What is it?

A retinal tear is a rip in the retina (the thin tissue of nerve cells that lines the back of the eyeball). The retina is the tissue that receives what we see – similar to photographic film in a camera.

What are the symptoms?

Symptoms occur during the formation of the tear or as a result of secondary complications related to the tear. Most retinal tears develop when the vitreous gel peels from the retina (posterior vitreous detachment). During the process of peeling, the vitreous gel can pull hard enough to tear the thin retinal tissue. Flashes and floaters, symptoms associated with peeling of the vitreous gel, are also the most common symptoms experienced by patients with a retinal tear. Floaters can appear as an insect or semi-circle suspended in the field of vision. Alternatively, some patients describe thousands of black dots or a dark area blocking part of their vision. Flashes appear as lightning streaks, which occur repeatedly in the field of vision. If a retinal tear progresses to a retinal detachment, a loss of peripheral (surround) vision may be noted. This is often described as a curtain, which blocks some of the peripheral vision – gradually extending to involve the central vision.

What is the cause?

Most retinal tears develop as a complication of posterior vitreous detachment – peeling of the vitreous gel from the retina. As the vitreous peels, it can pull hard enough to rip the thin retinal tissue. Peeling off the vitreous gel is a normal aging change that typically occurs after the age of 60. Severe eye trauma or eye surgery can also precipitate peeling of the vitreous gel. Eyes that are very nearsighted have a higher risk of developing a retinal tear.

What is the prognosis?

A retinal tear alone will not cause any permanent damage to the vision. However, some retinal tears progress to a retinal detachment – a serious visually threatening complication. Tears associated with symptoms (see above) are more likely to progress to a retinal detachment. Therefore, patients with symptoms should be evaluated promptly. The visual prognosis is excellent in eyes that do not progress to a retinal detachment and in eyes with successfully treated retinal tears.

How is it diagnosed?

A thorough eye examination, including drops which dilate the pupil, is necessary to diagnose a retinal tear. An illuminated instrument, called an ophthalmoscope, is used to carefully examine the retina. Some retinal tears are easy to find on examination, while others may be difficult to locate because of their small size or due to poor visualization into the eye. Occasionally, an ultrasound examination is used to assess the retina when the visualization is very poor.

Is there a treatment?

The goal of treatment is to prevent progression to a retinal detachment. This is accomplished by sealing the edges of the retinal tear to the eyewall behind it (similar to spot welding two layers together). The torn retina can be sealed with laser treatment or with cryopexy (freezing treatment). Both work by inducing a scar that firmly holds the retina to the wall of the eye. This prevents the vitreous fluid from migrating through the tear to the underside of the retina, where it billows the retina away from the eyewall (retinal detachment). Laser treatment and cryopexy are in-office procedures that involve minimal or no patient discomfort.