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.
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 Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Retinal Detachment — EyeWiki
- Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration PPP — AAO
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.