Is a retinal detachment always an emergency?

Yes — the suspicion of one is always an emergency, even when the symptoms appear mild and nothing hurts. A detached retina is cut off from its supply, and nerve tissue tolerates that only for a limited time. Not every shadow in the field of vision turns out to be a detachment, but that distinction is made by the examination with the pupil dilated, not by how it feels. So: with new flashes, a new shower of floaters or a shadow, call the same day. It is better to have a harmless vitreous detachment examined too early than a detachment too late.

How quickly must a retinal detachment be operated on?

As quickly as the situation and the centre's operating schedule allow — as a rule within hours to a few days. Exactly how urgent it is depends above all on whether the point of sharpest vision, the macula, is still in place or already involved. If the macula is still in place, every hour is an argument for preserving it. If it has already detached, the operation remains urgent, but the window is then a little less tight. That judgement is made by the examination, not by the telephone — which is why the call is the first step.

Does vision come back after a retinal detachment?

That depends above all on two things: how long the retina was detached, and whether the macula was involved. If it was not, and surgery followed quickly, the outlook for central vision is at its best. If it was, a loss of sharpness or distorted vision frequently remains even after successful reattachment. In both cases recovery drags on over months, not days. Nobody can give you sound percentages before the operation — what we can give you are the factors that count for or against in your case.

Can a retinal detachment occur in the second eye as well?

Yes, and that risk is increased compared with the general population — particularly when the cause is a predisposition that affects both eyes, such as pronounced short-sightedness or thin patches of retina in the periphery. That is why we examine the second eye as a matter of course, even when it has no symptoms. If an early stage is found there, it may in some circumstances be secured with the laser before anything happens. And regardless of that, this holds for life: new flashes or a new shower of floaters in the other eye need assessing immediately.

Floaters or a genuine warning sign — how do I tell the difference?

By the way they change, not by the way they look. 'Floaters' known for years and unchanged are as a rule harmless and need no treatment. What is suspicious is the sudden change: markedly more dots than usual, an outright swarm or shower of floaters, together with flashes of light or a shadow at the edge. That combination suggests the vitreous is separating from the retina — usually without consequence, sometimes with a tear. From the outside the two cannot be told apart; with the pupil dilated they can. If in doubt, call us and describe what has changed and since when.

May I fly with a gas tamponade in the eye?

No. As long as gas is in the eye, flying is not permitted — the lower cabin pressure lets the gas bubble expand, and intraocular pressure can rise dangerously as it does. The same applies to journeys to high altitude, over high passes or on a mountain railway, and to anaesthesia with nitrous oxide: before any procedure, say that you have a gas tamponade. The gas dissolves on its own over weeks, at different speeds depending on the gas used. You may fly only once your ophthalmologist has confirmed that there is no gas left in the eye — not by how it feels and not by the calendar.

Retina & Vitreous

A shadow in your field of vision: recognising retinal detachment — and acting today

Flashes of light, a swarm of new black dots, a dark curtain moving in from the side: a retinal detachment almost always announces itself — painlessly, and that is exactly why it is often watched for too long. A retina detached by a tear does not reattach on its own. Anyone who has these signs assessed today rather than next week has a hand in deciding how much vision is left at the end.

Call now — have the suspicion assessed book an appointment online

The four warning signs of a retinal detachment

A retinal detachment does not hurt. The eye is not red, it does not water, it does not burn, and there is nothing to see on it from outside. It announces itself solely through what you see — and because nothing hurts, many people put the call off until tomorrow. That is the real reason a readily treatable finding becomes lasting damage.

Retinal detachment: the symptoms that matter — there are four, and they usually appear in this order:

Flashes of light. Brief bright flashes, arcs or twitches of light, usually at the edge of the field of vision and clearer in the dark. They arise from traction on the retinal tissue: the retina knows only one language, and that language is light.
A shower of floaters. Suddenly many new black dots, flecks or an outright swarm of them that drifts along with your gaze. Behind it is material that does not belong in the vitreous — blood cells or pigment, often from a fresh tear.
A shadow or curtain. A dark area that moves into the field of vision from the outer edge or from below and grows over hours to days. This is the sign that leaves no room for judgement.
Sudden, painless deterioration of vision. One eye becomes blurred quickly, letters jump, straight lines appear distorted — without pain, without redness, without any outward cause.

What is not part of a retinal detachment: pain, a red eye, discharge, eyelids stuck together. Anyone waiting for it to finally hurt before calling is waiting for a sign that will not come. The other way round, that does not mean a painful, red eye with worse vision is harmless — that is an emergency too, just a different one, and needs assessing the same day just as much. After eye surgery this applies all the more.

