Retinal Detachment: Symptoms, Causes, and Modern Treatment Methods

What is retinal detachment?

Retinal detachment is a serious ophthalmological condition in which the light-sensitive tissue lining the back of the eye (the retina) separates from the underlying layer that provides its nourishment. This can lead to significant and irreversible vision loss if not diagnosed and treated in a timely manner. There are various types of retinal detachment, including exudative detachment, which is often associated with other eye diseases [1, 2].

Causes and risk factors for retinal detachment

Retinal detachment can be caused or triggered by a number of factors and diseases:

• Coats' disease: This is a rare, usually unilateral condition, more common in young males. It is characterized by abnormal development of retinal blood vessels (telangiectasias) that leak, causing fluid to accumulate under the retina and leading to exudative detachment. Without treatment, Coats' disease can progress to total exudative retinal detachment and secondary glaucoma [2].
• Coats'-type retinitis pigmentosa: Some patients with retinitis pigmentosa (a hereditary degenerative retinal disease) may develop changes resembling Coats' disease, including retinal telangiectasias and/or exudative detachment. Such changes are observed in 1.2–3.6% of patients with retinitis pigmentosa. In severe cases, this can lead to total retinal detachment and vision loss [1].
• Retinopathy of prematurity (ROP): Although primarily known as a cause of blindness in premature infants, ROP can also be associated with the development of secondary glaucoma, especially in stage 5 of the disease, when the angle of the anterior chamber closes. Increased intraocular pressure in infants with ROP requires careful monitoring, as eyes in this condition can enlarge rapidly [4]. Severe forms of ROP can lead to tractional retinal detachment.
• Metabolic syndrome: This syndrome, which includes central obesity, insulin resistance, hypertension, and dyslipidemia, has a significant impact on eye health. It can contribute to the development of systemic vascular and neurometabolic pathology affecting the retina, optic nerve, and choroid, increasing the risk of conditions such as diabetic retinopathy and retinal vein occlusion [5]. These conditions, in turn, can lead to serious complications, including retinal detachment.
• Retinal vein occlusion (RVO): Patients with RVO are at an increased risk of postoperative macular edema after cataract surgery. RVO itself is a serious vascular disease of the retina that can lead to neovascularization and, consequently, tractional retinal detachment [6].

Symptoms and complications of retinal detachment

Symptoms of retinal detachment can vary but often include the sudden appearance of "floaters," flashes of light, and a gradual deterioration of vision that may feel like a "curtain" descending over the field of vision. In advanced cases, this leads to significant vision loss [1, 2].

Complications can be severe:

• Total retinal detachment: Complete separation of the retina from the underlying tissues, leading to irreversible blindness [1, 2].
• Secondary glaucoma: This is a condition in which intraocular pressure increases, which can damage the optic nerve. Secondary glaucoma is a common complication of untreated Coats' disease [2] and can develop in retinopathy of prematurity, especially at stage 5 [4]. Clinical signs of glaucoma, such as corneal clouding and an increase in its diameter, can serve as a key to diagnosis, but glaucoma can also manifest much later in life [4].

Diagnosis and differential diagnosis

Accurate diagnosis of retinal detachment and related conditions is crucial. An ophthalmologist performs a thorough examination of the fundus, often using optical coherence tomography (OCT) and fluorescein angiography [6].

When diagnosing Coats' disease, it is important to perform a differential diagnosis to exclude other diseases with similar clinical manifestations [2]. For patients with retinopathy of prematurity, lifelong monitoring is necessary, as glaucoma can develop significantly later [4].

Modern treatment approaches

Treatment for retinal detachment depends on its type, cause, and severity. The goal of treatment is to reattach the retina to its normal position and prevent further vision loss.

• Anti-VEGF therapy: Vascular endothelial growth factor (anti-VEGF) inhibitors are an effective treatment option, especially for patients with extensive areas of exudative retinal detachment and total detachment in Coats' disease. They are often used in combination with ablative therapy [2]. Anti-VEGF agents are also used to treat macular edema in retinal vein occlusion [6]. However, there are anecdotal reports of glaucoma developing after anti-VEGF injections, although there is not yet sufficient conclusive evidence [4].
• Ablative therapy: For the treatment of telangiectatic vessels in Coats' disease, ablative therapy is used, often in combination with anti-VEGF drugs [2].
• Glaucoma treatment: If retinal detachment leads to secondary glaucoma, its treatment may include medication, anterior chamber angle surgery, or filtration surgery [4].
• Individualized approach: Choosing the optimal treatment strategy requires an individualized approach that takes into account the specific characteristics of the patient and the disease [2].

Prognosis and prevention

The prognosis for retinal detachment largely depends on the timeliness of diagnosis and the adequacy of treatment. Untreated Coats' disease can lead to total exudative retinal detachment and secondary glaucoma [2]. Patients with retinopathy of prematurity require lifelong monitoring for the timely detection and treatment of glaucoma [4].

Prevention includes the management of systemic diseases, such as metabolic syndrome, which can affect retinal health [5], as well as regular ophthalmological examinations, especially for high-risk groups.

Sources

1. Coats'-type retinitis pigmentosa. (Survey of ophthalmology, 1988) https://pubmed.ncbi.nlm.nih.gov/2457260/
2. Pearls and pitfalls in diagnosis and management of coats disease. (Retina (Philadelphia, Pa.), 2015) https://pubmed.ncbi.nlm.nih.gov/25811949/
3. Glaucoma in retinopathy of prematurity: A review. (Survey of ophthalmology, 2025) https://pubmed.ncbi.nlm.nih.gov/40147616/
4. Ocular Manifestations of Metabolic Syndrome: A Systemic Vascular Phenotype. (Diabetes, obesity & metabolism, 2026) https://pubmed.ncbi.nlm.nih.gov/42477295/
5. Timing of anti-VEGF therapy and postoperative macular edema after cataract surgery in eyes with retinal vein occlusion: a retrospective cohort study. (BMC ophthalmology, 2026) https://pubmed.ncbi.nlm.nih.gov/42380785/

The information provided in this article is for reference purposes only and does not replace professional medical advice. Always consult a qualified specialist for the diagnosis and treatment of any medical condition.