Retinal Tear Surgery: What It Involves And What To Expect
Seeing sudden floaters, flashes of light or a dark shadow in your side vision can be a sign that the retina has torn. The retina is a thin layer at the back of the eye that helps you see.
A retinal tear is not the same as a retinal detachment. But a tear can turn into a detachment, and that can happen quickly. This is why these symptoms are checked the same day, often during an eye exam.
Quick Overview
- Retinal tear surgery is usually a short treatment in a clinic, not a big operation. Which one is used depends on where the tear sits.
- It may be needed if you suddenly notice floaters, flashes of light or a shadow in your peripheral vision, and an eye doctor finds a tear.
- The goal is to seal the tear so fluid cannot get behind the retina. It does not bring back lost vision or clear away floaters.
- How a tear behaves afterwards depends on several factors, such as its size, type and position.
- Your symptoms and what the eye doctor sees during the exam usually guide what happens next.
Below, we explain what each treatment involves, what recovery is like, and when to get your eyes checked.
What Is A Retinal Tear?
The retina is a thin layer of tissue that lines the back of the eye. It senses light and sends pictures to your brain.
The middle of your eye is filled with a clear jelly called the vitreous gel. As we get older, this gel shrinks and pulls away from the retina. Most of the time nothing happens. Sometimes it pulls hard enough to make a small tear in the retina.
A tear matters because fluid can pass through it. If fluid gets behind the retina, it lifts the retina away from the underlying tissue. That is a retinal detachment, and it can cause permanent vision loss.
What Is Retinal Tear Surgery?
The word surgery sounds bigger than it is. To treat retinal tears, an eye surgeon usually does a short procedure in a clinic room. You go home the same day.
The aim is to create scar tissue around the tear. Scar tissue acts like glue and holds the retina to the layer underneath. Fluid then cannot get behind it.
There are two main treatment options.
Laser Photocoagulation (Laser Surgery)
Drops numb the eye. A special lens is placed on the front of the eye. The laser emits a beam of light through the lens, and that laser beam makes small burns in a ring around the tear. These burns heal into scar tissue.
The procedure usually takes 10 to 20 minutes. You will see bright light the whole time. Most patients say it feels uncomfortable rather than sore, but this is different for everyone. It can be more uncomfortable when the tear sits near the far edge of the retina.
Cryotherapy (Freezing)
Here, a cold probe is placed on the outside of the eye, over the tear. The freezing makes the same kind of scar tissue.
Freezing is often chosen when a tear is too far forward for the laser to reach, or when bleeding or cloudiness blocks the laser beam. It usually needs a stronger local anaesthetic than drops alone. You may be given an eye patch to wear for a short time afterwards.
Neither treatment clears away floaters, and neither brings back lost vision. The point is to preserve the vision you still have by stopping the tear from getting worse. Both are generally safe, but no procedure is completely free of potential risks, and your eye doctor will talk these through with you.
At Armadale Eye Clinic, our eye doctors check each tear with a dilated eye exam before talking about whether treatment is right for you.
What Are The Risk Factors For A Retinal Tear?
Multiple factors can raise your chance of a retinal tear:
- Being short-sighted. A more short-sighted eye often has a thinner retina at the edges.
- Eye trauma. A knock to the eye can tear the retina at any age.
- Past cataract surgery. This is linked with a higher long-term risk of detachment.
- Family history. A retinal detachment in a close relative raises your risk.
- A tear or detachment before. If one eye has had a detachment, the other eye is at higher risk too.
- Lattice degeneration. This is thinning at the edge of the retina, and it is often found alongside tears.
Various factors also change how a tear is treated. These include the size and type of the tear, where it sits, and how soon it is found. Small round holes without pulling are sometimes just watched instead of treated. Because several factors work together, two people with similar tears may be given different advice.
What Happens If A Retinal Tear Is Not Treated?
Fluid can pass through the tear and lift the retina off the underlying tissue. This is a retinal detachment. Left alone, it can cause permanent vision loss in that eye.
This is why sudden flashes of light, a burst of new floaters, reduced vision or a shadow across your peripheral vision should be checked the same day.
How Is A Retinal Detachment Repaired?
Once the retina has lifted, laser alone is not enough. Retinal detachment repair usually happens in an operating theatre. There are three main ways to do it, and they are sometimes used together.
