Complaints & connections · borters.ch
Ablatio retinae · Amotio retinae
Painless, and that is exactly the trap. A shadow growing in from the side counts in hours — while the centre is still attached, the outcome is a different one.
Also known as: retinal detachment · retinal hole · curtain in the visual field
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
The retina is the light-sensitive layer lining the inside of the eye. It is not grown onto the wall but lies against it — held by the pressure inside the eye and by a pump beneath it that continuously carries fluid away. If a hole tears in it, fluid runs under the layer and lifts it. What is lifted is no longer supplied and no longer sees.
The sequence is almost always the same. First flashes and new floaters — the vitreous has pulled and torn a hole. Then, hours to days later, a dark shadow at the outer edge of the field that grows: a curtain, a wall, a field that is missing. Because the detachment starts below, the loss is often noticed above, and the other way round. There is no pain, the eye does not turn red. So people wait — and that is why waiting is the most expensive mistake here.
One single boundary decides: the spot of sharpest sight in the centre. While it is still attached, sight after surgery is usually good. Once it has lifted, the result drops markedly, even if the retina goes back into place. Between those two states there is often only a day or two. That is the whole reason for the hurry.
Both are found by the same examination: wide pupil, view carried to the edge. A tear alone without detachment is ringed with a laser in one sitting and is usually settled with that. An established detachment is operated on — with a buckle from outside, or from inside by removing the vitreous and placing a gas bubble that presses the retina back. After a gas bubble a particular head position applies for days, and flying is forbidden while gas is in the eye: at altitude it expands. Anyone who has had a detachment in one eye carries a raised risk in the other — about one in ten.
A growing shadow belongs in an eye clinic or emergency department, including evenings and weekends. The reason is not drama but the boundary to the centre: it moves in hours, and it does not come back.
If the hole is found before fluid runs beneath it, a laser session of a few minutes in the clinic is enough. The scar then holds. The whole urgency serves to arrive at this stage.
Cover one eye and look at a wall, then swap. Where is something missing — above, below, outer, inner? Is it growing? It takes twenty seconds and is worth more at the appointment than any description from memory.
A gas bubble only pushes upwards. So the head position is prescribed, often for several days. While gas is in the eye, flying and large changes in altitude are forbidden — gas expands at lower pressure and drives the pressure inside the eye up.
After a detachment the risk in the fellow eye is around ten per cent. That is no reason for daily worry, but a reason to take the same signs seriously there — and to know them before they come.
The defining sign. A dark or grey field at the edge of vision that grows over hours. It may be described as a wall, a curtain, a veil or a missing piece — and it always travels on in one direction.
The shadow is usually preceded by hours to days of flashes and suddenly many small dots — soot, pepper, a swarm of gnats. Those dots are blood, and blood means a vessel was torn along with the hole.
The retina has no pain fibres. The eye looks unchanged from outside, nothing hurts, and that regularly leads to waiting until the next working day. It is precisely in those hours that the centre is lost.
While only the edge is involved, reading still works and the loss is easily overlooked. Once the detachment reaches the centre, acuity collapses. Both are the same condition — only a day or two apart.
A blunt injury, earlier cataract surgery, marked short-sightedness, a detachment in the other eye or cases in the family raise the risk clearly. Anyone with one of these should not consider but call when flashes appear.