An Overview of Retinal Tear

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A retinal tear can lead to fluid and blood collecting in the eye, which can cause the development of several new floaters and loss of vision if the tear leads to a retinal detachment. The retina plays a vital role in vision. Damage to the retina can cause vision loss and even permanent blindness.

The retina is the thin layer of tissue that lines the back of the eye on the inside. Located near the optic nerve, the retina's purpose is to receive light and then send pictures to the brain of what the eye sees.

The retina processes light through light-sensitive cells called photoreceptor cells. These cells are responsible for detecting light stimuli which in turn gets interpreted as images. The photoreceptor cells pass the information on to the optic nerve which sends visual information to the brain. The brain then sorts through the information and "develops" the pictures.

If the retina is unable to receive and process light, the brain won't receive information. One condition that can stop this communication between the retina and the brain is a retinal detachment, which can result from a retinal tear.

Symptoms

The most common symptoms of a retinal tear include flashes of light in the eye and visible spots called floaters. Retinal tears can develop and progress quickly, which in turn may lead to retinal detachment. Other symptoms to watch out for include:

  • A sudden increase in size and number of floaters, indicating a retinal tear may be occurring
  • A sudden appearance of light flashes, which could be the first stage of a retinal tear or detachment
  • Having a shadow appear in your peripheral (side) field of vision
  • Seeing a gray curtain slowly moving across your field of vision
  • A sudden decrease in vision, including focusing trouble and blurred vision
  • Headache

In some cases, however, a retinal tear may not cause any noticeable symptoms.

Retinal Detachment

A retinal detachment is a medical emergency. If you notice any symptoms of retinal tear and you start to lose vision, call your eye doctor immediately. A delay in treatment could worsen your outcome.

Causes

In most cases, a retinal tear occurs when the vitreous gel inside the eye contracts and tears the retina away from the eye wall. The vitreous gel, also called the vitreous humor, is a clear jelly-like substance that fills most of the eye's interior.

The main function of vitreous gel is to help the eyeball hold its spherical shape during fetal eye development. There is still a lot to learn about the function of the gel that we do not yet know. After the eye develops in utero, the purpose of the vitreous gel is unknown.

This gel also helps the retina hold its place against the interior wall of the eyeball. The contraction of the vitreous gel can occur slowly over time or suddenly after experiencing a trauma to the eye.

Associated Conditions

Other conditions associated with retinal tears include the following:

  • Diabetes
  • Sickle cell disease
  • Scar tissue
  • High myopia (nearsightedness)
  • Past eye trauma
  • History of retinal tear or detachment
  • Retinal degeneration
  • Inflammatory disorders
  • Autoimmune diseases
  • Certain cancers
  • Certain hereditary eye conditions
  • Retinopathy of prematurity

At around the age of 60, the vitreous gel naturally begins to separate from the back of the eye. This normal occurrence, known as posterior vitreous detachment (PVD), is part of the normal aging process. However, the risk of developing a retinal tear also increases during this time.

Diagnosis

Your doctor will need to perform a thorough comprehensive eye examination. In most cases, no signs of a retinal tear are visible from the outside. The eye may be red or swollen due to increased eye pressure, but it will look normal otherwise. Within the eye, however, your doctor will be able to see signs of a tear with the use of ophthalmoscopy.

Your doctor may dilate your pupils using eye drops. A binocular indirect ophthalmoscope may be used to obtain a three-dimensional view to examine the inside of your eye.

The doctor may also use the aid of a slit lamp. A slit lamp magnifies the eye many times and illuminates it with a bright light so individual structures can be examined. Traces of pigment or blood cells may be seen floating within the liquid in the front of the eye. Tears and detachments of the retina can often be visualized directly during the examination. In some instances, blood may obstruct the view, making it difficult for your retina to be examined.

An ultrasound device can be used to look at your eye, especially if there is dense bleeding inside your eye. The ultrasound device produces sound waves that bounce off the back of the eye, forming a picture that helps your doctor see if your retina is truly torn or even detached.​

Treatment

A retinal tear is repaired with a surgical procedure. Your doctor will discuss the type of procedure recommended depending on the extent of the tear. You will also be informed about the various risks and benefits of your treatment options.

Torn Retina Surgery

Prompt treatment of a retinal tear usually yields an extremely good prognosis. Most retinal tears are treated by resealing the retina to the back wall of the eye with the use of laser surgery or cryotherapy (freezing).

Both procedures create a scar that helps to seal the retina to the back of the eye, preventing fluid from traveling through the tear and under the retina. The procedure usually prevents the retina from detaching completely.

These treatments are usually performed in your eye doctor's office, and tend to cause very little or no discomfort. They include:

  • Laser surgery (photocoagulation): Your doctor will use a laser to make small burns around the retinal tear. The scarring that results will seal the retina to the underlying tissue, helping to prevent a retinal detachment.
  • Freezing treatment (cryopexy): Your doctor will use a special freezing probe to freeze the retina surrounding the retinal tear. The result is a scar that helps secure the retina to the eye wall.

Not all retinal tears require treatment. Low-risk tears with no symptoms can sometimes be monitored closely without treatment. Some tears even resolve on their own, developing an adhesion around the tear without treatment.

A Word From Verywell

A retinal tear requires immediate professional attention because it can quickly lead to a retinal detachment. If left untreated, a retinal detachment can cause total vision impairment. If caught early, however, most detached retinas can be surgically reattached with vision partially or completely restored.

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Article Sources
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  1. Boyd K. Retinal detachment: Torn or detached retina symptoms. American Academy of Ophthalmology. Updated March 1, 2016.

  2. National Eye Institute. Retinal detachment. June 26, 2019.

  3. National Eye Institute. Types and causes of retinal detachment. Updated July 9, 2019.

  4. National Eye Insititute. Vitreous detachment. Updated July 11, 2019.

  5. American Society of Retina Specialists. Posterior vitreous detachment.

  6. Boyd K. Retinal detachment: Torn or detached retina treatment. American Academy of Opthalmology. Updated March 2016.

Additional Reading
  • Thompson JT. Retinal tears, American Society of Retina Specialists (ASRS). 2016.