Symptoms of Retinal Detachment
The cardinal symptoms of retinal detachment are sudden onset of light flashes (photopsias), floaters (myodesopsias), peripheral visual field loss described as a "dark curtain," and blurred vision. 1
Primary Warning Symptoms
Light flashes (photopsias) are caused by vitreous traction on the retina as the vitreous separates from the posterior retina, and patients typically report these as being most noticeable in the dark. 1
Floaters may result from:
- Blood from a torn or avulsed retinal vessel 1
- Condensations of vitreous collagen 1
- Epipapillary glial tissue (Weiss ring) torn from the optic nerve head 1
The presence of pigmented cells in the vitreous ("tobacco dust") suggests a retinal break. 2
Progressive Visual Symptoms
Peripheral visual field loss manifests as a "dark curtain" or shadow in the visual field, which correlates with the location and progression of the detachment. 2, 3
Decreased visual acuity or blurred vision occurs, particularly when the detachment involves or threatens the macula. 2, 3
High-Risk Symptom Patterns
Multiple floaters combined with flashes carry significantly higher risk than either symptom alone—20% of these patients have retinal tears at presentation. 4
More than 10 floaters or a "cloud" or "curtain" in vision indicates particularly high risk for retinal tears (OR 19.8). 5, 4
Vitreous or retinal hemorrhage is associated with 30% risk of retinal tears and appears as sudden increase in floaters or decreased vision. 4
Critical Timing Considerations
Between 8% and 22% of patients with acute posterior vitreous detachment symptoms have a retinal tear at initial examination. 1, 6
New retinal breaks can develop within 6 weeks following the onset of symptoms, with approximately 2% of patients with initially normal examinations developing breaks during this period. 1, 7, 6
Age and Risk Factor Context
Symptoms typically occur between ages 45-65 in the general population, though they can occur earlier with myopia, trauma, or following cataract surgery. 1, 6
Clinical Pitfalls to Avoid
Do not reassure patients based on isolated flashes alone—while isolated flashes carry lower risk (5.3% retinal tear rate), they still require urgent ophthalmologic evaluation. 4
Any patient reporting new or changing symptoms of flashes, floaters, peripheral field loss, or decreased vision requires same-day ophthalmologic examination, as early intervention before macular involvement dramatically improves visual outcomes. 2, 3, 8