What is Tractional Retinal Detachment?
The retina is the light-sensitive layer at the back of the eye that captures light and sends signals to the brain for vision. In tractional retinal detachment, scar tissue forms on the retina and gradually contracts, pulling it away from the underlying layer. Unlike other types, there is no tear—this is a slow, progressive separation caused by traction over time.
Understanding Tractional Retinal Detachment
Think of the retina as a thin carpet laid across the back of a room. In tractional retinal detachment, adhesive bands of scar tissue form on top of the carpet and then shrink. As they shrink, they pull the carpet upward and away from the floor. Once the carpet lifts, it no longer lies flat and cannot function as it should.
These scar tissue bands form as a result of abnormal new blood vessels that grow in certain eye diseases, most commonly diabetic retinopathy. In diabetic retinopathy, high blood sugar damages the small blood vessels of the retina over time. The damaged vessels leak and close off. In response, the eye tries to grow new replacement vessels. But these new vessels are fragile, poorly formed, and grow into the vitreous gel that fills the eye. When these vessels bleed or are resorbed, they leave behind fibrous scar tissue. It is this scar tissue that contracts and causes the tractional pull on the retina.
Because tractional retinal detachment often develops slowly, the early changes can be entirely without symptoms. By the time a person notices blurring, distortion, or a change in their visual field, the detachment may already be significant. This is why regular retinal screening for people with diabetes is so critical.
What are the Symptoms of Tractional Retinal Detachment?
The tractional retinal detachment symptoms develop gradually rather than suddenly, which is what sets them apart from the more abrupt presentation of tear-related retinal detachment. Because the symptoms of tractional retinal detachment come on slowly, people often attribute the changes to their general diabetes-related vision problems and delay seeking care. Recognising these specific warning signs can make a significant difference to the outcome.
Tractional Retinal Detachment Symptoms to Watch For
Symptom | What it feels like | |
🌫️ | Gradual blurring of vision | Vision slowly becomes less clear, particularly in one eye |
📉 | Progressive visual field loss | A dark or blurred area spreading across part of the visual field |
📏 | Distortion of straight lines | Lines that should appear straight, such as doorframes or road edges, look bent or wavy |
🖼️ | Central vision affected | When the detachment reaches the macula, central vision becomes significantly blurred |
🪰 | Floaters | New dark shapes drifting across the vision, caused by bleeding from abnormal blood vessels |
🌑 | Shadow or curtain | A dark area in vision that slowly grows larger over time |
💡 | Light sensitivity | In some cases, bright light feels more uncomfortable as the retina is affected |
How Tractional Differs from Tear-Related Retinal Detachment Symptoms
Feature | Tractional retinal detachment | Tear-related (Rhegmatogenous) detachment |
Onset | Gradual, over weeks to months | Sudden, over hours to days |
Pain | Usually painless | Painless |
Floaters | May be present due to bleeding | Sudden shower of new floaters is a classic sign |
Flashes of light | Less typical | Common warning sign |
Who is most at risk | Diabetic patients, sickle cell disease | Older adults, high myopia |
When Should You See a Doctor?
Please visit an eye specialist if you have diabetes and notice:
- Any change in your vision, even if gradual
- Straight lines appearing wavy or bent
- A dark or blurred area appearing in any part of your visual field
- New floaters or a sudden increase in existing floaters
- Vision in one eye that seems to be slowly getting worse despite glasses being correct
Anyone with diabetes should have a dilated retinal examination at least once a year, even if they have no eye symptoms. By the time tractional retinal detachment symptoms are noticed, significant damage may already have occurred.
What are the Types of Tractional Retinal Detachment?
There are two main ways doctors classify the types of tractional retinal detachment: by how far the detachment has spread, and by whether it is pure tractional or combined with a retinal tear. Understanding the types of tractional retinal detachment helps determine the urgency and type of treatment needed.
By Location
Extramacular Tractional Retinal Detachment In this type, the detachment is present in the peripheral retina but has not yet reached the macula. The macula is the central part of the retina responsible for the detailed, sharp vision used for reading, recognising faces, and watching television. Because the macula is still attached and working, central vision may still be relatively preserved. However, peripheral vision may already be affected. This type needs to be closely monitored and treated promptly to prevent the detachment from reaching the macula.
Macular Tractional Retinal Detachment When the scar tissue pulls the detachment into the macula, central vision is directly affected. This is a more urgent situation. Once the macula detaches, central vision deteriorates significantly and recovering good central vision after surgical repair becomes more difficult, even when surgery is technically successful. Acting before the macula is involved always gives a better visual outcome.
By Nature of the Detachment
Pure Tractional Retinal Detachment Caused solely by contracting scar tissue with no tear or break in the retina. This is the most common form, particularly in diabetic retinopathy.
Combined Tractional-Rhegmatogenous Retinal Detachment In this type, the pulling force of the scar tissue has eventually created a break or tear in the retina. Fluid from inside the eye can then pass through the tear and accelerate the detachment. This combined type progresses faster than pure tractional retinal detachment and needs urgent surgical attention.
What Causes Tractional Retinal Detachment?
The causes of tractional retinal detachment all share a common mechanism: abnormal tissue growing on or into the vitreous gel inside the eye contracts over time and pulls the retina out of position. The most common cause in India by a significant margin is diabetic retinopathy, but other conditions can cause the same process.
Common Causes of Tractional Retinal Detachment
Diabetic Retinopathy (Proliferative Stage) This is the single most common cause of tractional retinal detachment in India and globally. When diabetes is poorly controlled over many years, it causes progressive damage to the tiny retinal blood vessels. In the advanced stage called proliferative diabetic retinopathy, the eye responds by growing new abnormal blood vessels (neovascularisation) that extend into the vitreous. These vessels are fragile and bleed easily. As they are resorbed, they leave behind fibrovascular scar tissue. When this scar tissue contracts, it pulls on the retina causing tractional retinal detachment.
The risk is directly related to how long a person has had diabetes and how well it has been controlled. People who have had diabetes for more than 15 to 20 years without good sugar control are at significantly higher risk.
Sickle Cell Disease Sickle cell disease causes abnormal red blood cells that can block the small retinal vessels, promoting abnormal new vessel growth and scarring, similar to the process in diabetes. Tractional retinal detachment is a known complication in advanced sickle cell retinopathy.
Retinopathy of Prematurity (ROP) Premature babies who develop abnormal retinal blood vessel growth as part of ROP can develop tractional retinal detachment if the condition progresses to its advanced stages. This is one of the more common causes in neonatal eye care in India.
Penetrating Eye Injury or Previous Surgery Trauma to the eye, particularly injury that penetrates the eye wall, can introduce fibrotic tissue that contracts and pulls on the retina. Previous eye surgeries can sometimes also be associated with this process.
Proliferative Vitreoretinopathy (PVR) This is a complication that can occur after any type of retinal detachment surgery. Cells proliferate and form membranes on the retina and vitreous surface that contract and cause a tractional type of re-detachment. It is one of the main reasons why some retinal detachments require more than one operation.
How is Tractional Retinal Detachment Diagnosed?
Diagnosing tractional retinal detachment requires a thorough examination of the retina. Because the changes can be subtle in the early stages, a dilated retinal examination is essential. A regular vision test at an optician is not sufficient to detect early tractional retinal detachment, as the retina cannot be properly examined without dilating the pupil.
Diagnostic Tests Used
Test | What it checks |
Dilated fundus examination | The pupil is widened with eye drops so the retina can be viewed in full, identifying the extent of scar tissue and detachment |
Optical Coherence Tomography (OCT) | A scan that gives a detailed cross-section of the retina, showing whether the macula is involved and the degree of traction |
B-scan ultrasound | When bleeding inside the eye blocks the view of the retina, ultrasound can reveal the presence and extent of a detachment |
Fundus fluorescein angiography | A dye is injected and photographs are taken to map the retinal blood vessels and identify areas of leakage or abnormal new vessels |
Blood tests and HbA1c | Assesses blood sugar control, which is relevant both for diagnosis and surgical planning |
What Does Tractional Retinal Detachment Treatment Look Like?
Tractional retinal detachment treatment depends on how far the detachment has spread, whether the macula is involved, and the overall condition of the eye and the patient’s general health. Not every case of tractional retinal detachment requires immediate surgery. However, once the macula is involved or the detachment is progressing, tractional retinal detachment treatment cannot be delayed.
Tractional Retinal Detachment Treatment Options
- Controlling the Underlying Condition: Foundation of all tractional retinal detachment treatment Managing diabetes, blood pressure, and cholesterol is not just background care. It is an active part of tractional retinal detachment treatment. Poor blood sugar control accelerates the growth of new abnormal vessels and scar tissue, making the situation worse. Every stage of tractional retinal detachment treatment is more effective when the underlying condition is properly managed. Patients are advised to work closely with their physician alongside their eye specialist.
- Observation and Monitoring: Extramacular detachment, macula not yet involved
When tractional retinal detachment is identified but the macula remains attached and the detachment appears stable, a period of careful monitoring may be appropriate before surgery. The patient is reviewed at regular short intervals with OCT scans to track whether the detachment is progressing. This period also allows time to optimize blood sugar control and assess whether anti-VEGF injections can help stabilize the situation. - Anti-VEGF Injections: Reducing abnormal vessel activity before surgery
Anti-VEGF (anti-vascular endothelial growth factor) injections are medicines injected into the eye that reduce the activity of the abnormal new blood vessels driving the process. As a standalone tractional retinal detachment treatment, they do not remove scar tissue or reattach the retina. However, they are frequently given one to two weeks before surgery to shrink the abnormal vessels and reduce the risk of bleeding during the operation. In some carefully selected cases with mild traction, they may help stabilize early changes over time. - Vitrectomy Surgery: Primary surgical tractional retinal detachment treatment
Vitrectomy is the cornerstone surgical tractional retinal detachment treatment. In this procedure, the surgeon removes the vitreous gel from inside the eye through small incisions. This exposes the scar tissue on the retina, which is then carefully peeled away or cut using very fine instruments. Once the traction is released, the retina can settle back into its normal position. A gas bubble or silicone oil is then placed inside the eye to hold the retina flat while healing occurs.
Tractional retinal detachment surgery is technically complex, requiring significant expertise, particularly when the scar tissue is dense and adherent to the retina in multiple locations. At Vasan Eye Care, our vitreoretinal surgeons are trained in advanced techniques for diabetic tractional retinal detachment surgery, which represents some of the most challenging work in retinal surgery.
After tractional retinal detachment surgery, patients with a gas bubble may need to maintain a specific head position for several days. Those who receive silicone oil may require a second procedure to remove it at a later date. Recovery of vision depends significantly on whether the macula was involved at the time of surgery. - Laser Treatment (Scatter Photocoagulation): Reducing abnormal vessel growth, often combined with surgery
Laser treatment applied to the peripheral retina (panretinal photocoagulation, or PRP) reduces the stimulus driving the growth of abnormal new vessels. It is used both as a preventive measure in proliferative diabetic retinopathy before tractional retinal detachment develops, and as a supporting treatment alongside or following tractional retinal detachment surgery.
Tractional Retinal Detachment and Diabetes: The Indian Context
India has one of the world’s largest populations of people with diabetes, with over 77 million diagnosed cases and a significant additional number undiagnosed. This creates a substantial burden of diabetic eye complications, including tractional retinal detachment.
Several factors contribute to why tractional retinal detachment is seen at advanced stages in India:
Late diagnosis of diabetes: Many people in India are diagnosed with diabetes only after it has been present for several years, sometimes discovered incidentally or when complications have already begun. By this time, retinal changes may already be developing.
Irregular retinal screening: Annual dilated retinal examinations are not yet a routine practice for all diabetic patients in India, particularly in smaller cities and rural areas. Many patients are unaware that diabetes affects the eyes, or they attend a general physician who does not refer them for retinal screening unless they complain of vision problems.
Gap between vision symptoms and underlying damage: Because tractional retinal detachment develops gradually and can be painless for a long time, patients often do not seek eye care until vision is significantly affected. At that point, the macula is often already involved.
Poor glycaemic control: A significant proportion of diabetic patients in India do not achieve adequate blood sugar targets, either because of limited access to care, cost of medications, or insufficient awareness about the relationship between blood sugar and eye complications.
Vasan Eye Care’s network of centres across South India and beyond plays an important role in improving access to retinal screening. Bringing the eye examination closer to patients and raising awareness about the link between diabetes and vision are central to reducing the burden of tractional retinal detachment in India.
Anti-VEGF Injections for Tractional Retinal Detachment: What Patients Should Know
Anti-VEGF injections are a relatively recent addition to the treatment landscape for diabetic retinal disease and tractional retinal detachment. Many patients ask about them, so here is a plain explanation.
VEGF stands for vascular endothelial growth factor, a protein that stimulates the growth of new blood vessels. In proliferative diabetic retinopathy, VEGF is present in high amounts, driving the growth of the abnormal new vessels that eventually cause tractional retinal detachment.
Anti-VEGF medicines, such as Bevacizumab, Ranibizumab, and Aflibercept, are injected in very small amounts directly into the eye. They block the VEGF protein and reduce the activity of abnormal new vessels. When given one to two weeks before vitrectomy surgery, they shrink these vessels and reduce bleeding risk during the operation, making tractional retinal detachment surgery safer and easier to perform.
The injection itself takes only a few minutes and is done under local anaesthetic eye drops. Patients may feel pressure during the injection but generally tolerate it well. Mild redness and irritation for a day or two are common and settle on their own.
Tractional Retinal Detachment Surgery: What to Expect
For patients and families preparing for vitrectomy to treat tractional retinal detachment, here is what the process typically looks like:
Before surgery:
- Blood tests, blood sugar measurement, and a general health assessment
- Anti-VEGF injection given one to two weeks before the planned surgery in most cases
- Detailed discussion of what the surgery involves, what outcomes are realistic, and what to expect in recovery
During surgery:
- Performed under local or general anaesthesia, typically taking one to three hours depending on severity
- Three small incisions are made in the white of the eye
- The vitreous gel is removed
- Scar tissue is carefully peeled from the retinal surface using fine instruments
- A gas bubble or silicone oil is placed inside the eye to hold the retina in position
- The small incisions are self-sealing or closed with small stitches
After surgery:
- The eye is patched and reviewed the day after surgery
- Head positioning instructions are given if a gas bubble is used
- Eye drops are prescribed for several weeks to prevent infection and reduce inflammation
- Vision may be reduced or blurry in the first weeks while the gas is still in the eye
- Follow-up reviews at one week, one month, three months, and six months to track recovery
Tractional Retinal Detachment Care at Vasan Eye Care
Tractional retinal detachment is one of the more complex retinal conditions requiring a high level of surgical skill and careful patient management. At Vasan Eye Care, our retinal specialists provide the full range of assessment and treatment for this condition across our network.
When you come to us with tractional retinal detachment, here is what you can expect:
- A dilated retinal examination with OCT and fundus imaging on the same visit
- A clear explanation of the stage of your condition and what it means for your vision
- An honest discussion of whether monitoring, injection treatment, or surgery is the appropriate next step
- Access to vitreoretinal surgery at our equipped centres
- Coordination with your physician or endocrinologist for blood sugar management alongside the eye treatment
- Close follow-up to monitor recovery and check the other eye
Our 500+ eye care specialists across 150+ centres are part of ASG Enterprises, India’s largest eye care network. For appointments, call 1800 571 2222 or visit your nearest Vasan Eye Care centre.
