Retinal detachment

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

Last reviewed: 3 Dec 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.

მადლიერება

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

რეცენზენტები

David Steel, MBBS, FRCOphth

Consultant Ophthalmologist

Sunderland Eye Infirmary

Sunderland

გაფრთხილება:

DS declares that he has no competing interests.

Michael W. Stewart, MD

Professor and Chairman of Ophthalmology

Mayo Clinic

Jacksonville

გაფრთხილება:

MWS declares that he has no competing interests.

Ron Adelman, MD, MPH, FACS

Associate Professor of Ophthalmology

Yale University School of Medicine

New Haven

Declarações

RA declares that he has no competing interests.

Scott Fraser, MD, FRCS (Ed), FRCOphth

Consultant Ophthalmologist

Sunderland Eye Infirmary

Sunderland

Declarações

SF declares that he has no competing interests.

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Principais artigos

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.Texto completo

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

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

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.Texto completo Resumo

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.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao 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

მადლიერება

რეცენზენტები

David Steel, MBBS, FRCOphth

გაფრთხილება:

Michael W. Stewart, MD

გაფრთხილება:

Ron Adelman, MD, MPH, FACS

Declarações

Scott Fraser, MD, FRCS (Ed), FRCOphth

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao 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