What is the cause of retinal tears or holes?

The retina is in contact with the vitreous gel that covers the eye. A healthy eye vitreous gel homogenates, tightens, supports the retina and pushes it towards the outer layer tissues, such as underlying choroid and sclera. This viscous consistency of the vitreous gel’s homogeneous nature can deteriorate in some special cases. Diseases such as high myopia, eye trauma and intraocular inflammation facilitate the fluid confluence of the vitreous gel. Liquid convulsion causes the supporting function of the vitreous which serves as a roof to be lost. It starts to separate from the surface where it sticks to the retina. During this separation, in some cases it attracts retinas and comes to the torn fruit. Intrusion of this viscous vitreous from the torn area leads to retinal detachment.

Why is retinal detachment emergent and dangerous?

Retinal detachment is a disease that can progress to blindness. The tearing apart of the retina from the cohesive layer will result in the deterioration of the nutrition and the death of the cells. Progressive retinal detachment causes the central vision to disappear. Even if the retina is successfully seated in place, time loss makes it impossible for cells to regenerate. In such a case, it is impossible even in the most successful operation to obtain the same old image. Early diagnosis and early surgery is important.

Conditions requiring a treatment for patients with retinal degeneration

  • If there is retinal detachment in the other eye
  • If there is familiar retinal detachment
  • Coexistence of other diseases with risk of retinal detachment
  • If the retinal thinning area is torn
  • If eye surgeon is planned
  • Having a profession with a high risk of eye or head trauma

What is a retinal detachment?

Retinal detachment is a serious eye disease that is seen in 1 person every 10,000 years. It may occur at any age, including middle age and over. If it’s not treated urgently, it may cause partial or complete loss of vision. Retinal detachment is the separation of the pigment epithelium layer below the retinal nerve layer. Often due to tears or holes in the retina, these two layers develop into a fluid infiltration. It is most commonly seen in high myopia patients. The retinal layer is stretched as the anterior-posterior diameter of the eye increases. Than it begins to thin and deteriorate. In some familial or degenerative diseases and infections, thinning and deterioration may occur in the periphery of the retina. In the meantime, for the same reason, the vitreous gel begins to lose it’s homogeneity and deteriorate, the gel consistency changes and it gradually leaves the retina. This is called vitreous detachment. Meanwhile, as the vitreous tissue, which is shrunken and opaque locally, passes through the eye in the eye, it is perceived by the person as a flies or fog flies in front of the eye.

Reasons and symptoms for retinal detachment

Retinal detachment is the separation of the pigment epithelium layer beneath the retinal nerve layer. Often due to tears or holes in the retina, these two layers develop into a fluid infiltration. It is most commonly seen in high myopia patients. The retinal layer is stretched as the anterior-posterior diameter of the eye increases and the stretching area on it begins to thin and deteriorate. In some familial or degenerative diseases and infections, thinning and deterioration may occur in the periphery of the retina.

In the presence of thinned, distorted areas around the retina, retraction may occur when retracting from the retracted vitreous retina. These feelings can rarely develop in people with healthy retinas. Retina  withdrawals are perceived by the patient as “light flashes, flash bursts”. These light flashes can sometimes be short-lived, and sometimes last for days. In some patients it may not be felt at all.

These withdrawals, which occur in the retina layer of the vitreous shrinkage, can lead to tearing and puncturing in the areas of the thinned and deteriorated retinal wall. If a vein passes through the torn retinal layer, sometimes it breaks and can cause some bleeding in the eye. This is perceived by the patient as “the tissue is falling.” If a tear or hole is formed in the retina, the fluid in the vitreous passes through these tears and separates the retinal nerve layer from the pigment layer that it adheres to. This condition is called retinal detachment. The retinal area that separates from the underlying tissue does not have a visual function and the patient feels ‘blurred’, ‘black spot’ or ‘curtain’ sensation on the exact opposite side of that area. Retinal detachment can sometimes be limited to a region but is often progressive.