Simple Guide to Tractional Retinal Detachment Terms
| Word or phrase | What it means in simple terms |
| Retina | The light-sensitive layer at the back of the eye that allows us to see |
| Tractional retinal detachment | When scar tissue pulls the retina away from its normal position |
| Vitreous | The gel-like fluid that fills the inside of the eye |
| Macula | The central part of the retina responsible for sharp, detailed vision |
| Neovascularisation | The growth of new, abnormal blood vessels in response to retinal damage |
| Fibrovascular scar tissue | The fibrous tissue that forms when abnormal vessels are resorbed, which then contracts |
| Proliferative diabetic retinopathy | The advanced stage of diabetic eye disease with new blood vessel growth |
| Anti-VEGF injection | A medicine injected into the eye to reduce abnormal blood vessel activity |
| Vitrectomy | Surgery to remove the vitreous gel and release scar tissue from the retina |
| Panretinal photocoagulation (PRP) | A type of laser treatment that reduces new blood vessel growth in the retina |
| OCT | Optical coherence tomography, a scan that shows a detailed cross-section of the retina |
| Silicone oil | A material used to hold the retina in place after surgery, removed in a second operation |
RELATED EYE CONDITIONS
- Diabetic Retinopathy
- Rhegmatogenous Retinal Detachment
- Retinopathy of Prematurity
- Proliferative Vitreoretinopathy
- Diabetic Macular Oedema
REFERENCES
- Yanoff M, Duker JS. Tractional Retinal Detachment. StatPearls, National Library of Medicine. Updated 2023.
https://www.ncbi.nlm.nih.gov/books/NBK558952/ - Medical News Today. Tractional Retinal Detachment: Causes, Diagnosis and Treatment. Reviewed January 2024.
https://www.medicalnewstoday.com/articles/tractional-retinal-detachment - Hussain N, et al. Current management of diabetic tractional retinal detachment. Indian Journal of Ophthalmology. 2018;66(12):1751. https://journals.lww.com/ijo/fulltext/2018/66120/current_management_of_diabetic_tractional_retinal.16.aspx
- Cleveland Clinic. 9 Tips for Treating Diabetic Tractional Retinal Detachment. https://consultqd.clevelandclinic.org/9-tips-for-treating-diabetic-tractional-retinal-detachment
- Mayo Clinic. Retinal Detachment: Diagnosis and Treatment. Last reviewed 2023. https://www.mayoclinic.org/diseases-conditions/retinal-detachment/diagnosis-treatment/drc-20351348
For appointments, call 1800 571 2222 or visit your nearest Vasan Eye Care centre.
Frequently Asked Questions (FAQs)
Tractional retinal detachment cannot be reversed without surgery, and there is no medicine that can reattach a detached retina or remove scar tissue. Surgery, specifically vitrectomy, is the only way to release the scar tissue pulling the retina and allow it to return to its normal position. Whether vision is restored depends heavily on how early tractional retinal detachment treatment is received. If the macula (the central part of the retina) was still attached at the time of surgery, there is a significantly higher chance of preserving useful central vision. If the macula has been off for a long time, central vision may not fully recover even after a successful operation. This is why acting before the macula detaches is so important.
From the patient’s perspective, tractional retinal detachment typically causes a gradual loss of vision, distortion of straight lines, and a dark or blurred area in the visual field that slowly expands. Unlike tear-related detachment, there is usually no sudden curtain effect or shower of floaters. For the doctor examining the retina, tractional retinal detachment appears as a tented or elevated area of the retina, often with white fibrous scar tissue bands visible pulling it upward from the surface. OCT scans give a detailed cross-section view that can show the exact extent of traction and whether the macula is involved.
It depends on the stage. If the macula is still attached, tractional retinal detachment is not an immediate emergency in the way a sudden tear-related detachment is, but it is urgent. Any detachment involving or rapidly approaching the macula requires prompt surgical attention, typically within days to a few weeks, not months. A combined tractional-rhegmatogenous detachment, where a tear has also developed, is urgent and needs to be operated on much sooner. The advice to anyone with diagnosed tractional retinal detachment is always to follow up closely and not delay when the doctor recommends intervention.
