Retinal detachment is often preceded by a posterior vitreous detachment and the following are symptoms of posterior vitreous detachment [7]:

• Photopsia (flashes of light often very brief in the extreme peripheral part of vision)
• A sharp upsurge in the number of floaters
• Slight feeling of heaviness in the eye

Most cases of posterior vitreous detachments don’t progress to retinal detachments but when progression occurs, the following symptoms are often seen:

• Dense shadow beginning from the peripheral vision and slowly progressing towards central vision. 
• The impression of a curtain or veil being drawn over the field of vision.
• Positive Amsler grid test (straight lines suddenly appearing curved).
• Central visual loss.

As soon as an appearance of sudden flashes of light or floaters is seen or any kind of vision loss is recorded adequate consultations must be made as this is an emergency.

• Blurred Vision

  These symptoms may be accompanied by blurred vision, reduced peripheral or side vision and the sensation that there is a curtain coming down over your visual field from the top or side. [avceyes.com]

  When this happens, you may see flashes of light (usually on a side of the eye), or an increase in floaters (pigmented or clear spots that obscure the vision temporarily and look like cobwebs or insects), shadows, or blurred vision. [magrudereye.com]

  Abstract A 24-year-old healthy male presented with a chief complaint of blurred vision in the right eye for 1-week. Fundus examination indicated right exudative retinal detachment and choroidal ischemia. [ncbi.nlm.nih.gov]

• Photopsia

  Early symptoms of rhegmatogenous detachment may include dark or irregular vitreous floaters (particularly a sudden increase), flashes of light (photopsias), and blurred vision. [msdmanuals.com]

  RESULTS: On initial evaluation, the patient had decreased vision with photopsias and distortion in the affected eye. Her history revealed 3 years of preexisting neurosensory hearing loss and corneal scarring in the affected eye. [ncbi.nlm.nih.gov]

  Small detachments typically present with photopsia, floaters, and/or visual field defects. Loss of vision may be severe if the retinal detachment is extensive and/or the macula is affected. The diagnosis is confirmed by ophthalmoscopy. [amboss.com]

  Retinal tears may occur without symptoms, but often photopsia (luminous rays or light flashes in vision) is noted. Photopsia results from mechanical stimulation of the retina by vitreoretinal traction. [aafp.org]

• Vitreous Floaters

  The prompt and conscientious vitreoretinal examination of each patient older than 45 years of age who experiences vitreous floaters, even though limited to one or two, should be undertaken without delay. [ncbi.nlm.nih.gov]

  […] detachment, retinal haemorrhage, visual disturbance, eye pain, vitreous floaters, conjunctival haemorrhage, eye irritation, foreign body sensation in eyes, lacrimation increased, blepharitis, dry eye, ocular hyperaemia, eye pruritus et Nii pikalt ette [et.glosbe.com]

  Early symptoms of rhegmatogenous detachment may include dark or irregular vitreous floaters (particularly a sudden increase), flashes of light (photopsias), and blurred vision. [msdmanuals.com]

  The vast majority of patients with eye floaters have a benign condition known as vitreous syneresis in which portions of the normally clear and transparent vitreous jelly inside the eye becomes less transparent. [emedicinehealth.com]

• Scotoma

  RESULTS: A 41-year-old woman was referred with a 2-week history of decreased vision and scotoma in the left eye. She was in her sixth month of pregnancy. [ncbi.nlm.nih.gov]

  […] due to perforating injuries or intraocular surgery Retinoblastoma Malignant melanoma of the choroid References:[1][2][3][4][5][6] Pathophysiology Clinical features Prodromal symptoms Floaters Flash of light (photopsia) Localized retinal detachment: scotoma [amboss.com]

  […] response to local tumors–eg, melanoma, local inflammation, or malignant HTN, idiopathic, trauma, aging, tumors, inflammation; in premature infants, RD is caused by retinopathy of prematurity Clinical Progressive loss of visual field, often accompanied by scotomas [medical-dictionary.thefreedictionary.com]

  Macular degeneration is the leading cause of painless sudden vision loss in older patients, but the scotoma is central and the peripheral field is intact. [aafp.org]

• Retinal Lesion

  The interplay between vitreoretinal traction and predisposing retinal lesions is associated with retinal detachment. [radiopaedia.org]

  Rhegmatogenous retinal detachment Posterior vitreous detachment Peripheral retinal lesions (eg, enclosed oral bays, meridional folds, cystic retinal tufts, lattice degeneration) Myopia Senile retinoschisis Cataract extraction Trauma Intraocular inflammation [web.archive.org]

  Family history of retinal break or detachment: there may be a tendency towards inherited myopia or degenerative retinal lesions. [patient.info]

  Lattice lesions are more common among patients with high myopia. Usually, the lesions are non-progressive or very slowly progressive. Lattice degeneration is typically asymptomatic unless associated with symptomatic retinal breaks. [institut-vision.org]

• Confusion

  This rare case highlights the similarity in presentation between flexor sheath infection and herpetic whitlow which can lead to diagnostic confusion and mismanagement. [hindawi.com]

  The central, large collection of vesicles can be easily confused for superficial purulence… so look for smaller vesicles on the periphery. The vesicles remain for 7-10 days and eventually crust over. [acep.org]

Examination for retinal detachment can be completed by ophthalmoscopy or fundus photography [8]. Fundus photography generally needs to be completed with instruments larger than the ophthalmoscope but is has the distinct advantage of make the image available to be viewed by a specialist elsewhere. It also delivers photo documentation for future reference. Modern fundus photographs often reproduce much larger areas of the fundus than what can be seen at any point in time with the aid of handheld ophthalmoscopes.

