About This Page
This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
The Bottom Line
- Ophthalmic EMERGENCY — delay worsens prognosis, especially if macula detaches
- Classic triad: sudden flashes (photopsia), new floaters, progressive visual field loss like a "curtain"
- Commonest type is rhegmatogenous (retinal tear → vitreous fluid tracks underneath)
- Risk factors: PVD, myopia, previous cataract surgery, trauma, lattice degeneration
- Treatment: vitrectomy (most common), scleral buckling, or pneumatic retinopexy
Overview
Retinal detachment (RD) occurs when the neurosensory retina separates from the underlying retinal pigment epithelium (RPE). Three types exist: rhegmatogenous (commonest — full-thickness retinal break allowing liquid vitreous under the retina), tractional (fibrous membranes pull the retina off, seen in proliferative diabetic retinopathy), and exudative (serous fluid without a break, seen in tumours and inflammation). Most rhegmatogenous detachments are preceded by posterior vitreous detachment (PVD).
Epidemiology
Annual incidence approximately 10–15 per 100,000, with around 7,300 new cases per year in the UK. Average age of presentation is 60. Risk factors include age, high myopia (axial length >26 mm), previous cataract surgery (4–7 fold increased risk), family history, trauma, lattice degeneration, and previous RD in the fellow eye (~10% risk).
Clinical Features
Symptoms
Sudden flashes of light (photopsia) — vitreous traction on retina
Shower of new floaters — "cobwebs", "flies", or "dark spots"
Progressive visual field defect — "curtain" or "shadow" across vision
Sudden painless central vision loss if macula detaches
No pain — differentiates from inflammatory causes
Signs
Visual field defect on confrontation testing
RAPD in extensive RD
Elevated grey retina on fundoscopy (retina billows like a sail)
Shaffer sign (pigment in anterior vitreous — "tobacco dust")
Reduced or absent red reflex if large detachment
Investigations
First-line
Dilated fundoscopyDefinitive — visualises detached retina and identifies breaks
Visual acuityMacula-on vs macula-off determines surgical urgency
Second-line
B-scan ultrasonographyEssential when fundal view obscured (vitreous haemorrhage, dense cataract)
OCTAssesses macular status and confirms subtle detachments
Specialist
Widefield fundus photographyDocuments extent of detachment for surgical planning
1
Urgent referral
- Same-day emergency referral to vitreoretinal service
- Macula-on RD: surgery within 24 hours
- Macula-off RD: surgery ideally within 72 hours
2
Surgical repair
- Pars plana vitrectomy (PPV): most commonly used — gas or silicone oil tamponade
- Scleral buckling: external indent — used for simple inferior RDs or young patients
- Pneumatic retinopexy: gas bubble + cryotherapy/laser — for selected superior breaks
- Postoperative posturing may be required
3
Retinal tear without detachment
- Laser retinopexy or cryotherapy within 24–48 hours
Complications
- Permanent visual loss: Especially if macula detaches
- Proliferative vitreoretinopathy (PVR): Commonest cause of surgical failure
- Cataract: Common after vitrectomy
- Re-detachment: ~5–10%
- Fellow eye detachment: ~10% lifetime risk
UKMLA Exam Tips
- 1Flashes + floaters + curtain/shadow = retinal detachment → same-day ophthalmology referral
- 2Macula-ON is more urgent than macula-OFF — preserving macular attachment preserves central vision
- 3Gas tamponade patients CANNOT FLY (gas expands at altitude) — classic exam question
- 4An inferior visual field defect = SUPERIOR retinal detachment (retina is inverted)
- 5Myopia, previous cataract surgery, and trauma are the key risk factors
practicetest your knowledge on retinal detachmentApply what you've learnt with UKMLA-style questions from the iatroX Q-Bank — ophthalmology and beyond.
open q-bank