Retinal Tear and Detachment

As the eye ages and the vitreous shrinks and pulls away from the retina flashes and floaters may be seen (see Flashes and Floaters). Sometimes the vitreous gel pulls hard enough to tear the retina in one or several places. Fluid is then able to pass through the tear and under the retina and gradually lift the retina off the back of the eye (rather like wall paper peeling off a wall). In this way a retinal tear can become a retinal detachment.

Retinal tears are commonly due to vitreous detachment, but can be associated with previous ocular surgery or trauma. An increased risk for retinal detachment is present in highly myopic patients, those who have had previous retinal detachment in the fellow eye, or a family history of retinal detachment. Any previous eye surgery or eye injury can increase the risk for retinal detachment, as can areas of thinning in the retina that can be detected on dilated ocular examination (such as Lattice Degeneration).

It is possible to have retinal tears without symptoms, however more commonly a patient will notice a sudden onset of flashes and increased floaters, blurred vision or loss of vision, a shadow in one side of the visual field, or the impression of a curtain moving up and down or sideways in their vision.

If you have risk factors for retinal detachment and experience any of these signs or symptoms, you should see your Optometrist or Ophthalmologist immediately. It is recommended that patients who are very myopic or have a family history of retinal problems should have regular dilated eye examinations, as some retinal tears and detachments are found during routine examinations, without symptoms.

Retinal tears may be treated with retinal laser to seal the retina to the back wall of the eye. The laser creates small burns around the tear, and the resulting scar prevents fluid getting through the tear and so helps to prevent a retinal detachment. This treatment can be performed in rooms with minimal discomfort.

Retinal detachments will generally require surgery to reattach the retina. Without surgery the retina will lose function and blindness can result. The surgery may be either vitrectomy or scleral buckling surgery. Vitrectomy surgery is the removal of the vitreous jelly to remove traction on the retina and also to remove factors in the gel that contribute to retinal scarring. Retinal laser or cryosurgery is performed during the surgery, and a gas is also injected into the eye to apply pressure to the retina. In some cases silicon oil is used to flatten the retina. Vitrectomy surgery is often used together with scleral buckling surgery. This surgery involves the use of a flexible reinforcing band around the eye to close the retinal tear. It is used together with cryotherapy to seal the tears and again air, gas or oil may be injected into the eye to assist with closing the tears. Scleral buckles remain in place as part of the wall of the eye, but can occasionally need to be removed later on.

Following retinal detachment surgery, vision will not be at its best until up to a year later. Completely normal vision may not return due to photoreceptor layer damage. The improvement seen will be dependent on the size of the detachment and the time the detachment was present before surgery.