Retinal Tears, Holes and Detachments

What causes a retinal tear or detachment?

Development of a retinal tear is usually a spontaneous event caused by natural changes in the vitreous, which is the gel-like substance that fills the eye. Early in life, the vitreous is adherent to the surface of the retina (the tissue lining the inside of the eye which is responsible for converting light into an image). At some point in most individuals, the adhesion between the retina and vitreous weakens, and the vitreous separates from the retinal surface. This usually does not cause any problems. However, in some cases, the vitreous is stuck firmly to the retina in small areas and is unable to separate from it. Instead, the vitreous pulls on the retina and can cause the retina to tear open. This, in turn, can lead to retinal detachment.

Occasionally a patient will be diagnosed with a retinal ‘hole’ rather than a ‘tear.’ While this sounds similar, a retinal hole often implies that no traction on the retina from the vitreous is present, and the risk of serious complications developing is much lower. Treatment is often still indicated for retinal holes, but in some cases a retinal hole can be safely followed without requiring treatment.

What problems does a retinal tear cause?

A retinal tear can result in serious complications. As the retina tears, the retinal blood vessels may also tear and cause bleeding inside the eye. This is noted as dark floaters by the patient. Once a defect in the retina has formed, fluid from inside the eye can make its way underneath the retina and cause the retina to detach from the wall of the eye, which can lead to irreversible vision loss in some cases. Most retinal tears need to be treated promptly to prevent development of a retinal detachment. If a retinal detachment has already developed, this also needs urgent treatment in most cases.

What are the symptoms of a Retinal Tear?

Some retinal tears cause no symptoms and are only discovered when the doctor closely examines the inside of the eye. More often, tears come to attention because of sudden floaters or flashes of light in the visual field. If the retina begins to detach, loss of a portion of peripheral vision may be noted. People often use the words curtain or shadow to describe the related event. “It was like a dark curtain fluttered from the outside of my vision inward,” a common description.

What is the treatment for a Retinal Tear?

Retinal tears are usually treated preventively by applying laser around the area of the tear, a procedure called laser demarcation. This creates a strong bond around the edge of the tear between the retina and the eye wall. This treatment is effective at preventing development of a retinal detachment from a tear in well over 90% of cases. If significant bleeding is present however, this may impede the ability to apply laser treatment, and traditional surgery may be necessary. If a retinal detachment is present, surgery is usually indicated.