In medical reports and operation notes you will find two Latin names for the same condition: Ablatio retinae and Amotio retinae. Both literally mean 'detachment of the retina' and mean exactly what this page describes. How the retina and the vitreous relate to each other, and which other findings originate there, you can read in the overview of Retina and vitreous.

When you must come in immediately

This page has one most important message, and it stands here so that nobody misses it: With a shadow, a curtain, new flashes of light or a sudden shower of floaters, call today — not tomorrow, not on Monday, not at the next regular appointment.

An emergency that comes before even that: A sudden, complete loss of vision in one eye — particularly together with headache, pain on chewing, difficulty with language or speech, or signs of paralysis — does not belong in our consultation but in an emergency department, immediately: call the ambulance (144). Behind it can be a vascular occlusion or a vascular inflammation, where minutes and hours count.

Every one of the following situations needs assessing the same day:

a dark shadow or curtain, moving into the field of vision or growing larger
new flashes of light, particularly if they last for hours or increase
suddenly a great many more black dots than before, or a swarm of them you have never seen before
a pair of rapid, painless deterioration of vision in one eye
the same signs after eye surgery, a blow to the eye or an accident — even weeks later

Even when the shadow has already reached the centre of the field of vision, the same day still applies. The urgency does not drop then; it only shifts what is at stake: no longer preserving sharp vision, but recovering as much of it as possible. Do not wait to see whether it improves overnight. A retina detached by a tear does not reattach on its own.

How to reach us — Zurich, Wetzikon, Meilen

The quickest route is our central number: +41 44 500 69 00. Say at the very start that you are seeing flashes, a shower of floaters or a shadow — then we know it is not a question of scheduling. You can also reach the three locations directly:

Sehklinik Zürich, Hallenstrasse 8 — +41 44 422 25 55
Sehklinik Wetzikon, Bahnhofstrasse 126 — +41 44 930 61 00
Sehklinik Meilen, Dorfstrasse 94 — +41 44 923 03 81

Consulting hours are Mon–Fri 08:00–12:00 and 13:00–17:30; in Meilen Wednesday varies, so ask there by phone. An overview with directions and parking is at Locations. Outside consulting hours the ophthalmic emergency service applies — contact it, or go directly to the emergency department of an eye clinic. A suspected retinal detachment is no reason to wait until the next working day.

Referring physicians and optometrists reach us through the referring physicians' area. Where a retinal detachment is suspected we take your patient the same day during consulting hours; outside them we tell you on the phone where they should go immediately — call us rather than faxing.

How a retinal detachment develops

The retina is a wafer-thin layer of nerve tissue that lies against the inside of the wall of the eye like wallpaper that is not glued on but held by suction. It is nourished in large part from the choroid beneath it. As soon as fluid gets between the two layers the retina lifts off — and its outer, light-sensitive layers lose contact with the supply from the choroid that they depend on. Nerve tissue tolerates that only for a limited time. How that fluid gets there distinguishes three forms, and that distinction decides the treatment.

The vitreous, which fills the eyeball, liquefies over the years and shrinks as it does so. It separates from the retina — a posterior vitreous detachment, which taken on its own is age-related and usually harmless. It is exactly in this phase that the typical 'floaters' and flashes of light appear. In places, though, it adheres more firmly, and there its traction can tear the retina. Through that tear liquefied vitreous runs under the retina and lifts it off, often within hours to days. That is the reason the harmless vitreous detachment and the dangerous tear cause the same first symptoms — and the reason they can only be told apart with the pupil dilated.

Here no tear is needed. Scar-like membranes inside the eye pull the retina mechanically away from the layer beneath it. Such strands arise above all in advanced diabetic retinopathy and after vascular occlusions of the retina. This form develops more slowly and more insidiously than the tear-related one, so it causes few symptoms for a long time and is often noticed late. Anyone with diabetes as a rule notices nothing of it before something happens — which is why regular retinal check-ups in diabetes are obligatory, not optional.

The rarest form: the retina is intact, but fluid collects beneath it, escaping from the choroid. The triggers are inflammations inside the eye such as Uveitis, less often tumours of the choroid or severely uncontrolled high blood pressure. Treatment here is not primarily surgical but directed at the cause — and that is why it matters so much that the examination distinguishes between these three forms at all, rather than treating every detachment alike.

Who is at increased risk

A retinal detachment does not strike at random. There are constellations in which it occurs markedly more often — and anyone who belongs to one of them should know the four warning signs by heart. That is more effective than any interval between check-ups.

