What are Retinal Tears or Detachments and What Should I Do?

retina in the eyeA retinal tear is an eye problem with potentially serious complications that almost always ensue if not treated promptly. The retina feels no pain. Retinal tears can develop suddenly with little to no warning, and because of the lack of pain, people can easily fail to understand that something serious has occurred. Anyone who has symptoms of a retinal tear, or a more serious retinal detachment, should consult an eye doctor immediately.

Eye Anatomy
In order to grasp what a retinal tear is, it is necessary to understand a little eye anatomy. We are all familiar with our pupil and iris, since they are easily visible when we look at our eyes. The iris is the colored circle. The pupil — the black dot in the center of the pupil — changes size to let in more or less light depending on how bright it is. This change in size is created by the contraction and relaxation of the iris. Laid over the pupil and iris is the cornea, a thin, clear protective sheath. Behind them is the lens, which like the lens of a camera focuses light so that it lands clearly on the retina, the back part of the eye. Between the lens and the retina as a gel-like fluid called the vitreous, Latin for “glassy.”

As we age, the vitreous begins to dry and shrink, creating areas that are rubbery and areas that are puddles of runny fluid, much like the way a gelatin dessert disintegrates in the fridge over time. As it shrinks, the vitreous can begin to pull on the retina. It can pull hard enough to actually tear the retina.

Symptoms of Retinal Tears
Retinal tears are accompanied by visual changes. These changes usually take three forms.
First are floaters. Appearing like black specks or little worms in the visual field, 70% of people develop floaters at some point in their lives. If there are only or two and that doesn’t change over time, they are not a cause for concern. With a retinal tear, there is usually a river of them as bits of retina create debris in the vitreous, blocking incoming light from the lens.

Tears can also create flashes of light because as the retina tears, it is stimulated and sends a signal to the brain which is interpreted as light, or in some cases, whole images.

Lastly, the vision can develop shadows, especially at the periphery, where everything can seem dark and blurry. Because floaters are so common, people may not realize a serious event has taken place in their eye and may just put it down to fatigue or excessive screen time.

Prognosis — Why You Need Professional Help
Once the retina has torn, unless it is promptly treated,  serious complications that can lead to total blindness can develop. The vitreous tends to ooze out of the tear, further separating the retina from the choroid, the tissue behind the retina that provides its blood supply and sustains and nourishes it. Without contact with the choroid, the retina begins to die and can no  longer send visual signals to the brain. In some cases, the entire retina can become detached from the back of the eye. This is much more difficult to treat than a simple tear.

If a tear is caught promptly it can be fairly easily resealed with laser surgery or, in rare cases, cryotherapy. Some retinal tears do not require treatment but that can only be determine by an eye doctor.

If treatment is needed, the retina may be able to be glued back in place. If a retina progresses all the way to detachment, treatment grows more difficult and some vision loss is likely to be permanent. In these cases, one of three things is required:

  • a scleral buckle, in which a silicone band is placed around the eye to hold the retina in place;
  • pneumatic retinopexy, in which a gas bubble is injected into the eye, to refill the vitreous space, or
  • vitrectomy, in which the vitreous is removed.

Both scleral buckles and vitrectomies require full anesthesia. While pneumatic retinopexy does not, it has a low success rate and requires very exact positioning of the head for 7-10 days following surgery. Occasionally a retinal detachment can occur without a retinal tear and may not need treatment, but this is uncommon.

Retinal tears are very common in elderly populations but occur regularly in people over age 40. They are somewhat more common in women than in men. And they are more common in people with strong myopia, six diopters or greater, as this greatly elongates the eyeball.

Editor’s Note: There are a range of antioxidants and nutrients that help strengthen the retina and reduce the risk of vitreous tears/detachments and retinal tears/detachments including lutein, bilberry, gingko biloba, vitamin C and glucosamine sulfate. For more information, go to our Vitreous Support page.

References: NIH, WebMD, Wikipedia