelium are the usual cause, with hemorrhagic RD mostly observed after trauma.

Retinoschisis does not qualify as a true RD because layers of the neuroretina split and fluid enters the space created. Full thickness RD can rarely complicate retinoschisis.

History and exam

Key diagnostic factors

loss or deterioration of central vision
flashes of light
loss of peripheral visual field

Full details

Other diagnostic factors

floaters

Full details

Risk factors

posterior vitreous detachment
increasing age
myopia
previous cataract surgery
trauma
previous ophthalmic surgery
intraocular tumor
vitreous hemorrhage
affected fellow eye
diabetes mellitus
retinopathy of prematurity
ocular inflammation/infection
peripheral retinal degeneration
anatomic abnormality
age-related macular degeneration
phosphodiesterase-5 inhibitor use in men
genetic and vascular causes in childhood
childhood tumors

Full details

Diagnostic tests

1st tests to order

visual acuity testing
slit-lamp exam
indirect ophthalmoscopy

Full details

Tests to consider

wide-field color photography
optical coherence tomography (affected eye)
B-scan ultrasonography (affected eye)
CT/MRI of orbit

Full details

Treatment algorithm

ACUTE

posterior vitreous detachment without break/tear

retinal hole/tear without detachment

rhegmatogenous RD

tractional RD

exudative RD

hemorrhagic RD

Contributors

Authors

Ferenc Kuhn, MD, PhD

Director of Clinical Research

Helen Keller Foundation for Research and Education

Associate Professor of Ophthalmology

University of Alabama at Birmingham

Birmingham

Consultant and Chief Vitreoretinal Surgeon

Department of Ophthalmology

University of Pécs Medical School

Pécs

Hungary

Disclosures

FK declares that he has no competing interests.

Acknowledgements

Dr Kuhn would like to gratefully acknowledge Dr Robert Morris, a previous contributor to this monograph. RM declares that he has no competing interests.

Peer reviewers

David Steel, MBBS, FRCOphth

Consultant Ophthalmologist

Sunderland Eye Infirmary

Sunderland

Disclosures

DS declares that he has no competing interests.

Michael W. Stewart, MD

Professor and Chairman of Ophthalmology

Mayo Clinic

Jacksonville

Disclosures

MWS declares that he has no competing interests.

Ron Adelman, MD, MPH, FACS

Associate Professor of Ophthalmology

Yale University School of Medicine

New Haven

Disclosures

RA declares that he has no competing interests.

Scott Fraser, MD, FRCS (Ed), FRCOphth

Consultant Ophthalmologist

Sunderland Eye Infirmary

Sunderland

Disclosures

SF declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Kim SJ, Bailey ST, Kovach JL, et al. Posterior vitreous detachment, retinal breaks, and lattice degeneration preferred practice pattern®. Ophthalmology. 2025 Apr;132(4):P163-96.Full text

American Academy of Ophthalmology. Referral of persons with possible eye diseases or injury - 2014. Apr 2014 [internet publication].Full text

Hikichi T, Trempe CL. Relationship between floaters, light flashes, or both, and complications of posterior vitreous detachment. Am J Ophthalmol. 1994;117:593-8. Abstract

Znaor L, Medic A, Binder S, et al. Pars plana vitrectomy versus scleral buckling for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst Rev. 2019 Mar 8;(3):CD009562.Full text Abstract

Sena DF, Kilian R, Liu SH, et al. Pneumatic retinopexy versus scleral buckle for repairing simple rhegmatogenous retinal detachments. Cochrane Database Syst Rev. 2021 Nov 11;(11):CD008350.Full text Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Vitreomacular traction
- Retinoschisis
- Diabetic retinopathy
More Differentials
Guidelines
- Posterior vitreous detachment, retinal breaks, and lattice degeneration preferred practice pattern®
- Retina summary benchmarks - 2024
More Guidelines
Patient information
Macular degeneration
More Patient information
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Retinal detachment

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

posterior vitreous detachment without break/tear

retinal hole/tear without detachment

rhegmatogenous RD

tractional RD

exudative RD

hemorrhagic RD

Contributors

Authors

Ferenc Kuhn, MD, PhD

Disclosures

Acknowledgements

Peer reviewers

David Steel, MBBS, FRCOphth

Disclosures

Michael W. Stewart, MD

Disclosures

Ron Adelman, MD, MPH, FACS

Disclosures

Scott Fraser, MD, FRCS (Ed), FRCOphth

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice