Retinal tear: warning signs, laser treatment and preventing detachment

The retina is the light-sensitive layer at the back of the eye that relays visual signals to the brain. The Dudley Group leaflet explains that a hole or break in the retina is called a retinal tear. The most common cause is contraction of the vitreous, the jelly inside the back of the eye, which pulls on the retina and can cause a tear at one or several places.

The NHS describes a detached retina as the thin layer at the back of the eye becoming loose. It says retinal detachment is usually caused by changes to the jelly inside the eye as you get older, called posterior vitreous detachment (PVD). Not everyone with PVD has a tear, but a tear is the stage that needs treating to prevent a detachment.

For a detached retina or tear the NHS lists floaters (dots and lines) or flashes of light in the eye, a dark curtain or shadow in your vision, and changes such as blurred vision.

The NHS says to get help from NHS 111 if floaters suddenly appear in your vision or suddenly increase in number, you get flashes of light, a dark curtain or shadow moves across your vision, or your vision suddenly gets blurred. This is time-sensitive, so do not wait to see if symptoms go away. If you have been treated before the NHS notes that you can get a detached retina more than once and that you should get medical help as soon as possible if symptoms come back.

The Dudley Group leaflet says a tear can happen in a normal eye but is more common in people with short sight (myopia), with advancing age and after injury to the eye. For detachment, the NHS says it is more likely if you are short-sighted, have had an eye operation such as cataract surgery, have had an eye injury or have a family history of retinal detachment. It adds that there is nothing you can do to prevent PVD.

The NHS says that if tests show your retina may be detached or has started to come away (a retinal tear) you will be referred to hospital. The Dudley Group leaflet describes the pupil being enlarged with eye drops before laser treatment, which can make vision blurry and more sensitive to light, so plan how you will get home.

The Dudley Group leaflet explains that a laser is a focused beam of light that creates small controlled burns around the tear. This leads to scarring that acts as a barrier and prevents fluid from detaching the retina. Direct laser uses a laser attached to the slit lamp with a contact lens placed on the eye. Indirect laser is done while you lie back, with the doctor wearing a head-mounted device and sometimes gently pressing on the eye to see the tear.

If the tear is difficult to see or cannot be completely surrounded by laser, cryotherapy may be used. A small amount of anaesthetic is injected, then a freezing probe is applied to the outside of the eye. The leaflet says this produces the same scarring effect around the hole as laser. The NHS also lists vitrectomy, scleral buckling and a gas bubble (pneumatic retinopexy) as ways of repairing a tear or detachment, usually under local anaesthetic without an overnight stay.

The Dudley Group leaflet lists possible side effects of laser as occasional brief pricking pain, spots in vision, redness that usually settles in a day or two, rarely bleeding, and rarely accidental laser spots to the centre of the eye. Occasionally laser is not enough to prevent detachment and retinal surgery is needed.

You are reviewed in the eye clinic two to four weeks after the laser to check it has worked. The leaflet says laser reduces the risk of retinal detachment in most people, but that you must seek help straight away if you notice new or increased floaters, flashing lights, a decrease in vision or a curtain or shadow in the vision, because these can mean a continued tear or detachment.

If you needed surgery for a detachment, the NHS says for 2 to 6 weeks vision may be blurry, the eye may be sore and red, you may need time off work, may not be able to drive and may need to avoid flying if a gas bubble was used. It also says you may be asked to lie or sit in a particular position for up to 7 days.

The NHS says surgery will usually stop your vision getting worse, and most people are eventually able to return to normal activities. For a tear caught early, laser or cryotherapy often prevents the retina from detaching. Because new tears can develop in the same or the other eye, knowing the warning signs matters for life.

A suspected retinal tear is treated as an urgent problem by the NHS hospital eye service. Some private eye clinics also offer laser retinopexy. The procedure is the same, so the main differences are waiting times and how quickly you can be seen. If your symptoms are sudden, do not delay for a private appointment when NHS 111 or an emergency eye clinic is available.