# Retinal Detachment Types > Retinal detachment types for MBBS Ophthalmology: rhegmatogenous tractional exudative, photopsia floaters curtain, Shafer sign, buckling and vitrectomy. - Canonical URL: https://prepelephant.com/topics/mbbs/ophthalmology/retinal-detachment-types - Exam / course: MBBS · Subject: Ophthalmology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Retinal Detachment Types", PrepElephant, https://prepelephant.com/topics/mbbs/ophthalmology/retinal-detachment-types ## Direct answer Retinal detachment is separation of the neurosensory retina from the retinal pigment epithelium, and its three mechanisms define its three types: rhegmatogenous, where fluid enters through a hole or tear (the commonest type, after posterior vitreous detachment, lattice degeneration, trauma or aphakia); tractional, where vitreoretinal membranes in proliferative diabetic retinopathy pull the retina off without a break; and exudative or serous, where fluid accumulates beneath an intact retina from choroidal tumours, inflammation like Vogt-Koyanagi-Harada or posterior scleritis. Warning symptoms of the rhegmatogenous type — sudden flashes, a shower of floaters, then a spreading curtain — are an emergency because an attached macula decides the outcome; surgery is scleral buckling, vitrectomy or pneumatic retinopexy with laser or cryotherapy to seal the break. ## What you must remember - **Three types, three mechanisms:** rhegmatogenous — a full-thickness retinal break lets liquefied vitreous beneath the retina; tractional — contracted fibrovascular membranes drag the retina; exudative — subretinal fluid from leaky choroidal vessels with no break; identifying the type is the diagnostic task, because treatments diverge. - **Rhegmatogenous risk profile:** posterior vitreous detachment of age, lattice degeneration, high myopia, previous cataract surgery, trauma and fellow-eye history; the horseshoe tear at the posterior edge of the vitreous base is the classic culprit. - **Symptom triage that saves the macula:** photopsia (flashes), new floaters (vitreous haemorrhage or pigment), and a shadow or curtain progressing as detachment extends — any combination warrants urgent dilated examination with indentation; a curtain crossing the centre means the macula is newly off. - **Signs:** the detached retina loses transparency, ballooning grey with folds that shift with eye movement; the break is found by systematic search; tobacco dust (Shafer sign) is strong evidence of a break; intraocular pressure is often low. - **Tractional detachment logic:** proliferative diabetic retinopathy is the archetype; the detachment has a concave, taut configuration with no shifting fluid, and treatment is vitrectomy with membrane peel plus endolaser, often after preoperative anti-VEGF; a shallow stable detachment can be observed. - **Exudative detachment logic:** shifting subretinal fluid that re-deploys with posture, an absent break, and a cause-seeking workup — B-scan for a choroidal mass (melanoma, haemangioma), inflammatory markers for VKH and posterior scleritis; treatment is of the underlying lesion, never retinal surgery. - **Surgical menu:** scleral buckling (cryopexy plus silicone explant) for suitable superior peripheral breaks; pars plana vitrectomy with gas or oil for complex, giant tear or tractional cases; pneumatic retinopexy for selected superior small breaks; laser demarcation for small stable ones. - **Postoperative realities:** positioning with gas tamponade, no air travel with intraocular gas (expansion at altitude), cataract after vitrectomy, re-detachment risk — and examination of the fellow eye with prophylactic treatment of high-risk lattice. ## How to work through a curtain across the vision A 62-year-old myopic man reports a week of flashes and floaters, then since yesterday a grey curtain rising from below; vision is 6/18 with a superior field restriction. Walk the pathway: urgency first — the curtain's edge has not crossed fixation, so the macula may still be on; dilate and examine with indirect ophthalmoscopy and indentation: a grey, mobile superior bullous detachment tracks a horse-shoe tear at 11 o'clock with tobacco dust. The operation follows the break: a superior break suits scleral buckling with cryotherapy, while many units favour vitrectomy with gas in the pseudophakic; either way, the aim is to close the break, not to "drain fluid". Contrast him with the 38-year-old with poorly controlled type 1 diabetes whose dense fibrovascular membranes have tented the inferior retina in a concave, immobile dome: that is tractional detachment — vitrectomy with membrane peeling and endolaser. And a dome-shaped detachment with shifting fluid, no break and a cannon-ball shadow on ultrasound is a choroidal melanoma — where "retinal detachment" stops being a diagnosis and becomes a sign. ## Where students slip The commonest error is treating "retinal detachment" as a single disease with a single operation — examiners build stems around the type, and "buckle" answered to a diabetic tractional or an exudative detachment of VKH is wrong twice over. The second slip is missing the acute posterior vitreous detachment: not every flash-floater presentation is a detachment, but every one needs a peripheral examination to exclude a tear — sealing a fresh tear with laser before fluid tracks beneath it is the cheapest sight-saving procedure in ophthalmology. ## Frequently asked questions ### What distinguishes the three types of retinal detachment? Rhegmatogenous has a retinal break with fluid entry; tractional has vitreoretinal pulling, classically from proliferative diabetic membranes; exudative has subretinal fluid from choroidal disease with an intact retina. ### What is Shafer sign? Tobacco dust — pigment granules in the anterior vitreous — strongly suggesting a retinal break, hence a rhegmatogenous detachment. ### Why does exudative detachment show shifting fluid? The subretinal fluid is serous and mobile, redistributing with posture to the dependent position, unlike the fixed configuration of rhegmatogenous or tractional detachments. ### Which operations treat rhegmatogenous detachment? Scleral buckling with cryotherapy, vitrectomy with gas or oil tamponade, and pneumatic retinopexy for selected superior breaks — all aimed at closing the causative break. ### Why is macular status the key prognostic factor? A detachment sparing the macula retains good central vision with prompt surgery; once it detaches, final acuity is limited by photoreceptor damage — hence the urgency of the curtain presentation.