AbstractPurposeTo describe clinical characteristics and management in a large cohort of patients with retinal detachment due to a giant retinal tear (GRT).MethodsWe performed a retrospective cohort study with 222 eyes of 206 patients with a primary and non‐traumatic GRTs between 2005 and 2022. We analysed the relevant clinical and surgical data from these patients.ResultsEighty‐six per cent (n = 177) of patients were male. We observed no relation between refractive error and GRT size (Spearman's rho: r = −0.018, p = 0.83). We achieved a primary and final treatment success in 77%, respectively 92%, of eyes. The final visual outcome was 20/40 or better in 65% and 36% of eyes in fovea‐on and fovea‐off GRTs respectively. Thirty‐five per cent (n = 73) of patients developed a retinal detachment in the fellow eye. The median time until a retinal detachment in the fellow eye occurred after GRT was 20 months, and 10% developed within 1 month. A prediction model for the development of retinal detachment in the fellow eye resulted in a receiver operating characteristics curve with an area under the curve of 0.68 (95% CI: 0.57–0.78, p = 0.001).ConclusionWe observed a highly significant gender imbalance in patients with a non‐traumatic GRT. One third of patients developed a retinal detachment bilaterally. Ten per cent of fellow eye's retinal detachment that develop after GRT, occur within 1 month. Clinical parameters showed limited predictive value for a retinal detachment in the fellow eye. These findings suggest an underlying genetic factor.