Retinal Holes and Tears

What are retinal holes and tears?

Retinal holes and tears are small breaks in the retina. The retina is the lining at the back of the eye that senses light coming into the eye. Usually holes and tears do not mean you will have serious vision problems right away. However, retinal holes and tears may cause problems if they allow fluid from the vitreous (the clear gel in the center of the eyeball) to seep behind the retina. If a lot of fluid gets behind the retina, the retina can separate from the wall of the eye. The detached part of the retina will not work properly. Detachment of the retina is a serious condition that can lead to blindness and must be treated promptly to protect as much vision as possible.

What is the cause?

When we are first born, the gel in the center of the eyeball called the vitreous, is entirely clear and uniform. As we age, the vitreous gel develops pockets of fluid. When a pocket of fluid develops in the very back of the eye, the vitreous can pull away from the retina. This eventually happens to everyone, and is not itself dangerous. However, sometimes the vitreous may pull on a thin or weak area of the retina, and cause a tear or hole.

Problems that may increase the risk of retinal holes and tears in an eye include:

• nearsightedness
• eye injuries
• cataract or certain other types of eye surgery
• a history of retinal holes or tears in your other eye

This condition may run in families.

What are the symptoms?

Sometimes retinal holes and tears have no symptoms. However, the sudden appearance of many floaters (spots or squiggles before your eyes) or flashes (flickers or arcs of light in the peripheral or side vision) may indicate a hole or tear. Other symptoms may include:

• cloudy, blurry, or wavy vision
• a dark shadow or curtain in your peripheral vision

How are they diagnosed?

Your eye care provider dilates your eyes with eyedrops. Then he or she looks at your eyes through an ophthalmoscope (a lighted instrument for examining the inside of the eye) and a special lens.

How are they treated?

Your provider will seal the retinal holes and tears so that they do not get bigger, fluid does not get underneath the retina, and the retina does not detach. The main types of treatment are:

• Laser photocoagulation: Highly focused beams of light seal the tissue around the hole or tear and prevent fluid from entering the break. The procedure is generally quick and can be done in your health care provider’s office. Your eyes are dilated for this procedure. Your vision may be blurred for a few hours.
• Cryopexy: An instrument called a cryoprobe is used to freeze the tissue around the hole and secure it to the inside of the eyeball. You will be given local anesthesia. You can go home after the procedure. Your eye will be red for a few days after cryopexy. You may need to use eyedrops.

Rarely, retinal holes do not need treatment, but should be checked regularly.

How long will the effects last?

Treatments for retinal holes and tears are usually successful. However, the effect of the treatment is not immediate. That is, the holes do not seal immediately at the time of the treatment. Because of this delay in sealing, there is a small risk that the problem will progress to a retinal detachment before the holes have healed. There is also a chance that you will have a retinal hole or tear in another part of your eye later. Have your eyes examined regularly and tell all eye care providers that you have had retinal problems.

How can I take care of myself?

• Follow your treatment plan.
• Have your eyes examined regularly and tell all eye care providers that you have had retinal problems.

How can I help prevent retinal holes and tears?

Other than protecting your eyes from injury, there is no way to prevent retinal holes and tears. However, you can help prevent blindness if you see your eye care provider for regular checkups or as soon as you have symptoms of holes or tears.