Retinal tears usually arise from a posterior vitreous detachment (PVD), and frequently lead to a retinal detachment; prompt management by a retina specialist is therefore advised.
Retinal Tear Caused by PVD
A retinal tear usually occurs as a result of a posterior vitreous detachment (PVD). The vitreous is the clear, jelly-like substance in the middle part of the eye. As one matures, the jelly becomes softer, and the vitreous separates from the retina, creating a posterior vitreous detachment.
In most cases, a posterior vitreous detachment occurs with very few, if any, symptoms; flashes and floaters are usually most commonly described. But if the posterior vitreous detachment occurs with enough force, then a piece of the retina may become torn, creating a retinal detachment.
A retinal tear is an urgent condition, requiring prompt attention by a retina specialist.
What Causes a Retinal Tear?
In most cases, a retinal tear can be readily identified by an experienced retina specialist; examination in the office, sometimes with gentle pressure on the outside of the eye (called scleral depression) will show where the tear is located– and if more than one tear has occurred, they can usually all be identified.
Sometimes, if the tear involves one of the many blood vessels of the retina, then some bleeding can also occur, referred to as a vitreous hemorrhage. An experienced retina specialist can frequently see through the blood; but if the hemorrhage is particularly heavy, then an ultrasound of the eye can be used to help.
Treatment by a Retina Specialist
Once a a retinal tear has been identified by a retina specialist, most, if not all, can readily be treated the same day in the office. A retina specialist may choose to use either laser (laser retinopexy) which uses heat to create a barrier around the tear, or cryo (cryopexy) which uses very cold energy to create the same effect.
In almost all cases, anesthetic drops, or sometimes a small injection of local anesthetic, over the white part of the eye is all that is necessary to perform the procedure. There is very little if any pain involved when performed by an experienced retina specialist, and patients leave the office and are generally allowed to resume their usual daily activities.
An effective treatment usually takes about 10-12 days, and so patients return at around that time for a brief recheck.
Nader Moinfar, M.D., M.P.H.
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