Retinal detachment: recognising the emergency and acting fast

Flashes of light in the visual field, a shower of floaters, a dark curtain coming down: retinal detachment is an ophthalmic emergency. The faster the treatment, the higher the chances of visual recovery. Recognising the warning signs and knowing who to turn to without delay makes all the difference.

Contents

Décollement de la rétine, coupe de l'œil Coupe schématique d'un œil de profil. Au fond de l'œil, une portion de rétine, en teal, se soulève et se détache de la paroi. Une déchirure marque le point de départ ; du liquide s'accumule sous la rétine. Le nerf optique est à l'arrière. Une zone sombre figure la tache perçue par le patient. Mention : consulter rapidement. Décollement de la rétine Déchirure Liquide sous la rétine Nerf optique Rétine décolléeUne perte de vision soudaine doit conduire à consulter rapidement.

UNDERSTANDING

Understanding retinal detachment

Retinal detachment is the separation of the neurosensory retina from the underlying pigment epithelium. The most common form is rhegmatogenous detachment: a retinal tear or hole allows vitreous fluid to pass behind the retina, which gradually lifts away. Tractional forms (advanced diabetes, retinopathy of prematurity) and exudative forms (inflammation, tumours) are rarer.

According to Ibrar et al. (Br J Hosp Med, 2021), early clinical recognition relies on the classic triad: photopsia, recent-onset floaters and visual field loss. A dilated fundus examination confirms the diagnosis and determines the extent of the detachment and any macular involvement.

EMERGENCY

When to seek emergency care?

Four warning signs should prompt an ophthalmic consultation within 24 hours:

  • Photopsia (brief flashes of light): perceived even with eyes closed or in the dark, indicating vitreoretinal traction.
  • Recent floaters (specks, soot-like spots): especially if they appear suddenly or multiply rapidly.
  • Dark veil or descending curtain in the visual field: suggests an already extensive detachment.
  • Sudden drop in central visual acuity: macular involvement changes the visual prognosis.

Some patients are at higher risk: people with high myopia (risk multiplied by 5 to 10), patients who have had cataract surgery, those with a family or personal history of detachment, and recent eye trauma. In these profiles, any new visual symptom should be taken seriously and assessed quickly. A painless detachment is the rule: the absence of pain is not reassuring.

TREATMENT

The solutions: vitreoretinal surgery

Treatment of rhegmatogenous retinal detachment is surgical. Several techniques may be combined depending on the location, extent and characteristics of the tears:

  • Pars plana vitrectomy: removal of the vitreous through three micro-incisions, aspiration of the subretinal fluid, cryoretinopexy or endolaser to seal the tears, and tamponade with gas or silicone oil.
  • Scleral buckling: placement of a silicone band around the globe to bring the wall closer to the retina. Suited to peripheral detachments in younger patients.
  • Pneumatic retinopexy: injection of an intraocular gas bubble combined with laser, reserved for certain highly selected cases.

The timing of surgery is decisive when the macula is threatened. Elghawy et al. (BMC Ophthalmol, 2022) show, in a series of detachments with macular involvement, that the speed of vitrectomy after diagnosis has a positive influence on the final visual prognosis. In detachments where the macula is still attached, surgery is a deferred emergency within a maximum of 24 to 72 hours; in forms where the macula is already detached, the urgency is relative but should remain under 7 to 10 days.

For diabetic patients, regular retinal monitoring allows early detection of at-risk lesions. To find out more, see the page on ophthalmology of diabetes and the retina, as well as the SFO patient information sheet no. 16 “Retinal detachment”.

PREVENTION

Isolated retinal tear: laser barricade, an effective prevention

Every retinal detachment generally begins with a retinal tear, a small opening in the retina that lets vitreous fluid pass beneath the retina. When this tear is detected before the detachment sets in, a simple treatment performed in the consulting room can avoid surgery.

This treatment, known as laser barricade, involves creating a belt of coagulation points with the argon laser around the tear. The scars thus formed “weld” the retina to the underlying tissue and prevent the fluid from progressing beneath the retina. The procedure takes a few minutes, requires no general anaesthesia (just anaesthetic eye drops) and is carried out entirely in the consulting room.

At the Paris 13 (Diabet’) practice, the available equipment makes it possible to perform this laser barricade directly during the consultation, once its indication is confirmed by the fundus examination. If the screening is carried out in Cachan and a laser barricade is indicated, referral to the Paris 13 practice allows the procedure to be done without delay.

