Retinal
Tear and Detachment
As previously described in the “How
the Human Eye Works” section of this
website, the vitreous is the clear gel that
fills the inside cavity of the eye behind
the lens of the eye. The vitreous is a firm
semi-solid gel matrix that is 98% water
and has a solid outside surface called the
hyaloid. This hyaloid surface attaches everywhere
to the retina.
As we grow older, the vitreous gel matrix
breaks down with the solid parts of the
gel separating from the fluid parts and
the outside hyaloid surface separating from
the retina. This process is what leads to
the common symptoms of “flashes and
floaters”. The flashes result from
the hyaloid pulling on the retina; it is
this tractional stimulation of the retina
that produces the sensation of flashes of
light. The floaters are the patient’s
perception of the solid parts of the vitreous
get floating around inside the liquid parts.
It is normal for people to experience “flashes
and floaters” as they get older and
these symptoms usually subside over time.
However, a small percentage of eyes develop Retinal
Tears because the hyaloidal
traction on the retina is strong enough
to actually tear it (Figure 1A). If
the fluid part of the vitreous gel goes
through the retinal tear, this can lead
to Retinal Detachment.
(Figure 2A). Therefore, any patient
who notices new flashes and floaters
should promptly have a thorough retinal
examination to rule out these potentially
vision threatening problems.
Both Retinal Tear and Retinal
Detachment are treatable
conditions. Furthermore, in the majority
of cases the treatments can be safely
and quickly performed in the office
(Figures 1 B and C; Figure 2 B). However,
surgery in the operating room may be
necessary in many cases. Fortunately,
the success rate is very high and vision
is usually preserved following these
interventions.
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