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Retinal Detachment and Tear

A retinal tear occurs when the vitreous fluid inside the eye pulls away from the retinal surface with a force great enough to tear the retina. A retinal detachment occurs when the pulling away of the vitreous fluid causes the retinal tissue to become separated from the inside wall of the eye.

What Are the Symptoms of a Retinal Tear or Detachment?

  • Flashing lights in peripheral (side) vision
  • Onset of new floaters
  • Sensation of a curtain or veil over vision
  • Sudden decrease in vision

What Is a Retinal Tear and a Retinal Detachment?

As people age, the vitreous fluid which fills the interior of the eye begins to shrink and separate from its attachment to the retina. The separation of the vitreous fluid usually results in harmless floaters but occasionally can cause more serious complications. A retinal tear occurs when the vitreous pulls hard enough on the retinal tissue in the back of the eye to cause a tear. A retinal tear along a blood vessel of the retina can cause bleeding into the vitreous fluid (called a vitreous hemorrhage) and lead to a large amount of floaters and clouded vision. Retinal tears in any area of the retina can pose a threat to your vision because fluid in the eye is able to pass through the tear. As fluid passes through the tear it begins to accumulate and causes a retinal detachment by completely lifting the retinal tissue from the back of the eye.

A retinal detachment is the separation of the retinal tissue from the interior wall of the eye. A retinal detachment can occur because of a retinal tear (called a Rhegmatogenous retinal detachment) or can occur spontaneously. With a retinal detachment, the retinal tissue may develop folds or come completely away from its normal position along the back surface of the eye, resulting in vision loss.

How is a Retinal Tear or Retinal Detachment Treated?

A retinal tear can be treated either by laser surgery (photocoagulation) or freezing treatment (cryopexy). These treatments repair the tear and reattach that area of the retina to the interior wall of the eye by creating scar tissue. These treatments cause little or no discomfort and can be performed during an office visit. These treatments are effective in preventing a retinal detachment if the retinal tear is treated as soon as possible.

A minor retinal detachment can sometimes be resolved with laser treatment, but most retinal detachments will require surgery to place the retina back in its proper position. There are several surgeries that can be performed to correct a detached retina, depending on the characteristics of the detachment:

  • Scleral Buckle: In this procedure, the surgeon first treats the tear(s) in the retina with cryopexy. A flexible silicon band is then placed around the outside of the eye and sewn in place. The band, which is not visible after surgery, helps push the sclera (the white tissue surrounding the eye) inward, flatten the retina, and force the retinal tissue into correct position until scarring seals the tear(s). The surgeon may need to remove excess fluid that has accumulated under the retina by making a small incision before securing the band. Complications may require additional procedures, such as a vitrectomy, in certain cases. Scleral Buckle surgery is performed in a hospital setting under local or general anesthesia by an ophthalmologist specializing in the retina.
  • Pneumatic Retinopexy: This surgical procedure is most commonly used to correct detachments that occur in the upper half of the retina. Before beginning the procedure your surgeon may treat the tear(s) with cryopexy. During a Pneumatic Retinopexy, the surgeon injects a bubble containing an expandable gas into the vitreous cavity inside the eye. During recovery, over the course of several days, the bubble expands and pushes the retinal tear and the detached area around it closed by pressing it to the interior wall of the eye. Once the tear is closed, the fluid beneath the retina is gradually reabsorbed and the retina can begin to heal and attach to the back of the eye.
  • Vitrectomy: In this procedure, the clouded or scarred vitreous fluid is removed from the eye through a small incision in the sclera and is then replaced with a gas bubble. In time, your body will replace the gas bubble with its own fluid.
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