Any emergency consultation for signs suggestive of a tear (flashes of light, sudden-onset floaters) includes a fundus examination after pupil dilation, which makes it possible to assess the peripheral retina and decide on a possible same-day laser barricade.

To find out more about laser treatment of the retina, see the SFO patient information sheet no. 17 “Laser treatment of the retina”.

PATHWAY

The care pathway

If suggestive signs appear, the first point of contact is the Cachan practice (94) — 01 45 47 08 11, the main phone line for booking any scheduled consultation appointment during the day. If you cannot reach Cachan and have immediate warning symptoms, a second number can be used: Centre Diabet’ Paris 13 — 01 89 31 30 60 (urgent backup).

These practices offer a same-day deferred emergency consultation; they are not a 24/7 ophthalmic emergency service. Outside opening hours, head to a hospital ophthalmic emergency department (Hôtel-Dieu Paris, Fondation Rothschild, Centre Hospitalier National d’Ophtalmologie des Quinze-Vingts).

The consultation examination includes a visual acuity measurement, a slit-lamp examination, tonometry, a dilated fundus examination and a macular OCT. Depending on the lesions identified, two pathways are possible:

  • Retinal tear without detachment: argon laser barricade performed at the Paris 13 (Diabet’) practice, as indicated, during a dedicated consultation.
  • Confirmed retinal detachment: immediate referral to a specialised vitreoretinal centre. Surgery (vitrectomy, scleral buckling) is generally performed at the Clinique Sainte-Geneviève (Paris 14) for non-urgent cases within Dr Tourabaly’s network, or at the Fondation Rothschild, the CHNO des Quinze-Vingts or the Hôpital Cochin for emergencies outside practice hours depending on availability.

Dr Tourabaly’s view

“In consultation, I systematically remind my myopic patients and those who have a recent posterior vitreous detachment (PVD) how important it is to seek care quickly if they suddenly develop floaters or flashes of light. A dilated fundus examination takes 15 minutes and can radically change the visual prognosis. When an isolated tear is identified in time, a simple laser barricade is enough to avoid surgery. That is why rapid access to a consultation matters as much as the quality of the surgery when it becomes necessary.”

FAQ

Frequently asked questions

The three main warning signs are: photopsia (brief flashes), recent floaters (a shower of specks or soot-like spots), and a dark veil or curtain in the visual field. A sudden drop in central visual acuity suggests macular involvement. These signs call for an ophthalmic consultation within 24 hours.

No, retinal detachment usually occurs without pain. The absence of pain partly explains delays in seeking care. Only visual symptoms (flashes, floaters, a veil) raise the alarm. That is why any new visual manifestation, even a painless one, should prompt a rapid ophthalmic examination.

The timing depends on macular involvement. If the macula is still attached, surgery is an emergency within 24 to 72 hours to preserve central vision. If the macula is already detached, surgery remains urgent but can wait a few days (maximum 7 to 10 days) to optimise the operating conditions. The visual prognosis depends directly on this timing.

Surgery achieves anatomical reattachment of the retina in the large majority of cases (close to 90% at the first surgical procedure). Visual recovery, however, depends on the state of the macula before the operation: it may remain incomplete in cases of prolonged macular involvement. Long-term follow-up is essential to detect any re-detachment.

The main risk factors are: high myopia (beyond -6 dioptres), a personal or family history of detachment, recent eye surgery (cataract in particular), eye trauma, proliferative diabetic retinopathy, and peripheral lesions (lattice degeneration, holes, tears). An annual ophthalmic check-up with a dilated fundus examination is recommended for these profiles.

Suggestive symptoms? Emergency consultation

Cachan practice (main) — 01 45 47 08 11
Centre Diabet’ Paris 13 (urgent backup) — 01 89 31 30 60

Call Cachan
Paris 13 (backup)
Find out more — retina

Sources

  1. Ibrar A, Panayiotis M, Mohamed EA. Recognising and managing retinal detachments. Br J Hosp Med (Lond). 2021;82(11):1-6. PMID 34726948
  2. Elghawy O, Duong R, Nigussie A, et al. Effect of surgical timing in 23-g pars plana vitrectomy for primary repair of macula-off rhegmatogenous retinal detachment. BMC Ophthalmol. 2022;22(1):139. PMID 35337296

This article is for informational purposes. A personalised ophthalmic assessment remains essential for any treatment decision.

Written and reviewed by Dr Moïse Tourabaly, ophthalmic refractive surgeon — former chief resident (Quinze-Vingts National Eye Hospital).

Last updated: July 6, 2026

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