Retinal tears are a serious eye condition that can lead to permanent vision loss if left untreated.
What is a retinal tear?
The retina is the multilayered neural tissue lining the inside of the eye that creates a spatiotopic view of the world around us, and transmits it to the brain via the optic nerves to create the basis for vision. A retinal tear is a term to describe when the vitreous gel tugs on retinal tissue at an abnormal attachment site between the vitreous and the retina, causing a flap tear in the retina. The tear can allow fluid within the vitreous cavity to seep under the retina, causing a retinal detachment. Vitreous traction often occurs in the setting of a vitreous detachment, which often occurs with age, but can occur in younger patients with uveitis, vitreous hemorrhage, ocular trauma, myopia, or with a history of intraocular surgery.
What are the symptoms of a retinal tear?
Photopsias, where one sees flashing lights in the side vision, and the presence of new tiny floaters often too many to count.
What are the causes of a retinal tear?
Tears often result in the setting of a posterior vitreous detachment, which is an age-related process. Only a small percentage of those with a posterior vitreous detachment develop tears. A posterior vitreous detachment often occurs after the fifth decade of life.
How is a retinal tear diagnosed?
A dilated fundus examination to evaluate the peripheral retina is necessary. Scleral depression or indentation, where the specialist presses on the sclera to bring the peripheral retinal tissue into focus is often utilized. When the ocular media is cloudy due to hemorrhage or some other condition, an ultrasound of the eye is useful.
What are the treatments of a retinal tear?
Laser retinopexy: applying laser spots surrounding the tear in several rows of laser. This causes an intentional scar around the tear to lessen the chance of a tear leading to a retinal detachment.
Cryopexy: often when laser retinopexy cannot be delivered through an opaque ocular media, cryo or freezing treatment can.
Observation: sometimes recommended for tears that appear old in nature, or ones where an operculum has developed overlying the tear. When an operculum occurs, the vitreous traction on the retina spontaneously resolves because the vitreous gel pulls a piece of retina off, reducing future risk of detachment.
Vitrectomy: when significant bleeding/hemorrhage from the retinal tear blocks the view to adequately deliver laser or cryo treatment to the area of retina around a tear, a vitrectomy may need to be performed with urgency to lessen a chance of a retinal detachment, and to treat the retina around the tear.