Retinal Tear
Definition
A retinal tear occurs when the vitreous (the clear, gel-like substance inside the eye) pulls on the retina strongly enough to create a small rip or break in the retinal tissue. While a retinal tear is not the same as a retinal detachment, it can lead to a retinal detachment if left untreated.
A retinal tear is considered an eye emergency because prompt treatment can prevent serious vision loss.
Causes and Risk Factors
Causes
The most common cause of a retinal tear is posterior vitreous detachment (PVD), a natural age-related process in which the vitreous gel shrinks and pulls away from the retina. In some people, this traction is strong enough to tear the retina.
Other causes include:
- Eye trauma or injury
- Previous eye surgery, especially cataract surgery
- Areas of retinal thinning (such as lattice degeneration)
Risk Factors
People are more likely to develop a retinal tear if they:
- Are older adults (particularly over age 50–60)
- Are highly nearsighted (high myopia)
- Have lattice degeneration or a thin retina
- Have had previous eye surgery
- Have a family history of retinal tears or retinal detachment
- Have suffered eye trauma
Symptoms
Some retinal tears cause no symptoms, but many produce sudden visual changes.
Common Symptoms
- Sudden onset of floaters (spots, cobwebs, threads, or specks)
- Flashes of light (photopsias)
- Blurred vision
- Darkening of vision
- A shadow or curtain-like effect in peripheral vision (may indicate progression toward retinal detachment)
Emergency Warning Signs
Seek immediate eye care if you experience:
- A sudden increase in floaters
- New flashes of light
- A gray curtain, shadow, or loss of side vision
- Sudden blurred or decreased vision
These symptoms may indicate a retinal tear or retinal detachment and require urgent evaluation.
Retinal Tear vs. Retinal Detachment
| Retinal Tear | Retinal Detachment |
| Small rip or break in the retina | Retina separates from underlying tissue |
| Often treatable in the office | Usually requires surgery |
| May cause floaters and flashes | May cause vision loss and a curtain over vision |
| Can progress to retinal detachment if untreated | Medical emergency with risk of permanent vision loss |
Diagnosis
Dilated Eye Examination
The primary method of diagnosis is a comprehensive dilated retinal examination, allowing the eye specialist to inspect the retina for tears, holes, bleeding, or detachment.
Specialized Retinal Evaluation
Retina specialists may use:
- Special retinal lenses
- Scleral depression (gentle pressure applied to the eye during examination)
- Retinal imaging when necessary
to identify even small retinal tears.
Treatment
The goal of treatment is to seal the retinal tear before retinal detachment develops.
Laser Photocoagulation
- A laser creates small burns around the tear.
- Scar tissue forms and seals the retina to underlying tissue.
- Common office-based procedure.
- Success rates are typically greater than 90%.
Cryopexy (Freezing Treatment)
- A freezing probe is applied to the outside of the eye.
- Creates scar tissue that seals the retinal tear.
- Often used when laser treatment is difficult to perform.
Treatment of Associated Retinal Detachment
If fluid passes through the tear and detaches the retina, more advanced surgery may be needed, such as:
- Vitrectomy
- Pneumatic retinopexy
- Scleral buckle surgery
Prevention
Not all retinal tears can be prevented, but risk may be reduced by:
- Regular eye examinations for high-risk individuals
- Protecting the eyes from injury during sports and hazardous activities
- Prompt evaluation of new flashes or floaters
- Monitoring retinal thinning or lattice degeneration when identified by an eye doctor
Summary
A retinal tear is a break in the retina most commonly caused by age-related vitreous changes. Symptoms often include sudden floaters, flashes of light, blurred vision, or a shadow in the visual field. While a retinal tear is not the same as a retinal detachment, it can progress to one if untreated. Early diagnosis and treatment with laser photocoagulation or cryopexy are highly effective and can prevent permanent vision loss.