Short-sightedness. A short-sighted eye is built longer, its retina thinner and more stretched at the periphery, and vitreous detachment happens earlier on average. The higher the dioptre figure, the more pronounced this connection. What that means for the eye is set out under Myopia.
After a cataract operation. After the procedure for cataract the risk is increased, particularly in short-sighted eyes and where anything unusual occurred during the operation. The window extends over years. It is not an argument against the operation — it is an argument for knowing the warning signs.
Injuries. A blunt injury from a ball, a fist, a champagne cork or an airbag, as much as a penetrating injury. The detachment can follow immediately or occur weeks to months later.
Family history and your own history. Retinal detachments in the family, a detachment already suffered in the other eye, or known thin patches of retina such as lattice degeneration increase the risk.
Age. Posterior vitreous detachment is a normal process, and usually takes place between the ages of 50 and 70 — the stage of life in which tear-related detachments are most common.

A risk factor is not a diagnosis, and nobody needs to go through life uneasy because of one. What we are saying: if you are in one of these groups and one of the four signs appears anew, calling the same day is the right response — not the over-cautious one. If you have no such signs but would like the periphery of the retina checked, you can book an appointment online for a check-up with the pupil dilated — that appointment can wait; the same-day one cannot.

How we assess

The examination answers four questions: is the retina detached? Is the macula, the point of sharpest vision, involved? Where is the opening it began through? And is the other eye at risk? Everything else follows from the answers — the urgency, the procedure, the timing.

Dilation of the pupil (mydriasis). Without it the periphery of the retina — where tears form — simply cannot be assessed reliably. The drops need around 20 to 30 minutes to take effect. After that, for several hours: no driving yourself, blurred vision at near, sensitivity to light. That is the honest price of this examination, and we would rather tell you before than after.
Funduscopy of the entire back of the eye. Assessment of the retina far out to its edge, if needed with indentation of the wall of the eye so that even the outermost parts can be seen. This is where it shows whether the retina is in place, where it has lifted off and where the tear sits.
OCT (optical coherence tomography). A contact-free cross-sectional image of the retina at microscopic resolution. Above all it answers the question of the macula — whether it is still in place or already undermined by fluid — and makes the progression comparable over months and years.
Ultrasound of the eye. When a haemorrhage in the vitreous blocks the view of the retina, nothing more can be seen with the naked eye and a lens. Ultrasound shows through cloudy media as well whether the retina is in place — and so answers exactly the question that is then open.

The second eye is always examined too, even when it has no symptoms. If an early stage is found there, it may in some circumstances be secured before it becomes an emergency. What else belongs to a complete examination of the eye we describe under Eye examinations.

And what this assessment can not do: rule out a retinal detachment without the pupil having been dilated. A standard eye test, a look at visual acuity or a measurement of intraocular pressure say nothing about it. Anyone who has had flashes and a shower of floaters and been examined without dilation has not had the examination that decides it.

Treatment routes

The goal is always the same: to put the retina back in place and to close every opening permanently. Which route leads there depends on where the tears are and how many there are, how extensive the detachment is, whether the macula is involved, how old you are, whether you have your own lens or an artificial one, and what state the vitreous is in. That choice is made by the retinal surgeon who operates — on the findings we record.

Laser coagulation for a retinal tear

If the examination shows a tear or a hole, without the retina having already detached, laser coagulation can stop the process where it began. The laser places fine burns around the tear; over the following days these form a scar that bonds the retina to the layer beneath it. The tear itself remains; the scar is there to prevent fluid spreading from it under the retina. That cannot be ruled out with certainty — and a new tear can form elsewhere. New flashes, a new shower of floaters or a shadow therefore need assessing immediately after laser treatment as well. The procedure is done as an outpatient at the slit lamp, with anaesthetic eye drops and a contact lens, and as a rule takes a few minutes.

Two things we say openly about this. The laser does not improve vision — it prevents deterioration; anyone expecting to see more sharply afterwards will be disappointed, even though the treatment has done exactly what it is meant to do. And: a retina that has already detached cannot be lasered. Then there is no avoiding an operation. The laser treatment of a tear we carry out ourselves.

Vitrectomy — surgery inside the eye

In a vitrectomy the vitreous is removed through fine ports, the fluid under the retina is drained and the tear is closed from inside, usually with laser or cold. So that the retina stays in place until the scar holds, the eye is filled with a tamponade: either with a gas that dissolves on its own over weeks, or with silicone oil, which is removed again in a second procedure. After a vitrectomy, an eye with its own natural lens frequently develops, within the following months to years, a Cataract, which can then itself be treated.

