Retinopexy is a procedure that seals a tear or hole in the retina and makes the retina adhere to the inner wall of the eye, in order to prevent it from detaching. It is achieved either with a barrier of laser spots around the tear, or by freezing applied through the wall of the eye, and sometimes a gas bubble is injected into the eye to push the retina back into position while the head is held in a prescribed posture. The retina is the thin neural layer lining the back of the eye that transmits the image to the brain, and once it separates from its blood supply it stops working, which makes time the decisive factor. Retinal detachment is **a sight-threatening emergency that cannot wait**. You must therefore recognise these warning signs and act on them at once: **sudden flashes of light, a new dense floater or shower of floaters, or a black curtain or shadow blocking part of your field of vision all require an eye examination the same day, and delay costs sight that cannot be recovered**. Neural tissue that dies after a long-standing detachment is not replaced, and the window for preserving vision lies in the first hours and days, not weeks later. Retinopexy is used for retinal tears and holes, for limited detachment localised around a tear, for areas of retinal thinning in predisposed eyes such as high myopia, and prophylactically in the fellow eye of a patient who has already detached in one eye when a tear is found there. Extensive detachment, detachment involving the centre of vision, or one accompanied by bleeding or contracting membranes, requires intraocular surgery to remove the vitreous gel, or a scleral buckle. The limits must be clear. Retinopexy closes the tear and prevents the detachment from extending, but it **does not restore vision lost through an old detachment or one that has already involved the centre of vision**. It does not correct refractive error or remove the need for glasses, and it does not prevent new tears from forming elsewhere in the retina, which is why follow-up afterwards is not optional. Some patients need a second laser session or later surgery if the condition progresses. Suitability and the choice of technique are determined by a dilated examination of the back of the eye, not by reading.
Procedure steps
- 1
Urgent dilated retinal examination
The pupil is dilated with drops and the back of the eye is examined with special lenses, including careful inspection of the peripheral retina where most tears occur. Vision and eye pressure are measured, and if bleeding inside the eye obscures the view, an ocular ultrasound is used. The peripheral retina of the other eye is examined too, since it is at risk of the same problem.
- 2
Explaining findings and arranging prompt treatment
The location of the tear and the extent of any detachment are explained, and it is decided whether laser or cryotherapy will suffice or whether intraocular surgery is needed. Appointments are arranged on an urgent rather than a routine basis, because the area of detachment can enlarge within days, and you are asked to avoid strenuous exertion until treatment is complete.
- 3
Local anaesthesia
Laser is usually performed with anaesthetic drops while you sit at the machine, and an injection around the eye may be used for cryotherapy or when longer comfort is required. You remain awake in most cases, may notice bright flashes and mild pricking or heaviness around the eye, and a contact lens is placed on the surface of the eye to direct the beam.
- 4
Sealing the tear with laser or freezing
The beam is aimed to create rows of tiny spots around the tear, forming a barrier, and these produce adhesions that fix the retina to the layers beneath it and stop fluid seeping through the tear. With cryotherapy, a cold probe is applied to the outside of the eye wall to achieve the same effect in locations that laser cannot easily reach.
- 5
Gas bubble, posturing and close follow-up
In some cases a gas bubble is injected to push the retina back into place, and you then keep a specific head posture for days exactly as prescribed. **While the gas bubble remains in the eye you must not travel by air or go to high altitude, and you must tell any anaesthetist that it is there.** Close follow-up visits are scheduled to examine the periphery and confirm that no new tear has appeared.
Before the procedure
Come to your appointment with someone who can take you home, because you will not be able to drive after dilation or after the procedure, and bring sunglasses since light sensitivity lasts for hours. Tell the doctor exactly when your symptoms began: the flashes, the floaters, where the dark curtain is and whether it is enlarging, because this information determines how urgent the case is. Mention if you are highly short-sighted, if you have had cataract surgery, LASIK or previous eye injections, if you have had a blow to the eye, if your other eye has ever detached, and whether retinal detachment runs in your family. Give a full list of your medicines, especially blood thinners, and do not stop any of them yourself but ask your doctor. Tell the team if you have diabetes or high blood pressure, and never miss the appointment even if the symptoms seem to have settled.
After the procedure
Use the prescribed drops exactly on schedule, avoid rubbing or pressing on the eye, and wear the protective shield if you are given one. Avoid strenuous exertion, heavy lifting, prolonged bending and swimming for the period your doctor specifies, and if a gas bubble was injected, keep to the prescribed head posture precisely, **do not travel by air or go to high altitude, and tell any anaesthetist that the bubble is present**. Expect some floaters, light sensitivity and blurring for a few days. **Seek same-day review if flashes return or floaters suddenly increase, if the shadow or curtain enlarges, if vision drops again, if you develop severe eye pain, or marked redness with reduced vision, since these can indicate a new or extending detachment or inflammation.** Keep every follow-up appointment and have your other eye examined periodically as advised.
Expected duration
A dilated retinal examination usually takes 30 to 60 minutes, most of it waiting for the drops to work. The laser session itself takes 10 to 30 minutes, and cryotherapy slightly longer. You go home the same day, and blurred vision lasts hours to days. The first review is within days, then visits over weeks and months, while a gas bubble absorbs over one to several weeks.
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