Is retinal detachment painful?

Is Retinal Detachment Painful?

Retinal detachment itself is typically not painful, but it may be accompanied by other symptoms such as flashes of light (photopsias), floaters, peripheral visual field loss, and blurred vision. 1

Symptoms of Retinal Detachment

Retinal detachment presents with several characteristic symptoms:

• Light flashes (photopsias) - Most noticeable in the dark, caused by vitreous traction on the retina as it separates
• Floaters (myodesopias) - May be due to:
  • Blood from torn or avulsed retinal vessels
  • Condensations of vitreous collagen
  • Epipapillary glial tissue (Weiss ring) torn from the optic nerve head
• Peripheral visual field loss - Often described as a "dark curtain" in the visual field
• Blurred vision - Especially if the macula becomes involved 1, 2, 3

Types of Retinal Detachment

There are three main types of retinal detachment:

1. Rhegmatogenous retinal detachment (RRD) - Most common type (approximately 10-18 per 100,000 persons annually)

   • Results from retinal breaks caused by vitreoretinal traction
   • Occurs when fluid passes from the vitreous cavity into the subretinal space through a break in the retina 1, 2

2. Tractional retinal detachment

   • Caused by fibrous tissue pulling the retina away from its normal position 2

3. Exudative retinal detachment

   • Results from fluid accumulation beneath the retina without retinal breaks 2

Risk Factors for Retinal Detachment

Several factors increase the risk of developing retinal detachment:

• Advancing age - Peak incidence between 55-59 years
• Myopia - Individuals with low myopia (1-3 diopters) have a fourfold risk; higher levels of myopia carry even greater risk
• Previous cataract surgery - Overall risk of RRD after cataract surgery is approximately 1%
• Trauma - Accounts for about 10% of all retinal detachments
• Lattice degeneration - Present in 6-8% of the population and found in 20-30% of patients with RRD
• History of retinal detachment in the other eye
• Genetic disorders such as Stickler syndrome
• Family history of retinal detachments in a first-degree relative 1, 2, 3, 4

Mechanism of Retinal Detachment

Retinal detachment typically occurs through the following mechanisms:

• Posterior vitreous detachment (PVD) - A separation of the posterior vitreous cortex from the internal limiting membrane of the retina
• Vitreous traction at sites of significant vitreoretinal adhesion causes most retinal breaks
• In traumatic cases, shockwave propagation can lead to retinal breaks, while negative pressure and relative inertial motion can pull the retina away from supporting tissue 1, 5

Management Considerations

Retinal detachment is an ophthalmologic emergency requiring prompt evaluation:

• Patients with acute onset of flashes or floaters should be referred to an ophthalmologist immediately
• Early intervention facilitates prevention of retinal detachment after formation of retinal breaks
• Treatment options include scleral buckle, vitrectomy, or a combination of both
• Anatomical success rates are in the range of 85% to 90% 2, 3, 6

Important Clinical Pearls

• Patients presenting with an acute PVD and no retinal breaks have a small chance (~2%) of developing retinal breaks in the weeks that follow
• Between 5% and 14% of patients found to have an initial retinal break will develop additional breaks during long-term follow-up
• The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, preserving visual acuity 1, 3