Retinal Tear vs. Retinal Detachment

Retinal Tear vs. Retinal Detachment

Retinal tears and detachments are both eye conditions that can lead to vision loss or blindness if not treated. Retinal tears are more common than a full detachment, but they have similar symptoms that are important to catch as early as possible to avoid any potential long term damage to the retina or permanent loss of vision. This article will help you understand the two conditions, their signs and symptoms, and treatment options.

The Retina

The retina is a thin tissue covering the back of the eye that is essential to providing clear vision. Damage to the retina can affect vision permanently, and lead to severe vision loss or blindness in certain cases.

A normal eye is filled with a fluid called vitreous humor which helps maintain the round shape of the eye and protect against injuries. This fluid normally adheres to the retina, but as someone ages, it’s common for the vitreous to slowly start pulling away and separating from the retina – resulting in a condition called posterior vitreous detachment or PVD. The small pieces of vitreous that detach may actually cast a shadow over the retina that appears as a black spot, squiggle, or line in the field of vision (these are “floaters”).

Most of the time, PVD and seeing floaters are simply a part of aging and no cause for concern, as the brain typically learns over time to ignore the floaters. However, in certain cases the pulling of the vitreous can lead to a tear in the retina itself, or a complete retinal detachment.

Retinal Tears

Retinal tears are typically caused by separation of the vitreous pulling on the retina, but can also occur due to injury of the eye. Some factors may predispose individuals to retinal tears, such as age, nearsightedness, or a family history.

Symptoms of a Retinal Tear

Retinal tears may not always have obvious symptoms, but often they are associated with a sudden increase in floaters, or seeing bright flashes of light in the affected eye. Other potential symptoms include sudden onset blurry vision, vision seeming darker or dimmer than usual, or a sudden loss of peripheral vision.

If someone experiences any of these, they should see an ophthalmologist as soon as possible for a dilated eye exam. Dilation will allow the physician to examine the entire retina for any signs of retinal damage, and develop a treatment plan as soon as possible to avoid any permanent vision loss.

However, retinal tears may not always result in these symptoms or even be noticeable to the patient. That is why regular eye exams are so important, especially for anyone predisposed to retinal tears. Catching one early on provides the best chance for vision to be preserved and the retina protected against future damage.

Treatment of Retinal Tears

Depending on the severity of the tear, there are several different options for treatment. Some minor retinal tears may not require treatment at all and will resolve on their own with time. If your eye care physician finds a retinal tear during your exam, they will be able to decide whether or not treatment is required and discuss your options with you.

The most common method of treating a retinal tear involves creating a small ring of scar tissue around tear in order to get the retina to “stick” to the back of the eye, and prevent the tear from getting larger. This is typically done with a quick laser procedure, or using cold therapy.

Retinal Detachments

Retinal detachments often result from retinal tears or holes that have not been treated. Fluid from inside the eye leaks through the tear and begins to fill the space underneath the retina, like a bubble under wallpaper, raising it up from the back of the eye. This fluid can spread rapidly and continue to raise retinal tissues, which separates the nerve cells in the retina from their supply of nutrients.

The longer this persists, the more likely it will have a permanent effect on the patient’s vision. Because of this, it is critical to schedule an appointment with an eye care physician as soon as possible. This is considered a medical emergency and in most cases offices will make an effort to see patients with relevant symptoms on the same day, or refer them to an ER.

Symptoms of Retinal Detachment

Whereas retinal tears do not always produce noticeable symptoms, a retinal detachment always affects vision. Patients will often notice a sudden increase in floaters, flashes, followed by a dark “shadow” or “curtain” that starts to block out the visual field. If the macula (the part of the retina responsible for our central vision) becomes detached, patients will notice a severe impairment of their central vision.

Treatments for Retinal Detachments

Retinal detachments require urgent treatment in order to preserve vision. A common surgical treatment is scleral buckling, in which the surgeon attaches a silicone sponge or band to the outside of the eyeball that presses the wall of the eye inward, keeping the separated areas of the retina together. Depending on the situation the surgeon may recommend other procedures, such as a pneumatic retinopexy (placing a gas bubble in the eye to flatten the retina), or a vitrectomy (draining and replacing the fluid inside the eye).

Sources cited

Michel, R., C. Wilkinson, and T. Rice. “Retinal detachment.” St Louis: CV Mosby 117 (1990).

Gishti, Olta, et al. “Symptoms related to posterior vitreous detachment and the risk of developing retinal tears: a systematic review.” Acta ophthalmologica 97.4 (2019): 347-352.

Bond-Taylor, Martin, Gunnar Jakobsson, and Madeleine Zetterberg. “Posterior vitreous detachment–prevalence of and risk factors for retinal tears.” Clinical Ophthalmology (2017): 1689-1695.

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