We do not carry out operations inside the eye ourselves. If your finding calls for one, we tell you in the same conversation and arrange the referral to a retinal surgery centre, so that you do not have to see to it yourself. The diagnostics beforehand and the follow-ups afterwards we take on close to where you live, in Zurich, Wetzikon or Meilen.

Indenting procedures — buckle and cerclage

The second established route works from outside: a silicone element is sutured onto the sclera — either as a local buckle or as a band that encircles the eyeball (cerclage). This indents the wall of the eye slightly and brings it up to the detached retina, so that the tear comes back into contact. This procedure is often chosen for younger eyes whose vitreous is still attached, and it has the advantage of leaving the inside of the eye untouched. It can, however, change the refractive power of the eye — usually towards short-sightedness — irritate the eye for longer and cause temporary double vision. This procedure too is carried out at the operating centre.

What determines the outlook

Percentages have no place on this page; what can be known beforehand are the factors. Two weigh heaviest: the time until treatment and involvement of the macula. If the macula is still in place and surgery follows quickly, the outlook for central vision is at its best. If it had already detached, a loss of sharpness or distorted vision often remains even after successful reattachment.

Beyond that, the extent of the detachment, the number and position of the tears and the question of whether scar tissue forms inside the eye all play a part — if it does, a further operation can become necessary. That too is part of being honest: a retinal detachment is not in every case dealt with by a single procedure, and the recovery of vision drags on over months. We do not promise you a result — we do promise a prompt assessment and a clear next step.

After the operation

The time after the procedure demands more of your own cooperation than the operation itself. Exactly what is involved depends on the procedure chosen and on the tamponade; the following points apply to most cases.

Positioning. If a gas bubble has been placed, it presses the retina back into place only where it lies against the top — a gas bubble always rises in the eye. Which spot that is to be is decided by the position of the tear; that is why you are given a particular head position to hold, often over several days and for many hours a day. It is demanding, and for many people the most unpleasant part of the treatment. It is at the same time the part nobody can take over for you: the positioning is a component of the operation, not a recommendation afterwards. Have the operating centre show you what aids there are for it.

Gas tamponade. As long as the gas is in the eye you see very poorly with it — many describe a dark bubble with a moving 'water line' that gets smaller over the days. The gas dissolves on its own, over a few to several weeks depending on the gas used. During this time tell every doctor treating you that you have a gas tamponade — above all before any anaesthetic.

Ban on flying. With gas in the eye you must not fly. The lower cabin pressure lets the bubble expand, and intraocular pressure can rise so far that the blood supply to the eye is at risk. The same applies to journeys to high altitude. The ban does not end after a fixed number of weeks, and not when you feel it should, but only once an ophthalmologist has confirmed that there is no gas left in the eye. With silicone oil this problem does not arise — even so, have that expressly confirmed before you book a ticket.

Time off work and everyday life. How long you are off depends on the procedure, on the course it takes and strongly on your occupation. Physically heavy work, work in dust or wet conditions and tasks that require both eyes mean longer off than office work. Expect weeks, not days, and do not let anyone promise you a figure before the operation that nobody can know. Driving again only once your vision allows it and you have explicit clearance. Swimming pool, sauna and sport come later — the follow-up will tell you exactly when.

Follow-ups. The follow-up appointments come close together and are to be kept, even when the eye feels fine. We take them on close to where you live, at our three locations, and each time we examine the second eye as well. In between, contact us immediately if pain increases, vision worsens again or a shadow reappears.

Costs & health insurance

What does the insurer pay for — and what not?

A retinal detachment is treatment that is medically compulsory — there is nothing to weigh up here and no self-pay service to think over. What you should know concerns the deductible, the co-payment and what basic health insurance does not cover. If the detachment is the consequence of an accident, billing goes through accident insurance — the deductible and co-payment then do not apply. So tell us if there was a blow or a fall beforehand.

Service	Coverage	What this means for you
Emergency assessment where retinal detachment is suspected	Basic insurance (OKP)	Examination with the pupil dilated, funduscopy, OCT and — where needed — ultrasound are mandatory benefits where there is a medical indication. The deductible and co-payment apply as at any doctor's appointment.
Laser coagulation of a retinal tear	Basic insurance (OKP)	An outpatient procedure where the indication is confirmed. It is billed against the same deductible as the assessment it follows from.
Surgery for retinal detachment (vitrectomy or an indenting procedure)	Basic insurance (OKP)	The operation is billed by the centre that carries it out. If it is inpatient, your room and choice of doctor follow your insurance model — the operation itself is not affected by that. With inpatient treatment the statutory hospital contribution of CHF 15 per day is added as well (adults).
Follow-up appointments and checking the second eye	Basic insurance (OKP)	Follow-up checks after a retinal detachment are medically indicated, as is examination of the fellow eye. We take on both close to where you live, in Zurich, Wetzikon or Meilen.
New spectacle lenses after the operation	Usually not	Spectacle lenses are as a rule not a service of basic health insurance for adults. For individual medical indications the MiGeL provides for contributions — whether a change in refractive power after the procedure is one of them is for you to clarify with your insurer; we put together the details needed. Whether supplementary insurance contributes anything is likewise for your insurer to tell you.

