Retinal Tears and Detachments

A clear, jelly-like substance called the vitreous fills 80% of the inside of the eye, in the space between the lens and the retina. It is typically tightly attached to the retina. As we age, the vitreous becomes more liquid-like and can separate from the retina, resulting in the appearance of flashes or floaters. This separation is called a posterior vitreous detachment. The floaters may appear as dots, cobwebs, or curly lines, which move in front of your vision and move as your eye moves.

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Most floaters and flashes will subside over time and do not cause problems, though some may notice the floaters indefinitely. However, in some cases, floaters and flashes may be a warning sign of a retinal tear, particularly if they appear suddenly.

As the vitreous separates from the retina, it may pull hard enough that it causes a retinal tear. This will allow the vitreous fluid to seep behind the retina, causing the retina to separate from the back of the eye. This is called a retinal detachment. If this occurs, the retina begins to lose its function and your vision will be affected.

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Symptoms of a retinal tear or retinal detachment may include:

  • Flashes, often appearing suddenly
  • Floaters, often appearing suddenly
  • Darkened side vision
  • Seeing a curtain move across your vision

Though retinal tears and detachments often occur as we age, they may also occur due to injury, family history, and high nearsightedness.

Treatment

If retinal tears are caught early enough, retinal detachments may be preventable. Our ophthalmologists will perform a dilated comprehensive eye exam in order to look at the vitreous and retina to detect retinal tears. If a tear is found, laser or freezing (cryotherapy) treatment may be performed to seal the rip in the retina. Once the tear is treated, a scar will eventually seal around it and close the defect off so no more fluid will flow through it.

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If a retinal tear develops into a retinal detachment, more extensive procedures or surgery may be necessary to repair it.

  • Pneumatic retinopexy is an office procedure where a gas bubble is injected into the eye to cover the retinal tear and allow the retina to reattach. Once the retina is reattached laser or cryotherapy is used to permanently seal the tear.
  • Scleral buckling is a surgical procedure where a piece of silicone is sutured to the white part of the eye (sclera) behind the eye muscles. As the sutures are tightened the silicone element indents, or “buckles”, the underlying sclera to support any breaks in the retina from underneath.
  • In vitrecomy surgery the vitreous gel is removed from the eye and fluid under the retina is removed. Laser is applied to all retinal breaks and a gas bubble, or sometimes silicone oil, is then inserted to allow the retina to heal.

After retinal detachment surgery, vision typically takes several weeks or sometimes even months to improve. Vision sometimes does not recover completely after a retinal detachment, particularly if the macula, or center of the retina, was affected.

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