Retinal Breaks (Hole vs Tear)
Overview
Our vision comes from light waves stimulating retinal photoreceptors and these photoreceptors transferring their signals through the several different cells along the various layers of the retina and onwards to the brain. In order for light to focus on the retina, it must pass through the clear cornea at the front of the eye, the pupil, the clear lens and the clear vitreous humor gel before stimulating the retina.
A retinal break is usually caused by pulling forced between the vitreous humor gel and the retina, also know as traction. 20% of all retinal breaks are observed after a symptomatic posterior vitreous detachment (flashes, floaters, etc.) which, briefly, is a normal occurrence due to age where the vitreous humor separates from the retina. These breaks can occur during the PVD or a few weeks afterwards.
Signs and Symptoms
Signs
Bright red spot where the retina was torn, if fully torn then there may be an operculum, if the retina is still attached then there is a visible retinal flap.
Symptoms
Often asymptomatic (no symptoms), possible flashes of light like lightning bolts, possible large or very small floaters.
Causes and Risk Factors
Causes
Usually vitreous humor pulling on the retina causing a tear.
Risk Factors
Genetics of thin retinas, nearsightedness, previous retinal break, Marfan Syndrome/Stickler Syndrome/Ehlers Danlos Syndrome, trauma, current posterior vitreous detachment, retinal tufts, lattice degeneration.
Prevention and Treatment
Prevention
There are no known preventative measures.
Treatments
- Monitor every 1-2 years if low risk of progressing to a retinal detachment.
- Laser retinopexy surgery if high risk.
- Cryoretinopexy surgery if high risk.
Prognosis
A retinal break often does not affect vision except for the when it is formed (flashes, floaters, etc.). They often do not need treatment. When there is a risk of progressing to a retinal detachment, such as when there are flashes and floaters, when the break is large, when they are horseshoe in nature, and when they are located at the top of the eye (superior), surgery is warranted. Surgery can lower the chance of a retinal detachment from 90% after a symptomatic retinal break to 5% after surgery. There is a chance the surgery could cause a new retinal break so follow ups are necessary.