Retinal Holes and Tears

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What are retinal holes and tears?

Retinal holes and tears are small breaks in the retina. The retina is light-sensitive tissue at the back of 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 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 total blindness.

How do they occur?

Sometimes the tissues of the retina begin to thin or weaken over time. Holes and tears can develop in areas of thinning. The vitreous (the clear gel in the center of the eyeball) may pull the retina and tear it.

Eye problems that may increase the risk of retinal holes and tears include:

  • Nearsightedness
  • Eye injuries
  • Cataract or certain other types of eye surgery

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 and flashes (“spots before your eyes”) may indicate a hole or tear.

Other symptoms may include:

  • Cloudy, blurry, or wavy vision
  • A dark shadow in your peripheral (side) vision

How are they diagnosed?

Your eye doctor dilates your eyes with eye drops. Then he or she looks at your eyes through an ophthalmoscope (a lighted instrument for examining the inside of the eye).

How are they treated?

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

  • Laser photocoagulation. Highly focused beams of light seal the tissue around the hole or tear. The procedure is generally quick and painless. Your eyes are dilated for this procedure. You can go home right after the 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 eye drops
  • Diathermy. This is similar to cryopexy except that heat from an electric current is applied through a needle to seal a hole or tear

Treatments for retinal holes and tears are usually successful. However, you may have a retinal hole or tear in another part of your eye later. You should have your eyes examined regularly.

Some retinal breaks do not need treatment.

How can retinal holes and tears be prevented?

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 doctor for regular checkups or as soon as you have symptoms of holes or tears.

Reviewed and approved by the Wilmer Eye Institute of The Johns Hopkins Medical Institutions, Baltimore, MD.