There are different treatment procedures for a detached retina but each of them is dependent on finding the breaks that have formed in the retina and closing them [9]. All three of the procedures generally follow the same principles.

• Discovering all retinal breaks
• Sealing all retinal breaks
• Relieving present and future vitreoretinal traction 

The major types of treatment include the following: 

• Cryopexy and laser photocoagulation
• Scleral buckle surgery
• Pneumatic retinopexy
• Vitrectomy

The visual prognosis is difficult to predict in retinal detachment because the retina is a neuro-sensitive tissue [6]. On average however, retinal detachment devoid of macular involvement generally has better final prognosis.

Retinal detachment has various etiologic and risk factors some of which are [2]:

• Cataract surgery
• Diabetic retinopathy
• Eclampsia
• Family history of retinal detachment
• AIDS 
• Severe myopia
• Retinoblastoma
• Metastasis
• Malignant hypertension
• Homocysteinuria
• Von Hippel-Lindau disease
• Smoking 
• Stickler syndrome

In the United States, around 6% of the general population are believed to have retinal breaks [3]. Most of these however, are asymptomatic benign atrophic holes which are often without any accompanying pathology. This means a greater percentage of retinal leaks do not lead to retinal detachment. The annual incidence is approximately 1 in 10,000 or about 1 in 300 over a lifetime.

Worldwide, the most common etiologic factors associated with retinal detachment are aphakia, pseudophakia, myopia and trauma [4]. Around 40%-50% of all patients with detachments have myopia, 30%-40% have had cataract correction surgeries while 10%-20% have had direct ocular trauma.

There is no gender or racial predilection for retinal detachment incidence and the condition is mostly seen in people aged 40-70 years.

The retina refers to a thin layer of light sensitive tissue often found on the back wall of the eye. The optical system of the eye focuses light on the retina just as it is seen in the camera where light is focused on the film [5]. The retina then translates the focused image into neural impulses, before sending them to the brain through the optic nerve. Retinal detachment disintegrates the retinal pigment epithelium (RPE).

Separation of the sensory retinal from the underlying RPE happens in three different ways:

• Rhegmatous RD: Here there is a hole, tear or break in the neuronal layer which allows fluid from the vitreous cavity to seep in between the sensory and RPE layers separating them in the process. 
• Traction from inflammatory or vascular fibrous over the surface of the retina, which is connected normally to the vitreous body.
• Exudation of material into the subretinal space from retinal vessels as seen in hypertension, central retinal venous occlusion, vasculitis, or papilledema. 

Any of the above three mechanisms can be triggered by metabolic disorders, trauma (also including previous ocular surgery), degeneration, vascular disease, choroidal tumors, high myopia, disease affecting the vitreous.

There is no clear prevention path for retinal detachment [10]. However, permanent loss of vision can be prevented by taking note of the main signs of a detached retina which include bright flashes of light, sudden increase in floaters, a shadow or curtain that appears across the field of vision.

People older than 40 years of age who notice any of these signs, those who have a family member with a case of retinal detachment and those with extreme myopia should seek instant medical attention with any or all of these symptoms present.

Retinal detachment (RD) refers to a medical emergency of the eye where the retina is affected, peeling away from the supporting tissue beneath it [1]. Initially, detachment may be localised or partially broad but without quick treatment, the entire retina may detach and this often leads to blindness. Permanent damage kicks in following 72 hours of inaction.

Retinal detachment is an emergency disorder where an important layer of tissue in the back of the eye known as retina pulls away from the layer of blood vessels that supply it with nourishment and oxygen.

When the detachment is complete, the retinal cells are left in need of oxygen. Leaving the retinal detachment untreated for long greatly increases your chances of permanently losing your eyesight.

Retinal detachment however has symptoms which are clear warning signs. Early diagnosis by an ophthalmologist and treatment of retinal detachment will save your vision 85% of the time. The condition is seen mostly in people aged 40 and above.

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2. Haimann MH, Burton TC, Brown CK. Epidemiology of retinal detachment. Arch Ophthalmol. Feb 1982;100(2):289-92.
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6. Wilson CA, Khawly JA, Hatchell DL, Machemer R. Experimental traction retinal detachment in the cat. Graefes Arch Clin Exp Ophthalmol 1991; 229:568.
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9. Rumpf J. Jules Gonin. Inventor of the surgical treatment for retinal detachment. Surv Ophthalmol 1976; 21:276.
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