A retinal tear is a break in the retina. A retinal detachment occurs when fluid passes through that break and lifts the retina away from the wall of the eye, separating it from the blood supply it depends on.

The distinction matters enormously in practice. A tear identified before the retina detaches can usually be sealed in the office in a few minutes. Once detachment has occurred, treatment is surgical. Time is the variable that separates the two.

Symptoms that require immediate attention

Seek care the same day if you experience:

  • A sudden increase in floaters, particularly a shower of small dots
  • New or increasing flashes of light
  • A dark shadow or curtain moving in from the side or from above or below
  • A sudden decrease in vision, or a section of vision that has gone missing
  • Vision that appears as though you are looking through water or a wobbling film

A shadow or curtain suggests the retina is already detaching and warrants immediate care. Call (602) 613-5473 during office hours, or go to an emergency department outside them.

Central vision may remain normal until the detachment reaches the macula, which is why the absence of blurring is not reassurance when a shadow is present.

Who is at higher risk

  • Significant nearsightedness (myopia), which is the most common predisposing factor
  • Previous retinal detachment in either eye, or a family history of one
  • Previous eye surgery, particularly cataract surgery
  • Eye trauma
  • A recent posterior vitreous detachment
  • Lattice degeneration, a thinning of the peripheral retina found on examination
  • Advanced diabetic retinopathy, which can cause a tractional detachment by a different mechanism

Risk factors raise the value of prompt examination when symptoms occur; they do not mean detachment is inevitable.

How tears and detachments are found

Diagnosis is made by dilated examination of the entire retina, including the far periphery where most tears occur. The physician uses a bright light with a lens, frequently indenting the outside of the eye to rotate the peripheral retina into view. This is the part of the examination that no imaging currently replaces.

Where the view is obscured — for example by bleeding into the vitreous — ocular ultrasound can show whether the retina is detached beneath the blood. Widefield photography and OCT are used to document findings and to determine whether the macula is involved, which influences both urgency and expected outcome.

Treating a tear before it detaches

A tear without detachment is usually treated the same day in the office.

Laser retinopexy places a series of small laser applications around the edge of the tear. The resulting scar adheres the retina to the underlying tissue, forming a barrier so that fluid cannot pass beneath. Cryotherapy uses a freezing probe applied to the outside of the eye to achieve the same seal, and may be preferred depending on where the tear sits.

Both are performed with the eye numbed and take a matter of minutes. The seal takes days to weeks to reach full strength, so activity restrictions are usually advised for a period, and a follow-up examination confirms the result.

Surgery for a detached retina

Once the retina has detached, the objective is to close the break and reattach the retina. Several approaches exist, and the choice depends on the type, location and extent of the detachment:

  • Pneumatic retinopexy — a gas bubble is injected into the eye to press the retina back into position while the break is sealed with laser or freezing. It requires the patient to maintain a specific head position afterward.
  • Scleral buckle — a flexible band is secured around the outside of the eye to indent the wall inward, relieving traction on the break.
  • Vitrectomy — the vitreous gel is removed from inside the eye, the retina is flattened, breaks are sealed, and the eye is filled with gas or silicone oil to hold the retina in place while it heals.

These are sometimes combined. Where a gas bubble is used, patients must maintain a prescribed head position for a defined period and must not travel by air or to high altitude until the gas has absorbed, as changes in pressure can raise the pressure inside the eye dangerously.

Recovery of vision after reattachment depends substantially on whether the macula was detached and for how long. Your surgeon will discuss what is realistic in your specific case.

Retinal tear and detachment: common questions

There is no fixed timeline. Some tears never progress; others allow fluid beneath within days. Because progression cannot be predicted, tears causing symptoms are generally treated promptly rather than observed.

No. Retinal detachment is characteristically painless, which is why it is sometimes ignored until vision is substantially affected. Absence of pain is not a reason to delay evaluation.

No. A detached retina does not reattach without treatment, and the longer it remains detached the greater the effect on vision. This is why it is treated as urgent.

Successful reattachment is achieved in the majority of cases, though more than one procedure is sometimes needed. Vision outcomes vary and depend heavily on whether the macula was involved and how long it was detached. Detachments repaired before the macula detaches generally do better, which is the practical reason for urgency.

If a gas bubble was placed in your eye, reduced cabin pressure at altitude causes the gas to expand, which can raise the pressure inside the eye to a dangerous level. Your surgeon will tell you when the gas has absorbed and travel is safe. Driving over a high mountain pass carries the same risk and should also be avoided until then.

Significant myopia raises the risk of retinal tears and detachment, and a periodic dilated peripheral retinal examination is reasonable to discuss with your eye care provider. What matters most is knowing the warning symptoms and acting on them the same day if they occur.

Shadow or curtain across your vision?

This needs to be examined today. Call (602) 613-5473 to reach our Scottsdale office, or go to an emergency department if we are closed. A tear caught before detachment can usually be treated in minutes.