Symptoms of Retinal Tear — Recognising To Manage Them Early

Retinal tear symptoms can include flashing lights, eye floaters, blurred vision, and the appearance of a dark shadow or curtain across your vision. Recognising retinal tear symptoms early is important, as prompt treatment may help prevent retinal detachment and permanent vision loss. For what you need to know about a retinal tear and retinal detachment, keep reading.

What is the Retina?

The retina is the delicate light-sensitive tissue lining the back of the eye. With this tissue, you can receive incoming light, convert it into a neural signal, and send it onward to the visual centres of the brain.

To function, the retina is reliant on metabolic support from the underlying layers, such as the rich blood and oxygen supply from the blood vessels of the choroid and choriocapillaris. Without being connected to these tissues, the retina is unable to survive.

What is a Retinal Tear?

A retinal tear is exactly as it sounds – a break in the retina. Although a retinal tear may be a result of an eye injury, such as blunt trauma or a hit to the eye, most retinal tears occur spontaneously due to an event known as a posterior vitreous detachment.

The posterior vitreous is a gel-like substance filling the space at the back of the eye. With age, this gel liquifies and collapses in on itself. As the vitreous is attached to certain points on the retina, this process can cause some tension as the vitreous pulls away. If the vitreous is unable to detach from these points of retinal adhesion, it may cause a retinal tear.

Symptoms of Retinal Tear

Not all retinal tears cause symptoms, but when retinal tear symptoms do occur they should never be ignored. Early recognition of retinal tear symptoms can help reduce the risk of retinal detachment and vision loss.

However, an acute retinal tear may present with:

• Seeing flashes of light
• The sudden appearance of eye floaters

As most retinal tears are found in the periphery of the retina, you’re not likely to notice significant changes to your central vision. A retinal tear is not directly associated with blurred vision, vision loss, or pain.

Retinal Tear vs Retinal Detachment

Both a retinal tear and retinal detachment are conditions of the retina, but can differ significantly in their management. Where a retinal tear is a break in the retina without coming away from the eye, a retinal detachment occurs when the retina separates from the underlying tissues. A popular analogy is like wallpaper peeling away from the wall.

Retinal Detachment

A retinal detachment is a medical emergency that needs prompt treatment with a retinal eye specialist to achieve the best outcome for your vision. A lack of treatment or delayed treatment for retinal detachment can result in permanent vision loss. Conversely, some breaks in the retina, such as a retinal hole, can simply be monitored safely over time, and may never require laser treatment or evolve into a threat to the vision.

A retinal detachment may be confined to your peripheral vision or may involve your central vision. Like a retinal tear, a retinal detachment does not cause pain or physical irritation.

Symptoms of Retinal Detachment

The symptoms of retinal detachment tend to be more apparent compared to those of a retinal tear but share many similarities. Warning signs of a detached retina can include:

• Seeing flashes of light, most commonly in the peripheral vision
• Sudden appearance of new eye floaters; the most common cause is the leakage of blood from broken retinal blood vessels
• Seeing a dark shadow anywhere in your visual field
• Blurred vision or vision loss

These are indications you need to see an eye doctor in the emergency room without delay.

Risk Factors for Retinal Tears and Retinal Detachments

Risk factors for retinal tears and retinal detachments are similar. Having any of these factors doesn’t mean you’re guaranteed to experience a retinal detachment, but it does put you at a higher risk. Factors include:

• Older age
• History of eye injury
• Family history of retinal tears or retinal detachment
• Short-sightedness (myopia)
• A type of thinning of the retinal tissue known as lattice degeneration
• Other eye disease, such as diabetic retinopathy
• Certain types of eye surgery, such as cataract surgery

Is It Possible to Prevent Retinal Detachment?

It’s typically not possible to reduce your risk of retinal detachment as most of these factors are out of your control. The only modifiable factor is protecting yourself from eye injury, such as using safety goggles when engaging in higher risk activities.

Treatment for Retinal Detachment

Treatment for retinal detachment is through urgent retinal surgery with a retinal eye doctor.

