Literature discussing fellow eye risk in patients with rhegmatogenous retinal detachment secondary to posterior vitreous detachment (PVD) is limited, particularly in sub-groups where this risk may be greater than the general population. In this retrospective consecutive case series with 107 study patients, the risk of retinal tears in fellow eyes of patients with horseshoe tears in 3 or more quadrants of their presenting eye, secondary to PVD, was 81%. The fellow eye risk is high in this subgroup of patients, and it is important to inform them to seek prompt attention when symptoms of PVD develop in their fellow eye.