Posterior Segment
Retinal Detachment
Also known as: retinal detachment, RD, rhegmatogenous retinal detachment, curtain in vision, shadow in vision, field defect flashes floaters, macula-off retinal detachment, macula-on retinal detachment
Filed as: Emergency
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
Separation of the neurosensory retina from the underlying retinal pigment epithelium, most often following a retinal break. Presents with a curtain or shadow progressing across the visual field, usually preceded by flashes and a shower of new floaters, with reduced acuity once the macula is involved. A macula-on detachment is time-critical and warrants emergency vitreoretinal referral rather than a routine appointment slot.
Recognition
Symptoms: what patients report
- Curtain, shadow, or dark veil progressing across the visual field — the cardinal symptom.
- Preceding flashes and floaters, often with a sudden shower of new floaters.
- Peripheral visual field loss progressing toward the centre.
- Reduced visual acuity if the macula is involved (macula-off detachment).
- Photopsia — flashing lights, especially peripheral.
Signs: what the examination shows
- Visual field defect on confrontation — corresponds to the area of detachment; a curtain/shadow in acute flashes and floaters raises concern for retinal detachment and supports urgent retinal assessment.
- Relative afferent pupillary defect (RAPD) if the detachment is extensive.
- Reduced central vision if the macula is involved.
- Dilated fundal examination: elevated, bullous, or rippling retinal surface with loss of choroidal detail.
- Retinal break or tear is often visible at the leading edge.
- Vitreous haemorrhage may obscure the view — urgent referral regardless of acuity.
- Pigment in the anterior vitreous (Shafer's sign, tobacco dust) — present in nearly all rhegmatogenous detachments in one series.
What OptoGuide™ covers for retinal detachment
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked New Zealand therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Retinal Detachment — EyeWiki
- Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration PPP — AAO
- Retinal detachment. Lin JB, Narayanan R, Philippakis E, Yonekawa Y, Apte RS. Nature Reviews. Disease Primers. 2024;10(1):18.
- Acute-Onset Floaters and Flashes: Is This Patient at Risk for Retinal Detachment?. Hollands H, Johnson D, Brox AC, et al. JAMA. 2009;302(20):2243-9.
- COMBINED RHEGMATOGENOUS RETINAL AND CHOROIDAL DETACHMENT: A Systematic Review. Tsui JC, Brucker AJ, Kim BJ, Kolomeyer AM. Retina (Philadelphia, Pa.). 2023;43(8):1226-1239.
- Effect of surgical timing in 23-g pars plana vitrectomy for primary repair of macula-off rhegmatogenous retinal detachment, a retrospective study. Elghawy O, Duong R, Nigussie A, et al. BMC Ophthalmology. 2022;22(1):136.
- Effect of symptom duration on outcomes following vitrectomy repair of primary macula-off retinal detachments. Kim JD, Pham HH, Lai MM, et al. Retina. 2013;33(9):1931-1937.
- Acute posterior vitreous detachment: the predictive value of vitreous pigment and symptomatology. Tanner V, Harle D, Tan J, et al. British Journal of Ophthalmology. 2000;84(11):1264-1268.
- Senile retinoschisis versus retinal detachment, the additional value of peripheral retinal OCT scans (SL SCAN-1, Topcon). Stehouwer M, Tan SH, van Leeuwen TG, et al. Acta Ophthalmologica. 2014;92(3):221-227.
- The International Classification of Headache Disorders, 3rd edition: 1.2 Migraine with aura. Headache Classification Committee of the International Headache Society. Cephalalgia. 2018;38(1):1-211.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.