Retinal Tears and Detachments: Understanding the Difference

Rhegmatogenous retinal detachment is the most common type, accounting for approximately 90% of all detachments. It occurs due to one or more tears in the retina, allowing fluid from the vitreous cavity to seep beneath and lift the retina away from the underlying tissue. This fluid accumulation disrupts the retina's function, leading to rapid vision impairment. Aging is a primary risk factor, but other factors such as severe nearsightedness (myopia), previous cataract surgery, trauma, and certain retinal conditions (like lattice degeneration) significantly increase risk.

Key points:

• Most common type (about 90% of cases)
• Often related to posterior vitreous detachment (PVD) as we age
• Risk heightened by high myopia, trauma, or past surgeries

Specific symptoms include:

• Sudden increase in floaters and flashes of light
• A shadow or curtain moving across your visual field, usually starting from peripheral vision
• Rapid deterioration of peripheral vision, eventually affecting central vision if left untreated

Tractional retinal detachment occurs when scar tissue on the surface of the retina contracts and physically pulls the retina away from its normal position. This form of detachment commonly affects individuals with diabetes who have diabetic retinopathy, as prolonged high blood sugar levels cause abnormal blood vessels and scar tissue to form on the retina. Other conditions causing tractional detachment include severe eye injuries, infections, and inflammatory diseases of the eye.

Key points:

• Frequently linked to advanced diabetic retinopathy
• Scar tissue gradually tugs on the retina, causing distortion or separation
• Often has a slower onset than rhegmatogenous detachment

Specific symptoms include:

• Gradual onset of vision loss or distortion
• Slow progression of visual disturbances rather than sudden dramatic changes
• Areas of missing or blurred vision becoming more pronounced over time

Exudative retinal detachment is less common and occurs when fluid accumulates beneath the retina without any tears or breaks. It results from conditions that cause abnormal fluid leakage or inflammation within the eye, such as age-related macular degeneration (AMD), tumors, inflammatory diseases, or vascular abnormalities like central serous retinopathy.

Key points:

• No tear or break in the retina; fluid buildup pushes retina away from the eye wall
• Often associated with inflammatory disorders, tumors, or vascular conditions
• Symptoms can be more subtle initially, developing over days to weeks

Specific symptoms include:

• Blurred or distorted central vision developing gradually
• Lack of flashes or significant floaters, distinguishing it from other types
• Gradual but noticeable loss of visual clarity, often affecting tasks like reading or recognizing faces