What are the signs and symptoms of retinal detachment?

Updated: Jul 08, 2021
  • Author: Hemang K Pandya, MD, FACS; Chief Editor: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE  more...
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Answer

Initial symptoms of retinal detachment commonly include the sensation of a flashing light (photopsia) related to retinal traction and often accompanied by a shower of floaters and vision loss.

Over time, the patient may report a shadow in the peripheral visual field, which, if ignored, may spread to involve the entire visual field in a matter of days. Vision loss may be described as cloudy, irregular, or curtainlike.

Retinal tissue is stimulated by light but also responds to mechanical disturbances. Flashing lights usually are caused by separation of the posterior vitreous. As the vitreous gel separates from the retina, it stimulates the retinal tissue mechanically, resulting in the release of phosphenes and the sensation of light.

Pathologic stimulation of the retina and production of phosphenes cause photopsia.

If a retinal detachment involves the macula, acuity may be severely reduced.

The location of the light sensation in the patient's visual field has no correlation to the location of a retinal tear.

Floaters are a very common visual symptom in the population; thus, distinguishing their etiology requires eliciting a detailed history. The sudden onset of large floaters in the center of the visual axis may indicate posterior vitreous detachment (PVD). The patient observes a circular floater when the vitreous detaches from its annular ring surrounding the optic nerve (referred to as Weiss ring). More ominous and concerning is the description of hundreds of tiny black specks appearing before the eye, as this maybe be indicative of a vitreous hemorrhage, resulting from disruption of a retinal vessel caused by a retinal tear or mechanical traction of a vitreoretinal adhesion. A few hours after the initial shower of black spots, the patient can note cobwebs that result from blood forming irregular clots. Generally, the new onset of floaters associated with flashing lights is highly suggestive of a retinal tear.


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