Diabetic retinopathy, specifically its advanced stage called proliferative diabetic retinopathy, is by far the most common cause of tractional retinal detachment worldwide and in India. When diabetes is poorly controlled over many years, it damages the retinal blood vessels. In response, the eye grows new abnormal vessels that eventually leave behind scar tissue. This scar tissue contracts and pulls the retina away. In India, where diabetes is extremely prevalent and many patients do not receive regular retinal screening, tractional retinal detachment from diabetic retinopathy is seen frequently in advanced stages that could have been prevented or caught earlier.
In many cases, yes. For patients with diabetes, the most effective prevention for tractional retinal detachment is good blood sugar control from the beginning, combined with regular annual retinal examinations. Laser treatment (panretinal photocoagulation) applied early in proliferative diabetic retinopathy can significantly reduce the stimulus for abnormal new vessel growth and prevent progression to tractional retinal detachment. Anti-VEGF injections are also used in some cases to reduce new vessel activity before scarring develops. The key is detecting the early stages of proliferative retinopathy before scar tissue has formed and while intervention can still prevent a detachment.
Recovery after vitrectomy for tractional retinal detachment is gradual. In the first few weeks, the eye will be sore and vision may actually be reduced, particularly if a gas bubble has been placed inside the eye. The gas bubble is gradually absorbed over four to eight weeks, depending on the type used. During this period, specific head positioning is often required to keep the bubble pressing against the retina. If silicone oil has been used, a second operation to remove it is usually planned three to six months after the first. Overall vision stability takes three to six months after surgery, and in some patients, further improvement continues over a year. The final visual outcome depends on how long the macula was detached and the degree of pre-existing retinal damage from diabetes.
Yes, absolutely. In diabetic patients with tractional retinal detachment in one eye, the other eye is at significant risk of developing similar changes, particularly if blood sugar has been poorly controlled. Both eyes should be examined in detail when tractional retinal detachment is found in one eye. Preventive treatment, such as laser photocoagulation for proliferative retinopathy, may be recommended for the other eye before any tractional changes develop there.
The surgery itself changes the internal structure of the eye, particularly the vitreous, and this can affect the spectacle number. Most patients find their spectacle prescription changes after vitrectomy. An updated spectacle check is typically done three to six months after surgery once the eye has stabilised. If silicone oil was used, the spectacle assessment is done after the oil has been removed. Maximising the quality of vision through the correct spectacle correction after surgery is an important part of the overall recovery.
RELATED EYE CONDITIONS
- Diabetic Retinopathy
- Rhegmatogenous Retinal Detachment
- Retinopathy of Prematurity
- Proliferative Vitreoretinopathy
- Diabetic Macular Oedema
REFERENCES
- Yanoff M, Duker JS. Tractional Retinal Detachment. StatPearls, National Library of Medicine. Updated 2023. ncbi.nlm.nih.gov/books/NBK558952 https://www.ncbi.nlm.nih.gov/books/NBK558952/
- Medical News Today. Tractional Retinal Detachment: Causes, Diagnosis and Treatment. Reviewed January 2024. medicalnewstoday.com/articles/tractional-retinal-detachment https://www.medicalnewstoday.com/articles/tractional-retinal-detachment
- Hussain N, et al. Current management of diabetic tractional retinal detachment. Indian Journal of Ophthalmology. 2018;66(12):1751. journals.lww.com/ijo/fulltext/2018/66120/current_management_of_diabetic_tractional_retinal.16.aspx https://journals.lww.com/ijo/fulltext/2018/66120/current_management_of_diabetic_tractional_retinal.16.aspx
- Cleveland Clinic. 9 Tips for Treating Diabetic Tractional Retinal Detachment. consultqd.clevelandclinic.org/9-tips-for-treating-diabetic-tractional-retinal-detachment https://consultqd.clevelandclinic.org/9-tips-for-treating-diabetic-tractional-retinal-detachment
- Mayo Clinic. Retinal Detachment: Diagnosis and Treatment. Last reviewed 2023. mayoclinic.org/diseases-conditions/retinal-detachment/diagnosis-treatment/drc-20351348 https://www.mayoclinic.org/diseases-conditions/retinal-detachment/diagnosis-treatment/drc-20351348
For appointments, call 1800 571 2222 or visit your nearest Vasan Eye Care centre.