If you suspect you are experiencing the symptoms of retinal detachment, your eye doctor or optometrist will perform a dilated eye exam. This involves instilling eye drops that widen the pupil, allowing a more comprehensive examination of the retina. You may also have a test of your vision to assess whether the detached retina includes the macula area (your central vision).

If you’re found to have a retinal tear rather than a retinal detachment, your eye doctor can usually treat you on the spot using a medical laser to seal the edges of the tear so that this thin layer of tissue doesn’t break further. Being able to diagnose and treat a retinal tear before the retina separates further and deteriorates into a retinal detachment enables the best outcome for your vision. Areas of higher risk lattice degeneration may also be treated with laser surgery.

When Should You Seek Urgent Care for Retinal Tear Symptoms?

Any sudden onset of retinal tear symptoms should be assessed urgently by an eye specialist. New flashes, floaters, blurred vision, or a dark shadow in your vision may indicate a retinal tear or retinal detachment requiring prompt treatment.

Eye Surgery for Retinal Detachment

Cases of true retinal detachment require urgent retinal surgery. This will need to be performed in a hospital or operating theatre with an eye doctor specialised in the retina.

The aim of surgery is to prevent permanent vision loss.

Your eye doctor may provide you with either a general anaesthetic or a local anaesthetic around the affected eye. There are a few ways to treat a retinal detachment, including:

• Vitrectomy, which involves removing the vitreous and replacing it with a silicone gas or oil to push the retina back against the eye into its normal position.
• Scleral buckle, which involves stitching a band of silicone around the eyeball to press it inwards against the area where the retina detaches.
• Pneumatic retinopexy, which involves the injection of a gas bubble to push the retina against the back of the eye. Subsequent laser treatment seals the retina into its normal position.

Retinal detachment surgery typically takes around 90 minutes and you will be able to go home on the same day.

Recovery after Retinal Detachment Surgery

Always follow the post-op instructions from your eye doctor. You may be required to:

• Lie or sit in a certain posture
• Use eye drops
• Avoid strenuous activity
• Keep the affected eye area clean
• Attend for a follow up dilated eye exam

Never ignore the warning signs that may indicate a retinal tear or retinal detachment. Doing so can cause you to lose vision permanently. Eye floaters and flashing lights require a dilated eye exam with your optometrist or eye doctor.

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Frequently Asked Questions

What are the first signs of a retinal tear?

The most common early signs of a retinal tear include sudden flashes of light, new floaters in your vision, blurred vision, or the sensation of a shadow or curtain moving across part of your visual field. Any sudden change in vision should be assessed promptly by an eye specialist.

Can a retinal tear heal on its own?

No. A retinal tear does not typically heal on its own and requires assessment by an ophthalmologist. Early treatment can help prevent the tear from progressing to a retinal detachment, which may threaten vision.

What is the difference between a retinal tear and a retinal detachment?

A retinal tear occurs when the retina develops a small break or tear. A retinal detachment happens when the retina separates from the back of the eye. Retinal detachment is a more serious condition and often requires urgent treatment to preserve vision.

Are flashes and floaters always a sign of a retinal tear?

Not always. Flashes and floaters can occur as part of the normal ageing process, but a sudden increase in floaters, persistent flashes, or changes in vision may indicate a retinal tear or retinal detachment and should be examined urgently.

Who is most at risk of developing a retinal tear?

People who are short-sighted (myopic), older adults, individuals with a family history of retinal problems, those who have experienced eye trauma, or people who have previously had cataract surgery may have a higher risk of developing a retinal tear.

How is a retinal tear treated?

Treatment depends on the location and severity of the tear. Many retinal tears can be treated using laser treatment or cryotherapy to seal the retina and reduce the risk of retinal detachment. Early treatment often leads to the best outcomes.

Note: Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Sources

Retinal detachment
https://www.healthdirect.gov.au/retinal-detachment

Retinal detachment surgery
https://www.healthdirect.gov.au/surgery/retinal-detachment-surgery