Retinal Tear or Detachment

Floaters and flashes are common signs that may indicate the presence of a retinal tear or early detachment of the retina from the back wall of the eye. More serious signs are the presence of a shadow in the peripheral (side) vision and a curtain coming down across your line of sight. Both are indications that the retina is detaching from the wall of the eye and require prompt medical attention.

A common cause of a retinal tear or detachment occurs during the normal course of aging, when the vitreous gel within the eye begins to shrink and pull away from the retina. A tear in the retina can allow fluid from the vitreous gel to pass beneath the retinal layer and cause the retina to peel away from the back wall of the eye.

Other risk factors for a retinal tear or detachment are:

• Nearsightedness
• Trauma
• Family history of retinal detachment
• Retinal detachment in other eye
• Cataract surgery
• Glaucoma
• Diabetes (diabetic retinopathy)

In many instances, your eye doctor can see a retinal tear or early signs of retinal detachment during an eye exam. During this exam, when your eyes are dilated, he or she will examine the internal structure of your eyes, including the retina.

Treatment to repair a retinal tear or detachment may include laser surgery, cryotherapy (freezing), or surgery in the operating room, depending upon the severity of the tear or detachment.

• Laser surgery
  Laser surgery or cryosurgery (freezing) is the preferred treatment to repair a torn retina. Both procedures are performed in your ophthalmologist's treatment room. During laser surgery, heat generated by the laser causes a reaction around the tear that, when it heals, creates tissue which in turn "seals" or bonds the retina to the back wall of the eye. Cryosurgery does the same thing using a cold probe. Both procedures can help stop the tear from becoming a detachment.
  
• Eye surgery
  Repair of a detached retina is a serious medical condition requiring surgery in the operating room. A detached retina may be treated with a variety of surgical interventions, including the use of a scleral buckle, injection of a gas bubble into the vitreous space, and a vitrectomy. Retinal tears are repaired first using laser therapy or cryosurgery.
  
• Scleral buckle
  This surgical procedure places a flexible band around the sclera, the white portion of the eye, which counteracts the pulling of the vitreous gel within the eye. When the vitreous gel shrinks, as often occurs with aging, it can pull on the retina, causing a tear. Your ophthalmologist also may drain any fluid that has accumulated behind the retina, which then allows the retina to lie flat against the back wall of the eye. The flexible band is not visible in the eye socket.
  
• Gas bubble injection
  A gas bubble may be injected into the vitreous space, which pushes the retina flat against the back wall of the eye. This surgical procedure is called pneumatic retinopexy. The gas bubble, which eventually dissipates, gives the retina time to reattach to the wall of the eye. This procedure also may be used in conjunction with a vitrectomy.
   
  After this procedure, you will be asked to keep your head in a prone (face down) position for several days, which is important for the healing process.
   
  • Importantly, you will be instructed not to fly in an airplane or travel to high altitudes until your ophthalmologist determines that the gas bubble is gone. Flying or traveling to high altitudes can cause pressure build-up within the eye and permanent loss of vision.
• Vitrectomy
  A vitrectomy removes the vitreous gel within the eye so that it no longer pulls on the retina. When indicated for a retinal tear or detachment, the space is filled with a gas bubble, which pushes the retina against the back wall of the eye so that it can heal properly. The gas bubble eventually dissolves and the space is filled with your own body fluids.