You bear the deductible and co-payment yourself; with an operation the deductible is used up quickly. In an emergency we assess first and sort out the administration afterwards — nobody should lose a day over a question of cost. We are glad to answer billing questions beforehand on the phone: +41 44 500 69 00 or through the contact form.

Related conditions

Retina & vitreous Myopia (short-sightedness)Cataract

Medically reviewed by PD Dr. med. Andrea von Rückmann

Your ophthalmologistPD Dr. med. Andrea von RückmannView profile

Frequently asked questions

: Yes — the suspicion of one is always an emergency, even when the symptoms appear mild and nothing hurts. A detached retina is cut off from its supply, and nerve tissue tolerates that only for a limited time. Not every shadow in the field of vision turns out to be a detachment, but that distinction is made by the examination with the pupil dilated, not by how it feels. So: with new flashes, a new shower of floaters or a shadow, call the same day. It is better to have a harmless vitreous detachment examined too early than a detachment too late.
: As quickly as the situation and the centre's operating schedule allow — as a rule within hours to a few days. Exactly how urgent it is depends above all on whether the point of sharpest vision, the macula, is still in place or already involved. If the macula is still in place, every hour is an argument for preserving it. If it has already detached, the operation remains urgent, but the window is then a little less tight. That judgement is made by the examination, not by the telephone — which is why the call is the first step.
: That depends above all on two things: how long the retina was detached, and whether the macula was involved. If it was not, and surgery followed quickly, the outlook for central vision is at its best. If it was, a loss of sharpness or distorted vision frequently remains even after successful reattachment. In both cases recovery drags on over months, not days. Nobody can give you sound percentages before the operation — what we can give you are the factors that count for or against in your case.
: Yes, and that risk is increased compared with the general population — particularly when the cause is a predisposition that affects both eyes, such as pronounced short-sightedness or thin patches of retina in the periphery. That is why we examine the second eye as a matter of course, even when it has no symptoms. If an early stage is found there, it may in some circumstances be secured with the laser before anything happens. And regardless of that, this holds for life: new flashes or a new shower of floaters in the other eye need assessing immediately.
: By the way they change, not by the way they look. 'Floaters' known for years and unchanged are as a rule harmless and need no treatment. What is suspicious is the sudden change: markedly more dots than usual, an outright swarm or shower of floaters, together with flashes of light or a shadow at the edge. That combination suggests the vitreous is separating from the retina — usually without consequence, sometimes with a tear. From the outside the two cannot be told apart; with the pupil dilated they can. If in doubt, call us and describe what has changed and since when.
: No. As long as gas is in the eye, flying is not permitted — the lower cabin pressure lets the gas bubble expand, and intraocular pressure can rise dangerously as it does. The same applies to journeys to high altitude, over high passes or on a mountain railway, and to anaesthesia with nitrous oxide: before any procedure, say that you have a gas tamponade. The gas dissolves on its own over weeks, at different speeds depending on the gas used. You may fly only once your ophthalmologist has confirmed that there is no gas left in the eye — not by how it feels and not by the calendar.
: Assessment, laser treatment, surgery and follow-up appointments are medically indicated with this diagnosis; the cost is covered by basic health insurance (OKP). What remains for you is the deductible and co-payment, as at any doctor's appointment — with an operation the deductible is used up quickly. If the detachment is the consequence of an accident, billing goes through accident insurance — the deductible and co-payment then do not apply. So tell us if there was a blow or a fall beforehand. If surgery is inpatient, your room and choice of doctor follow your insurance model; the operation itself is not affected by that. In an emergency we assess first and sort out the administration afterwards.

A curtain in your field of vision does not wait until Monday.

Tell us on the phone what you are seeing and since when. Where a retinal detachment is suspected we examine you the same day during consulting hours; outside them we tell you on the phone where to go immediately. If an operation is needed, we arrange the referral, so that you do not have to see to it yourself.

Call now — get it assessed today

+41 44 500 69 00 — Mon–Fri 08:00–12:00 / 13:00–17:30. Outside consulting hours the ophthalmic emergency service applies. Or book an appointment online.