Retinal Tears and Detachments

About Retinal Tears and Detachments

The retina acts as a light-sensitive wallpaper lining the back of the eye, which sends visual signals to the brain. When the retina gets lifted or pulled away from its normal position, this is called a retinal detachment. Sometimes small areas of the retina get torn. These are called retinal tears or retinal breaks, leading to retinal detachment. If tears and detachments are not treated immediately, there can be permanent vision loss and even blindness.

There are three types of retinal detachments. They include:

• Rhegmatogenous – a tear or break that enables fluid to get under the retina and separate it from the retinal pigment epithelium (RPE). The RPE is a layer of cells that nourishes the retina. These types of retinal detachments are the most common. They are also the most dangerous type since they happen quickly.
• Tractional – scar tissue on the retina's surface shrinks and causes it to separate from the RPE. This type of detachment happens in people with diabetes. It does not progress as rapidly as rhegmatogenous.
• Exudative – where fluid leaks underneath the retina, but there are no tears or breaks in the retina. This type is usually caused by retinal diseases, including inflammatory disorders and injury or trauma to the eye.

Risk Factors

A retinal detachment is most likely to happen directly after a vitreous detachment. Usually, it takes three months after seeing a first “floater” for the vitreous to detach from the retina completely. Retinal detachment is more common in people over age 40. But it can happen at any age. It affects men more than women and Whites more than African Americans.

Other people at risk for retinal detachment include those who:

• Are extremely nearsighted
• Have had a previous retinal detachment in the other eye
• Have a family history of retinal detachment
• Have had cataract surgery
• Have other eye diseases or disorders, such as uveitis or pathologic myopia
• Have had an eye injury

Symptoms

If you have recently had a vitreous detachment, watch carefully for symptoms of retinal detachment, such as flashes of light, a shower of dots, and a pitch-black curtain entering and moving across your vision in any direction. If you have any of these symptoms, especially if you have more than one symptom at the same time, see a Columbia ophthalmologist or go to the nearest emergency room immediately.

Symptoms of retinal detachment include:

• An increase in floaters – these resemble little "cobwebs" or specks that float about in the field of vision. This increase can happen suddenly or slowly over time.
• Seeing flashes of light.
• Seeing a curtain that causes a loss of a field of vision. This curtain might originate from any direction.

Treatments We Offer

Caught early, there are many treatment options for retinal tears and detachments. If the retinal detachment goes untreated for too long (sometimes for only a few days), Columbia ophthalmologists may need to perform a vitrectomy or scleral buckle surgery. A retinal detachment and tears can also be treated with laser surgery in our office. Some of these treatments can be performed as an outpatient and include:

• Laser surgery – to treat small holes and tears. Tiny burns are made around the hole to "weld" the retina back into place.
• Cryopexy – a freeze treatment that can also help with small holes and tears. Cryopexy freezes the area around the hole and helps reattach or weld the retina.
• Gas injection –  a gas bubble gets injected into the eye. The gas bubble can help hold the retina against the eyewall while the areas are treated with laser or cryopexy to reattach at full strength, which can take up to a week.
• Surgery might include:
  • Scleral buckle – A tiny synthetic band attaches to the outside of the eyeball. The band gently pushes the wall of the eye in toward the center of the eye. This places the eye wall very close to the detached retina. Natural pumps in the eye then help reattach the retina to the wall.
  • Vitrectomy – A vitrectomy is a surgery to replace the vitreous, a gel-like substance that fills the center of the eye and helps the eye maintain a round shape. A tiny incision is made in the white of the eye, the vitreous is removed, and gas is injected to replace the vitreous. The gas pushes the retina back against the wall of the eye and reattaches it. The eye makes fluid that slowly replaces the gas and fills the eye as it heals.

Why Choose Columbia?

Columbia ophthalmologists use the most modern techniques, so our patients are successfully treated for retinal tears and detachments. Our ophthalmologists are renowned for their expertise and experience in treating retinal detachments and tears and ensuring we do everything to save and preserve your vision. We are the world leaders for using minimally invasive surgical methods to treat complex retinal disorders which allows patients to recover fast and return back to their daily life.