What does a retinal tear feel like?
A retinal tear is painless. The warning signs are visual, and they often appear suddenly:
- Flashes of light: brief streaks or arcs, often in your peripheral vision, especially in the dark. These flashes frequently occur before a retinal detachment and result from the vitreous gel "tugging" or creating traction on the retina, causing a retinal tear. Left untreated, a retinal tear often becomes a retinal detachment.
- New floaters: specks, strings, cobwebs, or a sudden shower of dots drifting through your vision
- A hazy or smoky area of vision: if the tear crosses a blood vessel, blood may accumulate in the vitreous gel causing an oily, mobile smudge in your vision
Some tears cause no symptoms at all and are found on a routine dilated exam. These tears are less urgent, but should still be treated in most cases, to prevent retinal detachment. Routine exams with your optometrist or ophthalmologist can help discover asymptomatic retinal tears.
What causes a retinal tear?
Most tears happen within the first few months following a posterior vitreous detachment (PVD), the normal aging process in which the vitreous gel inside the eye liquifies and separates from the retina. In most people this happens harmlessly. Occasionally the gel is particularly adherent to the retina, and instead of separating harmlessly from the retina, the gel pulls on the retina with sufficient tractional force to create a tear.
Retinal tears are more common in patients who are nearsighted, have areas of retinal thinning called lattice degeneration, have had recent eye surgery or an eye injury, or have a family history of retinal tears or retinal detachment.
How we diagnose a retinal tear
Retinal tears are typically diagnosed with a widefield retinal photo or with a dilated retinal exam. This highly-specialized examination, using skills developed over years of training and clinical experience, involves careful visualization of the retina, including the far periphery where most tears develop, and often with gentle pressure on the outside of the eye to identify the retinal tears and determine the best method for treatment.
How is a retinal tear treated?
Treatment seals the retina around the tear so fluid cannot accumulate at its edges and lead to retinal detachment. Both treatments are performed in the office and take about 10-20 minutes depending on the size and number of retinal tears.
If the retina has not only torn, but the tear has developed into a retinal detachment, the retina typically must be reattached first before applying laser around the retinal tear. The reattachment of the retina may be performed in the office with a gas bubble followed by laser or cryotherapy, or may require surgery in a surgery center or hospital. See our retinal detachment page for those options.
What is recovery like?
Laser treatment requires minimal recovery. Your vision may be blurry for about 15 minutes after the procedure and then will return to the vision prior to the laser, though floaters may persist and are not expected to be resolved from the laser. Your eye and eyelids may be slightly red or sore for about one day. Most patients drive themselves home and return to normal activity quickly. If only laser was performed (without an injection of a gas bubble), you may travel to higher elevations or on an airplane. We may ask you to avoid vigorous exercise or jarring activities for a week or two while the laser-induced seal between the retina and the eye wall strengthens over one to two weeks.
The flashes usually improve over days to weeks. Floaters improve more slowly, over weeks to months, as your brain learns to ignore them or any bleeding into the vitreous resolves. We will re-examine the retina several weeks to months after treatment to confirm the seal is complete and no new tears have formed.
Common questions
Is a retinal tear an emergency?
It is urgent, but not typically an emergency. A tear itself doesn't typically cause vision loss, but fluid can accumulate at its edges and detach the retina, which does. Treating a tear promptly, usually within a week of diagnosis, almost always prevents retinal detachment. A tear that is discovered on a routine exam should still typically be treated but often with less urgency as it may not have been present for quite some time and is lower risk of becoming a retinal detachment.
Does laser treatment hurt?
Laser for a retinal tear is not typically painful, unless the necessary laser is directly over one of several nerves beneath the retina. In most cases, the eye may feel dry and irritated during the laser, which can often be relieved with numbing eye drops. The most uncomfortable aspect of the laser treatment is the very brief flashes of bright light from the laser and light pressure which may be applied to the eye in order to treat the retinal tear completely.
Will the floaters go away after treatment?
The laser seals the tear but doesn't remove floaters. They typically fade and become less noticeable over weeks to months. If bleeding caused a heavy shower of floaters, that blood also clears gradually, but it may take several months for the blood to clear.
Can I get another tear later?
Yes. If you have had a retinal tear, you are at increased risk of developing other tears. This is not because of the tear itself, but because of the underlying traction of the vitreous on the retina, which can tear other areas of the retina. If you have the sudden onset of many, small, black specks and floaters in your vision, at any time but especially after having had a retinal tear, you should call to be seen within the next week.
Can I do anything to prevent retinal tears?
In most cases, there is nothing you can do to prevent retinal tears. Some tears may be caused by trauma, which may be able to be avoided, but in most cases, the tears develop due to age-related changes in the vitreous that causes the retinal tears. We are not aware of any supplements or eye exercises that are believed to prevent retinal tears. Recognizing the symptoms and calling with new concerns is helpful to discover retinal tears and treat the tears once diagnosed.
What if the tear already caused a detachment?
Then the repair moves from the office to surgery: pneumatic retinopexy, vitrectomy, or scleral buckle depending on your eye. Our retinal detachment page walks through each option.
This page is educational and is not a substitute for an examination. Content follows guidance from the American Academy of Ophthalmology and the American Society of Retina Specialists.