The retina is the paper-thin tissue lining the inside of the back of the eye. It’s made up of several layers of cells that work together to sense light and images entering the eye before sending along neural impulses to the brain for the perception of vision. Disease or damage to the retina, such as a significant retinal tear or retinal detachment, can result in permanent vision loss.
A retinal tear occurs when the tissue of the retina forms a break or rip. This is different from a detachment when part of the retina lifts away completely from the rest of the eye, though a retinal tear may risk deteriorating into a detachment, which must be then referred for urgent retinal surgery.
Symptoms of a retinal tear include:
- Floaters – appearing as tiny black specks, dots, or sometimes described as cobwebs, that float around the vision in the affected eye. These floaters can come in and out of view and persist for some time.
- Flashing lights – also called photopsia, sudden flashes in the vision from a retinal tear occurring may appear like a lightning strike or glint out of the corner of your eye.
Occasionally, a retinal tear may also result in an area of blurred vision if the tear caused some damage and bleeding from the tiny capillaries of the retina. There is never any pain or discomfort from a tear, or even a detachment, as the retina contains no pain receptors.
Most retinal tears occur spontaneously with no cause, though there are several risk factors that are associated with the likelihood of developing a tear. These include a family history of retinal tears or detachments, certain eye operations such as cataract surgery, or conditions which cause a thinned retina, such as high myopia (short-sightedness) or the presence of a peripheral retinal abnormality known as lattice degeneration. Advancing age and trauma to the eye area can also put a person at higher risk of forming a retinal tear.
Retinal Tear Treatment
Not all retinal tears need treatment. Some are safe to simply monitor with regular eye exams, and in fact, some will self-heal by naturally scarring and sealing themselves back against the eye.
When deciding if a retinal tear needs treatment, such as retinal surgery, the eye doctor will consider several factors based mainly around the risk of the tear deteriorating into a detachment. Any predisposing risk factors you have, such as the presence of high myopia or whether you’ve previously had a retinal tear or detachment in either eye, will be taken into account, as well as the location, size, and shape of the tear. Retinal tears that are small, peripheral (that is, far out to the edges of the retina, away from the central vision), and asymptomatic (not presenting with any flashes or floaters or disturbances to the vision), may be monitored by an experienced eyecare provider without needing referral for retinal surgery. The type of tear may also be taken into consideration as research has found that certain types of retinal tears and holes are more likely to deteriorate into a detachment.
If your eye doctor finds that your retinal tear is at a significant risk of becoming a sight-threatening retinal detachment, he or she will recommend retinal tear treatment as a preventative measure.
Depending on the facilities available to your local eye doctor, retinal surgery for tears is typically provided as an in-office treatment under local anaesthesia, meaning the ophthalmologist can perform it in the consulting room without needing to send you to an operating theatre or hospital. There are two types of retinal surgery procedures to treat a tear – laser photocoagulation or cryopexy.
Both photocoagulation and cryopexy aim to create controlled scarring around the edges of the retinal tear, thereby sealing the break and re-adhering the torn tissue back to the underlying structures of the eye. Photocoagulation utilises a laser device carefully aimed through the pupil of the eye to create this scarring while cryopexy is performed by placing a probe against the outside of the eye to essentially freeze the edges of the torn retina and induce scarring and reattachment. Depending on the experience and expertise of the ophthalmologist, both procedures take roughly 10 to 15 minutes to complete.
While there is minimal discomfort experienced during either procedure, the recovery time for photocoagulation tends to be much shorter than for cryopexy. Many patients are able to return to their normal routine immediately after a laser photocoagulation procedure with little to no disturbance to their vision post-treatment, though many surgeons will recommend avoiding any activities that risk traumatising the eye while the scarring forms for a couple of weeks. Conversely, an eye having undergone a cryopexy procedure may take up to 2 weeks to fully heal and settle, with the vision being temporarily blurred and the eye slightly red and swollen.
As with many medical procedures, there is a small chance of an adverse effect from either photocoagulation or cryopexy, such as permanent vision loss from the small areas of necessary scarring during treatment. However, because retinal tears tend to occur in the periphery away from the central vision and the treatment areas are quite small, it is very rare that the area of vision loss is significant enough to be noticeable or impact on normal activities.
It is important to remember to maintain regular eye examinations with your eyecare practitioner even after having successful retinal tear treatment as the tear may reoccur or a new tear may form in the same or opposite eye.
Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.