Pneumatic Retinopexy
A gas bubble is placed inside the eye. The bubble presses the retina back against the wall of the eye. Laser or freezing then seals the tear. You need to hold your head in a set position for a few days so the bubble stays over the tear. You also cannot fly until the bubble has gone.
Scleral Buckle
A soft silicone band is placed around the outside of the eye. It gently presses the wall of the eye inwards. This takes the pulling pressure off the retina.
Vitrectomy
The vitreous gel is removed and replaced. It may be replaced with gas, which the body absorbs over a few weeks, or with silicone oil in harder cases. Silicone oil is usually taken out later in a second procedure.
Which one suits you depends on where the tears are and whether you have had cataract surgery before. It is also worth knowing that putting the retina back in place and getting vision back are two different things. How much vision returns depends a lot on whether the centre of the retina was affected, and for how long.
Recovering After Laser Surgery Or Freezing
Recovery is usually simple, but the first couple of weeks matter:
- Your vision will be blurry for a few hours while the drops wear off. Arrange a lift home instead of driving.
- Use any eye drops exactly as directed. Some reduce inflammation, and others prevent infection.
- Avoid strenuous activities, heavy lifting and contact sports for as long as your eye doctor says. This is often one to two weeks.
- Follow the specific instructions you are given. They are based on your eye, not a general rule.
- Go to all your follow-up appointments. The seal takes a few days to start forming and keeps getting stronger over the following weeks. New tears can also appear somewhere else.
- Tell your eye doctor straight away about new floaters, new flashes of light, a curtain across your side vision, reduced vision or severe pain.
Australian guidance is that sudden flashes or floaters with any loss of side vision should be seen by an eye specialist the same day. If you have had a tear in one eye, ask how often your other eye should be checked.
Looking After Your Eye Health
A retinal tear is not something to wait out. Getting it looked at early gives you the best chance to protect your eye health and keep the vision you have.
Treatment cannot remove every risk of a later detachment, and it cannot bring back vision you have already lost. What it can do is seal the tear before fluid gets behind it.
If you have noticed new floaters, flashes of light or any change in your vision, please contact Armadale Eye Clinic on (03) 9070 5753 Armadale Eye Clinic to book an eye exam.
Frequently Asked Questions
Does retinal tear surgery hurt?
Laser surgery and freezing are both done using local anaesthesia, and people describe it differently. Some find it only a little uncomfortable. Others find it sore, especially when the tear is near the far edge of the retina. A dull ache or headache for a day afterwards is common, particularly after freezing. Tell your eye doctor if you have severe pain, because that is not normal.
How long does it take to recover?
Your vision is blurry for a few hours while the drops wear off. Most people are back to normal activities within a day or two. Strenuous activities are usually put on hold for one to two weeks.
Can a retinal tear heal by itself?
Sometimes. Small round holes with no pulling on them are often just watched. But a tear that is causing symptoms is unlikely to seal on its own, and research shows a good number of these go on to become detachments.
Will I still see floaters afterwards?
Usually, yes. The treatment seals the tear. It does not touch the vitreous gel that is causing the floaters. Floaters often become less noticeable over weeks or months. A sudden increase should always be reported.
What are the potential risks and complications?
Laser and freezing are generally safe. Possible complications include swelling, a small amount of bleeding, infection, or a new tear forming elsewhere. Your eye surgeon will explain the risks that apply to you before you agree to treatment.
References
- Kahawita S, Simon S, Gilhotra J. Flashes and floaters: a practical approach to assessment and management. Australian Family Physician. 2014;43(4):201-203. https://www.racgp.org.au/afp/2014/april/flashes-and-floaters
- Russell JF, Smiddy WE, Flynn HW Jr. Retinal breaks: clinical course and outcomes after retinopexy. Retinal Physician. November 2017. https://www.retinalphysician.com/issues/2017/novdev/retinal-breaks-clinical-course-and-outcomes-after-retinopexy/
- Nixon TRW, Davie RL, Snead MP. Posterior vitreous detachment and retinal tear: a prospective study of community referrals. Eye. 2024;38(4):786-791. doi:10.1038/s41433-023-02779-3. https://www.nature.com/articles/s41433-023-02779-3
- Ryan EH, Ryan CM, Forbes NJ, et al. Primary Retinal Detachment Outcomes Study Report Number 2: phakic retinal detachment outcomes. Ophthalmology. 2020;127(8):1077-1085. doi:10.1016/j.ophtha.2020.03.007
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