Retinal detachment is a sight-threatening condition in which the neurosensory retina separates from the underlying retinal pigment epithelium, interrupting the metabolic support the photoreceptors require and impairing vision in the affected field. It is classified by mechanism: rhegmatogenous detachment, the most c…
Retinal detachment is a sight-threatening condition in which the neurosensory retina separates from the underlying retinal pigment epithelium, interrupting the metabolic support the photoreceptors require and impairing vision in the affected field. It is classified by mechanism: rhegmatogenous detachment, the most common form, follows a retinal break or tear, such as a giant retinal tear, that allows liquefied vitreous to pass beneath the retina; tractional detachment results from contractile fibrovascular membranes pulling the retina forward, characteristically in proliferative diabetic retinopathy and other ischaemic retinopathies; and exudative detachment arises from fluid accumulation due to inflammatory, vascular, or neoplastic processes without a break. Predisposing factors include high myopia, prior intraocular surgery, ocular trauma, vascular occlusions, and retinopathy of prematurity in at-risk infants. Typical symptoms comprise sudden floaters, photopsia, and a progressing visual field shadow, with central vision lost once the macula detaches. Diagnosis relies on dilated fundus examination and imaging such as optical coherence tomography to assess macular involvement and surgical outcomes, while associated processes, including vitreous haemorrhage and Müller-cell responses to retinal injury, inform pathophysiology and prognosis. Management is largely surgical, employing techniques such as scleral buckling, pars plana vitrectomy, and pneumatic retinopexy to reattach the retina. Prompt recognition and repair are decisive for preserving vision, particularly before macular detachment occurs.
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