👁️ Retinal Detachment
A painless curtain across the vision. Why it is an emergency despite not hurting, and the one condition that gets face-down positioning.
🧬 What it is
The retina peels away from the layer that feeds it. The retina has no blood supply of its own — it sits against the choroid and is nourished by it.
Once separated, retinal cells begin to die. Time is sight.
| Risk factor | Why |
|---|---|
| Severe myopia (short sight) | A longer eyeball stretches the retina thin |
| Ageing | The vitreous shrinks and tugs on the retina |
| Cataract surgery | Changes vitreous dynamics |
| Trauma | Blunt injury, or a blow to the head |
| Diabetic retinopathy | Scar tissue contracts and pulls |
👀 How it shows up
⭐ The classic sequence
It is completely painless. There are no pain fibers in the retina - so patients delay coming in, and that delay is what costs them sight.
The exam phrase is almost always “a curtain coming down” or “a veil across my vision”.
Distinguish it quickly:
| Painless + sudden | Painful + sudden |
|---|---|
| Retinal detachment — curtain, floaters, flashes | Closed-angle glaucoma — halos, nausea, fixed mid-dilated pupil |
🩺 Treatment and nursing care
Detachment does not heal on its own. It is repaired by laser (photocoagulation), freezing (cryopexy), a scleral buckle, or vitrectomy with a gas bubble.
🚨 The positioning question
When a gas bubble is placed, the patient positions FACE DOWN — often for most of the day, for several days. The bubble floats upward and must press the retina back against the choroid.
Bubble floats up → face down puts the bubble against the retina
This is the one eye condition that gets prone or face-down positioning. Every other eye surgery avoids it.
✅ Post-operative care
- Position exactly as prescribed — adherence determines the outcome
- No air travel while a gas bubble is present — altitude expands the gas and spikes eye pressure
- Avoid anything that raises intraocular pressure: bending at the waist, straining, heavy lifting, vigorous coughing, rubbing the eye
- Stool softeners; antiemetics for nausea
- Eye shield, especially at night
⚠️ Report immediately
- Sudden severe eye pain — raised pressure or hemorrhage
- Sudden decrease in vision
- Increasing redness, discharge, fever
- A new curtain — re-detachment
Pain after eye surgery is never "expected discomfort". Report it.
🎯 NCLEX traps
- Painless — the absence of pain does not make it less urgent
- Face down after a gas bubble; no flying
- Floaters and flashes are the warning, before the curtain
- Bending at the waist is forbidden — teach squatting instead