What it is
In short: a retinal tear is a break in the retina, the layer at the back of the eye that senses light. A retinal detachment is when the retina lifts away from the wall of the eye. A tear can often be sealed with laser, while a detachment usually needs surgery. Symptoms of either need checking straight away.
Any tear or hole in the retina is called a retinal break. Fluid can pass through a break and collect under the retina, lifting it away from the layer that supports it. This is a retinal detachment.
The inside of the eye is filled with a clear gel called the vitreous. With age, the gel shrinks and can come away from the retina. This is called a posterior vitreous detachment (PVD), and it is not the same as a retinal detachment. But if the gel is firmly stuck to the retina in one spot, it can pull hard enough to tear it.
A detachment can also have other causes, such as scar tissue pulling on the retina in diabetic eye disease. The cause matters, because it affects the treatment.
Your risk of a detachment is higher if you:
- are short-sighted
- have had eye surgery
- have had an eye injury
- have had a retinal detachment before
Symptoms
Warning signs include:
- new floaters, or a sudden increase in floaters
- flashes of light
- a shadow over part of your vision
A detachment can look like a curtain spreading across your sight from the side. If it reaches the macula, the centre of the retina, reading and recognising faces can become difficult.
A tear does not always cause a curtain or a big change in vision. Some breaks cause no symptoms and are only found during an eye examination. You cannot tell from floaters alone whether the retina is torn. Only an eye examination can show this.
When it is urgent
A suspected retinal detachment is an eye emergency. Contact an eye doctor straight away if you notice:
- new flashes
- a shower of floaters
- a curtain across your sight
- sudden loss of vision
Do not wait to see whether it clears.
Call the clinic at +65 6694 0400. Outside clinic hours, call the 24-hour answering service at +65 6535 8833, or go to a hospital A&E with eye services. If you cannot reach the clinic quickly, get emergency eye care elsewhere. Do not drive yourself if your vision is affected.
What the assessment involves
Dr Chin will ask when your symptoms started and check the vision in each eye. Drops widen your pupils so that Dr Chin can examine the whole retina, including its outer edges, where breaks are usually found. To see these edges, Dr Chin may press gently around the eye.
The drops take 20 to 30 minutes to work and blur your sight for a few hours. Allow about 90 minutes to two hours for the visit, and arrange for someone to drive you home.
If bleeding or cloudiness blocks the view, an ultrasound scan can show the retina. An OCT scan, which takes detailed pictures of the layers of the retina, may be used to look at the macula.
Dr Chin looks at:
- how many breaks there are, and where they are
- how much of the retina has lifted away, if any
- whether the macula is involved
These findings decide how urgent treatment is and which treatment suits you. Your other eye may also need checking.
Before treatment, ask about:
- the operation being suggested
- the type of anaesthesia
- any head positioning you may need afterwards
Treatment options
Treating a retinal break
If a break is found before much of the retina has lifted away, laser or freezing treatment can make scars around it. The scars form a barrier that stops more fluid getting under the retina. Laser is done in the clinic, usually at the same visit the break is found, and the scars take one to two weeks to form.
Some small breaks with no worrying features can be watched instead. Only an examination can decide this.
Treating a detachment
A detachment usually needs surgery. The main operations are:
- Vitrectomy: the vitreous gel is removed, so that it stops pulling on the retina.
- Scleral buckle: a flexible band is stitched to the outside of the eye. It pushes the wall of the eye inwards to support the retina.
- Pneumatic retinopexy: a gas bubble is injected into the eye to press the retina back into place, together with laser or freezing treatment. It suits only some detachments.
These operations are sometimes combined. Which one suits you depends on where the breaks are and the state of your eye. Most retinal surgery is day surgery under local anaesthesia, and general anaesthesia can be used where needed.
Risks
Surgery is complex and has risks, including:
- infection
- bleeding
- cataract
- changes in eye pressure
- the retina lifting away again
Surgery aims to put the retina back in place, but how much sight returns varies. It depends on any damage already done to the retina, and on whether the macula was affected.
Recovery and follow-up
You will need follow-up visits after laser as well as after surgery. Treating one tear does not stop a new tear forming elsewhere. If you notice new flashes, floaters or a shadow, get checked again, even if you have had treatment or a recent check-up.
After surgery, you may need eye drops, an eye shield and to avoid some activities for a while.
If gas is used
- Your vision will be blurred while the gas is in the eye.
- You may need to keep your head in a certain position. Tell Dr Chin if a physical problem makes this hard.
- Do not fly or travel to high places, such as mountains, until Dr Chin confirms the gas has gone.
- Tell any doctor or anaesthetist that you have gas in your eye, because an anaesthetic gas called nitrous oxide must not be used.
If silicone oil is used
Silicone oil is sometimes used instead of gas. It usually needs a second operation to remove it later. Dr Chin will give you instructions for whichever is used.
Related articles
- Retinal detachment: what are the warning signs, and how is it treated?
- Retinal tears and laser treatment
- Floaters and flashes: when should I be worried?
- All eye health articles