Retinal detachments and retinal tears

Retinal tears

A retinal tear is a hole in the retina. The retina is the lining of the back of the eye responsible for your vision.  If untreated, retinal tears may lead to loss of vision. 

What are the symptoms?

Retinal tears do not always produce symptoms. However, you may notice the following; 

1. Flashing lights – these are brief flickers of light in the outer part of your field of vision.
2. Floaters – these are small specks floating in your field of vision.

How are retinal tears diagnosed?

Retinal tears have a typical appearance which can be diagnosed during an eye examination by a retina specialist.

What causes retinal tears?

The eye is filled with a jelly called the ‘vitreous’ which is normally in contact with the retina. With age, the jelly shrinks and pulls away from the retina. In some people, the jelly pulls on the retina in such a way that it tears the retina.

People who are short sighted or who have had intraocular surgery are at higher risk of developing a retinal tear.

Can retinal tears cause loss of vision?

If a retinal tear is not treated, fluid can pass underneath the retina and separate it from the eye wall. This is called a retinal detachment and can cause permanent blindness.

What is laser treatment for retinal tears?

Laser treatment is an effective treatment for retinal tears.  A laser is a concentrated beam of light energy. During laser treatment, multiple laser spots are placed on the retina to surround the retinal tear. The laser spots seal the retinal tear and prevent a retinal detachment from developing. Laser treatment will not improve your sight or get rid of floaters.

Retinal detachments

A retinal detachment is a serious condition in which the retina separates from the wall of the eye. The retina is the lining of the back of the eye responsible for vision. If not treated, retinal detachments commonly lead to permanent blindness.

What are the symptoms?

Initially, there may no symptoms. As the retinal detachment progresses, you may notice flashing lights, floaters or a shadow which blocks part of your peripheral vision.

What causes it?

The eye is filled with a jelly called ‘vitreous’ which is in contact with the retina. With age, the jelly shrinks and pulls on the retina. If the jelly pulls too hard, a hole forms in the retina, allowing fluid to passes underneath the retina and separate it from the wall of the eye.

The risk factors for a retinal detachment include short-sightedness, trauma and eye surgery.

What is the treatment for a retinal detachment?

Surgery is needed to reattach the retina. The type of operation depends upon the features of the retinal detachment and is usually performed using local anaesthesia. The options include:

1. Pneumatic retinopexy. A gas bubble is injected into the eye. It stops fluid from passing through the hole, allowing the retina to reattach. Laser or freezing treatment is performed between 1 to 3 days after the gas injection to seal the retinal tear.
2. Scleral buckling surgery. A piece of plastic (known as a buckle) is attached to the eye wall (known as the sclera). The buckle creates an indentation in the eye wall which closes the hole inside. Freezing treatment (cryotherapy) is used to seal the retinal hole.
3. Vitrectomy surgery. The vitreous is removed using keyhole surgery through tiny openings in the eye wall. A bubble of gas or silicone oil is placed in the eye. Laser or freezing treatment is used to seal the retinal holes. Vitrectomy surgery is used for both routine and complex retinal detachments.

Silicone oil is used in difficult cases (e.g. if the retina has been detached for a long time, or retinal scarring is present). This may remain in the eye long-term, or it can be removed after the retina has healed.

Because gas and oil bubbles float upwards, you will need to keep your head in a certain position for a number of day after the surgery to place the bubble in the correct position whilst the retina is healing.

Occasionally, a combination of the 3 surgical techniques described above is needed to fix complex retinal detachments.

Potential complications of surgery include infection, bleeding, a change in spectacle prescription, double vision and cataract formation. Most complications can be addressed with further treatment, however some may lead to permanent loss of vision.

Can the other eye become affected?

lf you have a retinal detachment in one eye, there is an increased risk of developing a retinal detachment in your other eye. Your retinal specialist should examine your other eye carefully and may recommend laser or freezing treatment to seal any tears or areas of weak retina to reduce the risk of a retinal detachment occurring in that eye.

Floaters

Floaters are particles within the eye which float around in your field of vision. They can take many different forms and are often described as cobwebs, spots, flies, mists, threads, hairs or smudges. There may be many small floaters or a few large ones. As you move your eye, the floaters shift position and move around your field of vision. Floaters are extremely common.

What is the cause?

The eye is filled with a jelly called ‘vitreous’. With age, the jelly degenerates, becoming cloudy and breaking up into small particles. These particles are the floaters which appear as shadow like shapes in your field of view. Occasionally, floaters can be caused by bleeding or inflammation inside the eye.

Because floaters can be associated with potentially blinding conditions such as retinal tears or retinal detachment, it is important that all people with new onset floaters have an eye examination to identify any retinal tears or retinal detachment which would require treatment.

Is treatment needed?

Although floaters can be very annoying, most people are not bothered enough to require treatment for them. If you do not have treatment, the floaters will not harm your eye and often become less noticeable over the course of a few weeks or months.

A small minority of people with longstanding floaters find them to be troublesome enough to interfere with activities such as reading, writing, driving or watching TV. If floaters are interfering with your quality of life, then you may benefit from treatment such as YAG laser treatment or vitrectomy surgery.

Dr Simon Chen

Dr Chen talks about a detached retina, as well as explaining what to do if a person has increased flashes and floaters.

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