Retinal tear
The retina is the membrane lining the back of the eye. It is a thin, light-sensitive tissue that transforms projected images into nerve signals to transmit them to the brain. Tears can form on the retina, particularly during a posterior vitreous detachment, creating a risk of retinal detachment and blindness.
What is a retinal tear?
A retinal tear is a full-thickness hole in the retina, the light sensor of your eye.
The tear looks like a piece of wallpaper that has been ripped off.
This fragility increases the risk of the wallpaper peeling off: this is retinal detachment.
Symptoms
A patient suffering from an acute retinal tear usually sees black spots or "floaters" (myodesopsia) suddenly appear in the affected eye.
Patients typically describe their vision as "soot rain." Flashes of light (photopsia or phosphenes) are another common symptom.
However, in some cases, a retinal tear may not present any noticeable symptoms.
Causes
The vitreous is a transparent gel that fills the ocular cavity, which is itself lined by the retina at the back of the eye.
At birth, this gel is attached to the retina, but with age, the vitreous separates from it, creating a posterior vitreous detachment or PVD. In most cases, this occurs without any problems.
However, in people whose vitreous is intrinsically more "sticky", when the vitreous separates from the retina, it pulls abnormally (abnormal vitreoretinal adhesion) and causes a retinal tear.
Although retinal tears can also occur as a result of eye trauma, most retinal tears occur spontaneously due to vitreous detachment.
Complications
Vitreous hemorrhage – In the event of a retinal tear, a blood vessel within the retinal layers can be severed, leading to bleeding and decreased vision. This is called a vitreous hemorrhage.
Retinal detachment – The tear can also lead to an influx of liquefied vitreous under the retina, forming a retinal detachment pocket.
Tears and holes in the retina
Retinal holes are a related entity. The terms retinal tears and holes may be used interchangeably by some retina specialists.
Retinal tears develop when the vitreous pulls on the retina, while retinal holes develop due to the progressive thinning of the retina.
Retinal holes are generally smaller and present a lower risk of causing retinal detachment.
In some cases, retinal holes must be treated in the same way as retinal tears.
Risk factors
Risk factors are not necessary to develop a retinal tear, but they increase the likelihood. Here are the main ones:
Age (> 50 years).
The degree of myopia (presbyopia).
Associated peripheral retinal degenerations (thinning in the retina).
Trauma.
A family history of retinal tear or detachment.
Some previous eye surgeries: vitrectomy, cataract, intravitreal injection.
There is no way to predict who will develop a retinal tear or when it will occur. Therefore, monitoring by a retina specialist is recommended.
Diagnosis
An examination of the fundus by an ophthalmologist, ideally a retinal specialist, is the crucial step in the detection and evaluation of retinal tears and associated fragilities.
In cases where retinal examination is limited by an underlying hemorrhage, an ophthalmic ultrasound may be necessary to help diagnose a retinal tear.
Laser treatment and prognosis
If a retinal tear is diagnosed early before it develops into a retinal detachment, the prognosis is extremely good.
Retinal tears are usually treated with argon laser (in an outpatient setting) or, more rarely, with a freezing procedure called cryotherapy or cryoapplication (in the operating room). The treatment is very effective and quite safe.
Argon laser
Topical anesthesia using anesthetic eye drops is used, and the laser is only slightly uncomfortable.
The treatment creates a spot weld around the edges of the tear, virtually eliminating the risk of the tear progressing to a retinal detachment.
After treatment of a tear, there remains a risk of developing other distinct retinal tears.
Similarly, the laser takes about 5 days to cauterize the retina, so it is important to continue early monitoring (after a few days) and then long-term monitoring.
Do all tears need to be treated?
Not all retinal tears require treatment. When low-risk tears are identified in asymptomatic patients, these tears can be observed without treatment.
Some tears "heal themselves," meaning they develop adhesions around them without treatment, and these situations can also be managed without treatment.
Cryoapplication
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Sometimes laser treatment is not effective in treating the tear, because the patient has a cataract or because the pupil dilates poorly.
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In this case, it is possible to perform a cryoapplication.
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The eye is anesthetized and the tear is cauterized using a cold probe placed against the sclera, outside the eye.
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The cold diffuses through the ocular wall and "freezes" the tear.