Symptoms of Retinal Detachment
Adults with retinal detachment typically present with new-onset light flashes (photopsias), floaters (myodesopias), peripheral visual field loss described as a "dark curtain," and/or sudden decrease in visual acuity—all of which require same-day ophthalmologic evaluation. 1, 2, 3
Classic Warning Symptoms
Primary Symptoms Requiring Urgent Evaluation
Light flashes (photopsias) are most noticeable in the dark and result from vitreous traction on the retina as the vitreous separates from the posterior retina toward the vitreous base 1
Floaters (myodesopias) may appear as dark spots, cobwebs, or "smoke" in the vision and can be caused by blood from a torn or avulsed retinal vessel, condensations of vitreous collagen, or detached vitreous tissue 1, 2
Peripheral visual field loss often described as a "dark curtain" or shadow advancing across the visual field indicates progressive retinal detachment 2, 3, 4
Sudden decrease in visual acuity suggests macular involvement or significant vitreous hemorrhage 2
High-Risk Symptom Combinations
New floaters with flashes indicate acute posterior vitreous detachment (PVD), with 8-22% of these patients having a retinal tear at initial examination 2
Shower of new floaters or sudden increase in floater density suggests vitreous hemorrhage, which has a direct correlation with likelihood of retinal tear 2
Floaters with peripheral field loss strongly suggests retinal detachment is already occurring 2
Critical Timing Considerations
Between 2-5% of patients with acute PVD who have no retinal breaks on initial presentation will develop a break in the following 6 weeks, making follow-up examination mandatory even when initial evaluation is normal 2. Approximately 80% of patients who later develop breaks had either pigmented cells (Shafer's sign), vitreous or retinal hemorrhage at initial evaluation, or developed new symptoms prompting return visit 2.
Common Pitfalls to Avoid
Do not assume isolated floaters without flashes are benign—there are no symptoms that can reliably distinguish between benign PVD and one with an associated retinal break, making peripheral retinal examination mandatory for all new-onset floaters 2
Do not delay referral for "mild" symptoms—early diagnosis before macular involvement is the single most important factor determining visual prognosis, with visual outcomes significantly better when repaired before the macula detaches 5
Do not miss the 6-week window—patients with any degree of vitreous pigment, vitreous/retinal hemorrhage, or visible vitreoretinal traction require follow-up within 6 weeks, as this is when new retinal breaks most commonly develop 2
Underlying Risk Factors That Modify Presentation
Myopia causes earlier PVD onset and increases risk of retinal detachment 1, 3
Previous cataract surgery is a major risk factor for both new retinal breaks and retinal detachment 1, 3
Trauma can precipitate earlier vitreous detachment and create traumatic dialyses or tears along the vitreous base 1, 3
Age 45-65 years is the typical range for PVD occurrence, with earlier onset in men than women 1
Prognosis Without Treatment
At least 50% of untreated symptomatic retinal breaks with persistent vitreoretinal traction will progress to clinical retinal detachment, and spontaneous retinal reattachment is rare, meaning nearly all patients will progressively lose vision unless surgically repaired 1, 5. However, prompt treatment by creating a chorioretinal adhesion around symptomatic tears reduces the risk of retinal detachment to less than 5% 5.