Retinal tears and retinal detachment

Seeing Flashes of Light and/or new Floaters

Seeing flashes of light or new floaters in your vision often indicate retinal detachment or retinal tears. These are symptoms of problems caused by the vitreous humour and retina. The information below will help you to understand what is occurring and what treatment is required..

The retina is the camera film that lines the back of the eye. It is comprised of millions of nerve cells and it is just 0.2mm thick. The cavity immediately in front of the retina is filled with a transparent, jelly-like substance called vitreous humor.

At birth, the vitreous humor is attached to the retina, like Blu-Tac attached to wallpaper. Throughout life, the vitreous degenerates into a watery state and sags with gravity. This causes it to gradually peel away from the retina. This process is called a “posterior vitreous detachment” and it is a normal ageing change. It typically occurs after age 50 years. As the vitreous detaches, small opacities within it cast shadows onto the retina, which we see as ”floaters”.

If you suffer from vitreous floaters, then you can consider having these floaters removed with a procedure called “YAG laser vitreolysis”. This is a non-invasive procedure that permanently erases floaters using laser energy.

As the vitreous sags with gravity, it tugs on the retina. This traction stimulates the retina, which we see as a flash of light.

If the retina is abnormally brittle, or if the vitreous is abnormally adherent, then a retinal tear can occur. Fluid seeps into this tear and peels off the adjacent retina. Eventually, the retina begins to fall off the back of the eye. This is called a retinal detachment. Retinal detachments are very serious because detached retinal cells quickly die. Emergency eye surgery is required to return the retina to its anatomic position. Despite surgery, vision is often permanently reduced.

Retinal tears occur through no fault of your own.

Risk factors include:

• Near-sightedness (myopia)
• A family history of retinal detachment
• An abnormally brittle retina (called retinal lattice degeneration)
• Abnormally strong vitreous adhesions to the retina

How are retinal tears treated?

Most retinal tears require treatment to prevent progression to retinal detachment. The two main treatments aim to seal off the tear:

• Laser treatment (most common) is performed in the clinic.
• In some cases, treatment is done in an operating theatre at a hospital.

Retinal laser is the treatment for preventing a retinal tear from progressing to a retinal detachment. A thermal laser is used to form a confluent row of tiny burns surrounding the retinal tear. Over the following 48 hours, a strong, watertight seal forms. Each burn is just 250um in diameter (one-quarter of a millimetre), but the protection lasts a lifetime. The medical name for the procedure is “barrier laser retinopexy”.

Note, there are many different lasers used in ophthalmology. Laser retinopexy will not change your vision or your need for glasses.

A retinal detachment is a serious condition that often requires urgent treatment. The treatment method depends on several factors, including the severity and location of the detachment.

1. Pneumatic Retinopexy

• A gas or air bubble is injected into the eye in the clinic.
• You will be asked to position your head in a specific way to help the bubble cover the retinal tear.
• Follow-up treatment may include laser therapy or vitrectomy surgery to permanently repair the detachment.

2. Vitrectomy Surgery (Most Common Treatment)

• A minimally invasive, keyhole procedure performed through the white part of the eye (sclera).
• The vitreous gel is removed, and fluid is drained from under the retina to reattach it.
• Laser therapy is applied to permanently seal the retina.
• The eye is then filled with a substance to hold the retina in place while it heals. Options include:

• • Gas bubble (which dissolves over time)
  • Silicone oil (may require later removal)
  • Heavy liquid

• After surgery, you may need to position your head in a specific way for a few days.
• If a gas bubble is placed in your eye, you cannot fly or travel to high altitudes until it dissolves.
• The amount of vision recovery depends on the severity of the detachment.

3. Scleral Buckle Surgery

• A plastic band is placed around the eye to support the retinal wall.
• The buckle stays in place permanently but is not usually visible.

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All readers/viewers of this content are advised to consult their doctors or qualified health professionals regarding specific health questions.

Neither Dr. Andrew nor the publisher of this content takes responsibility for possible health consequences of any person or persons reading or following the information in this educational content.

All surgical procedures carry risk. Before proceeding with any operation, always consider obtaining a second opinion from an appropriately qualified health practitioner.