A retinal tear is a physical defect or “rip” (“horseshoe tear”) in the retina, caused by traction on the retina, that can predispose people to retinal detachments and severe vision loss. A retinal hole (atrophic hole) is also a defect or break in the retina that is usually not caused by traction on the retina but by degeneration in periphery and usually associated with a condition called lattice degeneration.

The back of our eyes are filled with a substance called vitreous gel. You can think of this gel as a substance similar to gelatin. As we age this vitreous gel begins to liquify and form liquid pockets within the more solid gel substance. With time this process can cause the gel touching the retina to “pull off” or form a posterior vitreous detachment. In most people this does not cause any issues or problems, but in some people the gel is very adherent and does not separate cleanly. In these cases the gel elevates and tears the retina causing a break in the retina. 

Symptoms: flashes of lights, floaters in visual field, change in peripheral vision, vision loss

With a symptomatic tear in the retina about 1/3rd to greater than ½ of these eyes may go on to develop a retinal detachment and cause severe vision loss. The detachment is caused by the liquified gel flowing under the retinal break and filling this space.

The exact cause is not known, but thought to occur from an abnormal blood supply from under the retina and possibly changes from the overlying vitreous gel.

Many atrophic holes do not need to be treated because they are at low risk for progression to a retinal detachment. However, treatment is sometimes recommended in patients who are very near-sighted, have many holes and are associated with lattice degeneration, have a history of retinal tears in that eye or have had retinal tears or holes in the fellow eye.  

Most retinal tears or horseshoe tears are recommended for treatment given the greater chance of progressing to a retinal detachment and possible permanent vision loss.

Treatment consists of applying laser therapy or cryotherapy (freezing) around the defect to form a permanent adhesion/scar in the retina that prevents further progression to a retinal detachment.

Treating retinal tears or breaks decreases the risk of advancing to a retinal detachment to less than 5%.  

If you have symptoms of a retinal tear or detachment it is important seek urgent care by an eye care professional.