A sudden change in floaters and flashes can mean the retina has torn. If a tear is found, it is usually sealed with laser at the same visit. This is what that involves.
What is a retinal tear?
The retina is the light-sensing layer that lines the back of the eye. As the vitreous gel in the eye shrinks with age, it can pull on the retina and, in some people, tear it. Fluid can then pass through the tear and lift the retina away from the wall of the eye. This is a retinal detachment, which needs surgery and can cause lasting loss of vision.
A tear found early can usually be sealed in the clinic, before any detachment develops.
How laser treatment works
Laser retinopexy uses a laser to create a ring of small burns around the tear. Over one to two weeks these burns form scars that bond the retina to the tissue beneath it, forming a barrier that stops fluid getting under the retina. The tear itself is not closed. It is walled off.
Laser is also used for areas of weak retina and for small, localised detachments, to limit them.
Preparing for the treatment
No special preparation is needed. You do not need to fast, and the treatment is done as an outpatient, usually at the same visit the tear is found. You should not drive afterwards, so arrange for someone to take you home.
What the treatment involves
Laser retinopexy is done in the laser room. Anaesthetic drops are put in the eye, and a contact lens is usually placed on the eye to focus the laser. You sit at the laser machine, as you would at the microscope for an eye examination, and will be asked to look in a particular direction and hold still. The lights are bright. Sometimes the treatment is done lying back, with gentle pressure on the outside of the eye from a cotton bud or a small instrument to bring the tear into view.
Most people feel a series of brief, sharp sensations as the laser fires, ranging from mild to moderate. Painkillers can be given if needed. Holding still matters: the laser is aimed at the edge of the retina, and a sudden eye movement can put a burn near the centre of vision.
The treatment can be completed in one session or, for larger areas, over more than one.
After the treatment
Your vision will be dazzled by the lights immediately afterwards and will stay blurry for a few hours. It usually settles over the next few days. Glare and sensitivity to bright light are common in that time, and some people have a dull ache or headache, for which simple painkillers are enough. The eye may be red where it was pressed. This clears on its own.
The treatment does not remove floaters or flashes that were already there. Floaters usually fade with time as the brain learns to ignore them.
Avoid strenuous activity and driving until you are told otherwise. There are no dietary restrictions. You will be given a follow-up appointment to check that the scars have formed.
Risks
Serious complications are rare. The main ones are:
- Treatment not holding. The scars may not bond strongly enough, and further laser treatment may be needed.
- New tears or detachment. Laser protects the treated area, but the vitreous can go on pulling elsewhere. A detachment can still occur, which is why new symptoms need same-day assessment.
- A blind spot. The treated retina no longer sees. Because tears are almost always at the edge of the retina, this is rarely noticed.
- Bleeding inside the eye, which can cause more floaters or blurred vision and may need monitoring or further treatment.
- Damage to other parts of the eye, including the cornea, lens, iris or optic nerve. This is rare.
- Epiretinal membrane. A thin membrane can form over the centre of the retina months later, causing blurring or distortion. The tear itself, as well as the treatment, can contribute to this.
Other options
A small, long-standing hole that is already scarred and causing no symptoms may simply be watched. For a small localised detachment, surgery or a gas bubble (pneumatic retinopexy) may be discussed, depending on its size and position.
What happens without treatment
A fresh retinal tear left untreated can progress to a retinal detachment. Detachment can cause loss of field of vision and, if the centre of the retina is involved, lasting loss of central sight. A detachment usually needs surgery. The examination helps determine whether a tear needs treatment and how urgently this should take place.
When to call
After laser, contact the clinic the same day if you notice a new shower of floaters, new flashes, or a shadow or curtain in any part of your vision. Call +65 6694 0400 during clinic hours. Outside clinic hours, call the 24-hour answering service at +65 6535 8833, or go to a hospital A&E with eye services.
Related reading
The retinal detachment and tears condition page explains the assessment and different treatment options.
Sources
- American Society of Retina Specialists: Retinal tears
- Moorfields Eye Hospital: Laser retinopexy (patient information)
- The Dudley Group NHS Foundation Trust: Argon laser retinopexy for retinal tear or break
- Cambridge University Hospitals: Surgical repair of retinal detachment
- Blackorby et al.: Epiretinal membrane formation after treatment of retinal breaks