What is a retinal break?
A break is a tear or hole in the retina. The retina is a thin layer of nerve tissue that lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. Because the retina is very thin, breaks may develop and cause retinal detachment with loss of vision. There are two kinds of retinal breaks: holes and tears. Retinal tears cause retinal detachments more often than retinal holes.
What are the causes and symptoms?
Retinal breaks are fairly common in near-sighted eyes because near-sightedness is usually due to an elongation of the eye. As the eye enlarges deep in the eye socket, the retina has to stretch over a larger area. This stretching causes the retina to become thinner and may result in tiny round holes. These holes may cause no symptoms and may not cause retinal detachment.
In any eye, near-sighted or not, tears can occur from abnormal pulling on the retina by the vitreous (a clear gel that fills the eye and normally helps to hold the retina in place). Usually due to degeneration from aging, the vitreous gel condenses inside the eye and pulls on the retina. When this happens, patients usually notice the sudden onset of floating spots or “cobwebs”. Sometimes, brief lightning-like flashes of light occur in the side vision. About 10-15% of the time, new floaters and flashes mean a retinal tear has developed. This event places the eye at high risk of blindness from retinal detachment.
How is a retinal break treated?
Not all retinal breaks require treatment. The doctor may recommend observation alone. If a retinal break threatens to cause retinal detachment, the break is usually treated by laser or a freezing probe (cryopexy) to seal the retina to the eye wall at the site of the break. Treatment is NOT aimed at eliminating the flashes and floaters. Flashes usually disappear over a few weeks or months. The floaters gradually fade over many months, but they rarely disappear completely.
Treatment does not always prevent retinal detachment, so the patient should always report the new onset of more floaters or, more importantly, any progressive loss of side-vision or “curtain across the vision.”
Rarely, the central vision may become blurred and distorted due to scar tissue formation from the retinal break. This problem cannot be prevented with laser or cryopexy, though the scar tissue can be removed by surgery if it interferes with vision.
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