Background <p>Adult-onset Coats’ disease is an uncommon, vision-threatening disorder characterized by exudation and vascular abnormalities in the peripheral and macular regions. Retinal detachment is typically exudative, while rhegmatogenous retinal detachment (RRD) in this context is rare. Here, we describe a case of adult-onset Coats’ disease presenting with retinal detachment associated with an identifiable retinal break.</p> Case presentation <p>A 34-year-old man presented with a one-day history of decreased vision and a sensation of shadowing in his left eye. Dilated funduscopy of the left eye revealed telangiectatic and aneurysmal vessels in the superior quadrant, along with intraretinal exudation. A retinal break was identified in the periphery, along with retinal detachment in the superotemporal quadrant. Pars plana vitrectomy (PPV) with silicone oil tamponade achieved successful retinal reattachment. Silicone oil was removed three months later. During follow-up, best-corrected visual acuity (BCVA) in the left eye improved from 6/15 to 6/10; the postoperative course was uneventful.</p> Conclusion <p>This case demonstrates the occurrence of retinal breaks in adult-onset Coats’ disease, particularly in areas of peripheral retinal ischemia. Clinicians should maintain a high index of suspicion for this rare possibility to facilitate timely diagnosis and surgical intervention.</p>