Retinal Tear

How a retinal tear happens

The inside of the eye is filled with a clear gel called the vitreous. With age, usually from the 50s onward, the vitreous shrinks and liquefies and separates from the retina. This is called posterior vitreous detachment (PVD). It is normal and usually harmless.

Where the vitreous is stuck firmly to the retina, its pull can rip the retina as it separates. The result is usually a horseshoe (flap) tear. Fluid from the vitreous can then seep through the tear and under the retina, peeling it away like wallpaper. That is a retinal detachment, which threatens vision.

Roughly 1 in 7 people who see an eye doctor with sudden PVD symptoms has a retinal tear. If a blood vessel is torn too, bleeding into the gel (vitreous hemorrhage) causes a sudden haze or dense floaters and raises the chance that a tear is present.

Atrophic holes are a different, smaller type of break caused by thinning of the retina rather than traction. They are lower risk and often just monitored.

Symptoms

• Floaters: sudden appearance of many new dark spots, cobwebs or a "swarm of flies". See floaters.
• Flashes (photopsia): brief flickers or arcs of light, usually at the side of vision and more noticeable in dim light, as the gel tugs on the retina.
• Haze or smoky vision from bleeding.
• No pain: the retina has no pain nerves.

A shadow or curtain spreading across vision means the retina may already be detaching and needs emergency care.

Retinal tear vs retinal detachment

Risk factors

• age over 50
• nearsightedness (myopia), especially high myopia, which makes PVD occur earlier
• lattice degeneration, patches of thin retina
• previous cataract surgery or other eye surgery
• eye injury, including blunt trauma from sports
• previous tear or detachment in either eye
• family history of retinal detachment
• inherited conditions such as Stickler syndrome and Marfan syndrome

Diagnosis

An ophthalmologist or optometrist dilates your pupils with drops and examines the whole retina, including the far edges, with a bright light and a hand-held lens. Gentle pressure on the eyelid (scleral depression) helps reveal tears at the edge. If blood blocks the view, an ultrasound of the eye is used.

Even if no tear is found, the AAO recommends a repeat exam within about 6 weeks after an acute PVD, sooner if symptoms change, because tears can develop later.

Treatment

The goal is to create a scar around the tear that welds the retina to the wall of the eye, so fluid cannot get underneath.

• Laser retinopexy (photocoagulation): done in the office with numbing drops and a contact lens on the eye. The laser makes rows of tiny burns around the tear. You see bright flashes and may feel brief aching. It takes about 10 to 20 minutes.
• Cryopexy (freezing): a cold probe on the outside of the eye freezes the area around the tear. It is used when the tear is far forward or bleeding blocks laser access. It is done with local anesthetic and causes more soreness and lid swelling for a few days.

These treatments are highly successful at preventing detachment. Not all breaks need treatment: small atrophic holes and old tears surrounded by pigment are often monitored instead.

Recovery after laser treatment

• Your vision may be blurry for a few hours from the dilating drops and bright light.
• Most people return to normal daily activities the next day.
• The protective scar takes about 1 to 2 weeks to strengthen. Your doctor may ask you to avoid heavy lifting, high-impact exercise and contact sports during this time.
• Floaters from the original PVD often persist but become less noticeable over weeks to months as the brain adapts.
• Flying is generally safe after laser or cryopexy, because no gas bubble is used.
• You will have follow-up exams, typically within the first few weeks, to check the seal and look for new tears.

Seek urgent care if floaters increase, new flashes appear, or a shadow develops, since a small percentage of people develop new tears or a detachment despite treatment.

Prevention

Retinal tears cannot always be prevented, but you can lower the risk of vision loss:

• know the warning signs and act within 24 hours
• wear protective eyewear for sports and DIY
• have regular dilated exams if you are very nearsighted, have lattice degeneration, or have had a tear in the other eye

Frequently asked questions

What are the first signs of a retinal tear?

The usual first signs are a sudden shower of new floaters, often described as cobwebs or a swarm of dots, and flashes of light at the edge of vision. Some people notice a haze from bleeding. There is no pain. Any of these needs an eye exam within 24 hours.

Can a retinal tear heal on its own?

Usually not in a reliable way. A tear that causes symptoms has a high risk of leading to retinal detachment if untreated, so it is sealed with laser or freezing. Some small, symptom-free holes or tears already surrounded by scarring are safely monitored instead.

How long does it take to recover from retinal tear laser treatment?

Most people resume normal activities the next day. The laser scar strengthens over about 1 to 2 weeks, during which your doctor may advise avoiding heavy lifting and contact sports. Follow-up exams check that the tear is sealed.

Is a retinal tear an emergency?

It is urgent rather than an immediate emergency. You should be seen by an eye doctor the same day or within 24 hours of new floaters and flashes. A shadow or curtain across your vision suggests detachment and is an emergency.

Can floaters and flashes be harmless?

Yes. Most sudden floaters and flashes come from a posterior vitreous detachment without a tear. But the only way to tell is a dilated eye exam, because a tear causes the same symptoms. Get checked promptly whenever new floaters or flashes appear.