Center vision disappears when the macula leaves the underlying tissue. In long term detachments, the intraocular balances disintegrate and the eye squeeze begins to shrink. Sudden, severe or piercing blows that are noticeable may be the cause of the detachment. In diabetes and some degenerative diseases, retinal detachment of the vitreous can occur and tracheal detachments may develop. Rarely, some dislocations may develop without any tears in the eye, especially in the case of a tumor or a tension crisis in pregnancy.

Retinal detachment diagnosis

The pupil is dilated with drops to detect the perturbed areas around the retina, the perforations and tears in these areas. The  doctor uses various lenses to examine the eye all the way through the microscope. The result is a tear or detachment in the eye. If necessary (if the retina can’t be seen with cataract or hemorrhage) eye ultrasonography is applied.

Retinal detachment

The shrinking of the vitreous fluid filling the inside of the blindfold separates from the posterior wall of the resulting gel-like fluid blindfold. This is called back vitreous detachment. During the formation of the posterior vitreous detachment, in some cases, a tear may develop in the nerve layer called the retina. The indication of retinal tear is almost identical to the posterior vitreous detachment mentioned in the previous section. After the retina is ruptured, the intraocular fluid passes between the retina and the underlying wall from this tear and causes the “retinal detachment”.

What are the symptoms of retinal detachment?

Retinal detachment is an urgent disease that can result loss of vision. The symptoms are:

  • Light flashes when the eye is open or closed (in case of posterior vitreous detachment)
  • The sudden appearance of flying objects
  • Gray-black screen that develops in any direction within the visual field
  • Blurring or loss of vision that does not go through with screamingIf one or more of these symptoms are present, a retinal examination should be performed without delay.

Treatment of retinal tear

It is extremely important to detect and treat the retinal tear early, before retinal detachment developes. The indication of retinal tear is light strikes and flying objects. If this happens, a retinal examination should be performed as soon as possible.

If a retinal tear is detected during the examination and it is suspected that this rupture may lead to retinal detachment, a treatment is required. The treatment is closed with a tear laser.

Treatment of retinal detachment?

If retinal detachment develops, surgical intervention is necessary. The surgical method can vary depending on the number of retinal tears that cause retinal detachment, the size, the location, and the length of retinal detachment.

Outside buckling method (scleral buckling method):

It is the oldest method used in detachment surgery. The retina is torn in the area of the tear area, a piece of hard silicon is placed on the outer wall of the blind and the retina is closed with this application from the outside. If the retina is torn by this external intervention, retinal detachment fluid (fluid accumulating under the retina) is absorbed by the eye for a short time and recovery is complete.

Vitrectomy:

If there is a large number of tears that lead to retinal detachment, if the location is unusual, if a tear can not be detected, if there are other accompanying diseases (such as eye bleeding) or if the time has passed, vitrectomy surgery may be needed. During a vitrectomy surgery, retinal detachment is treated through the eye. For this, small holes are made in the eye, the vitreous fluid is cleaned with a set of cutter and aspirator rods (probe) and light sources, liquid aspirated under the retina is aspirated, tears are closed and laser treatment is applied. At the end of the operation, it is necessary to give a tampon material to the eye to paste the applied laser treatment into the tear zone and to continue this effect. Depending on the situation, this buffer may be air, similar gases or silicone oil. The postoperative patient needs to use a protective shield for some time and to sit in a certain head position.

Who should make a retinal examination from the perspective of retinal tear and detachment risks?

Light flashes in the eyes and suddenly floating objects should be examined in terms of the retina rupture. Patients with high myopia, impacted eyes, those who have had an eye surgery such as cataract, those who have had a laser treatment or retinal surgery because of familiar tearing of the, those who have had a laser therapy or retinal surgery because of rupturing the retina in the other eye, should seriously complain about it and must go through the retina examination as soon as possible.