A retina detaches when it separates from the layer of tissue behind it that supplies it with blood and nutrients. This can happen in three distinct ways: through a tear that lets fluid seep underneath, through scar tissue that physically pulls it loose, or through fluid buildup that pushes it away from behind. The most common type starts with changes inside the eye that most people experience as they age.
What Holds the Retina in Place
The retina is a paper-thin layer of light-sensing cells lining the back of your eye. It sits against a deeper layer called the retinal pigment epithelium (RPE), which feeds it oxygen and clears away waste. There’s no strong physical bond holding these two layers together. Instead, the retina stays in place through a combination of gentle suction, chemical adhesion, and the pressure of the gel-like substance filling the center of your eye, called the vitreous.
Because that attachment is relatively fragile, anything that introduces fluid between the retina and the RPE, pulls the retina forward, or pushes it from behind can cause a detachment.
The Most Common Type: A Tear That Lets Fluid In
About 90% of retinal detachments start with a tear or hole in the retina. This type is called a rhegmatogenous detachment, and it begins with age-related changes to the vitreous gel inside your eye.
In your early 20s, the vitreous is a firm, gel-like substance that fills the eye and presses evenly against the retina. Over time, this gel gradually turns to liquid. Without its solid structure, the vitreous collapses on itself and peels away from the retina in a process called posterior vitreous detachment (PVD). Most people experience this sometime after age 50, and for the majority, it’s harmless.
The problem arises when the vitreous is unusually sticky in certain spots. As it pulls away, it can tug hard enough to rip a small tear in the retina. Once that tear exists, liquefied vitreous seeps through the opening, enters the space behind the retina, and begins lifting it away from the RPE. The fluid undermines the retina progressively, like water getting under wallpaper. Left untreated, the detachment spreads until the entire retina is separated.
Tractional Detachment: Scar Tissue Pulls the Retina
In a tractional detachment, scar tissue growing on the retina’s surface contracts and physically pulls the retina away from the back of the eye. No tear is necessary. The most common cause is diabetic retinopathy, a condition where diabetes damages the blood vessels in the retina. As those damaged vessels heal, they leave scar tissue behind. As the scars get bigger and tighten, they can tug the retina forward until it separates. Other causes include eye infections and inflammatory conditions inside the eye.
Exudative Detachment: Fluid Builds Up From Behind
Exudative detachments are the least common type and work differently from the other two. There’s no tear and no pulling. Instead, fluid builds up behind the retina, accumulating until it physically pushes the retina away from the wall of the eye. This fluid comes from leaking blood vessels or swelling in the back of the eye, triggered by conditions like age-related macular degeneration, tumors, eye injuries, or inflammatory diseases.
Who Is Most at Risk
Age is the biggest risk factor because vitreous changes are universal, but certain people face dramatically higher odds. Nearsightedness (myopia) is one of the strongest risk factors. People with moderate nearsightedness have about a 4-fold increased risk compared to people with normal vision. Those with high myopia face a 10-fold increase, and over a lifetime, their risk is roughly 20 times higher than average. This is because nearsighted eyes are physically longer, which stretches the retina thinner and makes it more vulnerable to tears.
Previous cataract surgery also raises the risk, because removing the natural lens accelerates vitreous changes. A family history of retinal detachment, a detachment in your other eye, and direct trauma to the eye are additional risk factors.
Warning Signs Before Full Detachment
Retinal detachment itself is painless, but the events leading up to it usually produce noticeable symptoms. The most important warning signs are a sudden increase in floaters (dark spots or squiggly lines drifting across your vision) and flashes of light, especially in your peripheral vision. These flashes happen when the vitreous tugs on the retina, stimulating the light-sensitive cells mechanically rather than with actual light.
Having both symptoms together is more concerning than either one alone. In a large primary care study, people who reported many floaters along with flashes had about six times the risk of retinal detachment compared to people with flashes only. Even floaters alone carried about a 6% risk of detachment. As the detachment progresses, people typically notice a shadow or curtain moving across their field of vision from one side, which represents the area where the retina has already separated and stopped functioning.
Why Timing Matters So Much
The critical question with any retinal detachment is whether it has reached the macula, the central part of the retina responsible for sharp, detailed vision. A “macula-on” detachment, where the center is still attached, is treated as an urgent priority because preserving that connection protects central vision.
Once the macula detaches, the clock starts ticking. Research published in Ophthalmology Retina found that surgery within 2 days of the macula detaching produced significantly better vision at 6 months compared to waiting 3 or more days. Surgery within 3 days still offered a meaningful advantage over waiting 4 or more days. After 4 days, earlier surgery no longer made a substantial difference to the visual outcome, suggesting the damage to the macula’s delicate photoreceptor cells plateaus after that point.
How Detachments Are Repaired
All retinal detachments require treatment, and nearly all require surgery. The goal is always the same: push the retina back into place and seal any tears to prevent fluid from getting underneath again. The two main surgical approaches are scleral buckling, where a silicone band is placed around the outside of the eye to gently push the wall inward toward the retina, and vitrectomy, where the surgeon removes the vitreous gel, drains the fluid from behind the retina, and fills the eye with a gas bubble that presses the retina flat.
Both procedures have high success rates. Data from the American Academy of Ophthalmology shows that scleral buckling reattaches the retina in about 92% of cases with a single surgery, while vitrectomy succeeds in about 83% of cases. When both techniques are combined, the single-surgery success rate is around 91%. Cases that don’t succeed on the first attempt typically undergo a second procedure.
What Recovery Looks Like
Recovery after vitrectomy with a gas bubble is one of the more demanding parts of the process. The gas bubble works by floating upward inside the eye and pressing against the repaired area of retina, holding it in place while it heals. For this to work, you need to keep your head in a specific position, usually face-down or turned to one side, for days to weeks depending on the location of the detachment.
This positioning requirement applies nearly all the time: when you stand, sit, eat, walk, and sleep. Special equipment like face-down pillows and angled mirrors can make this more manageable, but it remains physically and mentally exhausting. The gas bubble gradually absorbs on its own over several weeks, and vision slowly improves as it shrinks. During this time, you cannot fly in an airplane or travel to high altitudes, because changes in air pressure can cause the bubble to expand dangerously inside the eye.
Visual recovery varies. If the macula stayed attached throughout, many people recover most or all of their previous vision. If the macula was detached, some degree of permanent vision change is common, even after a successful repair. The retina’s photoreceptor cells are highly sensitive to being separated from their blood supply, and even a few days of detachment can leave lasting effects on central sharpness, color perception, or the ability to read fine print.