Our topic this month will be retinal tears and detachments.
What is a retinal tear or detachment and what causes them?
The retina itself consists of several layers. A retinal tear a small separation of the layers. A tear can lead to a detachment. A detachment is when fluid collects in between these layers causing a much larger separation.
There are several causes and risk factors for tears and detachments. One risk factor is having severe nearsightedness. A posterior vitreous detachment, as we discussed last month, can pull on the retina causing a tear. Trauma to the eye can also bring about retinal tears and detachments. Other causes include prior eye surgery, inflammation, infection, and proliferative diabetic retinopathy.
A person is also at higher risk for a tear or detachment if they have had a detachment in the other eye or have a family history of them.
What are the symptoms?
Symptoms of a tear include seeing many new floaters and flashes of light. The floaters may be seen as black spots, strings or cobwebs, or like small flies that are not really there. The flashes of light look like a camera flash in the peripheral vision. Sometimes patients do not have any symptoms at all.
Retinal detachment symptoms include floaters and flashes of light as well. As it progresses, one may also see a dark curtain or shadow across the vision.
It is crucial to see a doctor if you experience any of these symptoms!
How are they detected?
A comprehensive exam is completed to look for a tear or detachment. Doctors may use a special instrument to push on the eye to look at all areas of the eye that are hard to see with lenses alone. Sometimes an ultrasound is used to look for tears if the view into the back of the eye is not clear. This can happen if one has bleeding in the back of the eye.
The arrow in this photo points to a large tear in the retina.
Retinal tear. Image Source1
The arrows here show the edge of the retinal detachment. Fluid has collected in the layers of the retina.
Retinal detachment. Image Source1
What are the treatments?
Nothing: Occasionally, patients who have no symptoms from a retinal tear do not require treatment. If the patient has no risk factors, doctors may decide to just watch a patient closely.
Laser and cryopexy: Laser is done in the clinic for tears. The laser is used to barricade the tear so that it does not become bigger. Cryopexy freezes the area around the tear to close it.
This photo shows the laser scars that are surrounding the tear.
Retinal tear after laser treatment. Image Source1
Pneumatic retinopexy: This clinic procedure is where a doctor inserts a gas bubble to prevent fluid from entering a retinal tear. Laser or cryopexy is then done to permanently close it.
Surgery: Most cases of retinal detachments require surgery. Doctors remove the gel in the back of the eye so that it does not pull on the retina. Laser may be done during surgery. Often a special gas or oil is placed into the eye to help force the retina layers back together. The eye reabsorbs the gas over time and the oil is usually removed a few months later unless there is a specific reason to keep it in the eye. Some surgeons use a silicone band, called a scleral buckle, that goes around the outside of the eye to repair the detachment.
This photo shows the gas bubbles in the eye after surgery.
Retinal detachment repaired with gas. Image Source1
This patient has had surgery with a scleral buckle. The arrows point to the area that is elevated from the band pushing on the outside of the eye.
Retinal detachment repaired with a scleral buckle. Image Source2
Usually the treatment for retinal tears and detachments is very successful. There are some cases when the vision does not return after retinal detachment repair and it can take months to learn the final visual outcome. It is important to see a specialist if you are noticing any symptoms so that treatment can be done immediately.
Return next month for a discussion on a new topic!