From the Guidelines
A retinal tear should be diagnosed and treated as soon as possible, ideally within 24 hours of symptom onset, to prevent progression to retinal detachment and permanent vision loss. Symptoms that warrant immediate medical attention include sudden flashes of light, a shower of new floaters, a shadow or curtain moving across your field of vision, or sudden vision loss. Prompt diagnosis is critical because an untreated retinal tear can progress to a retinal detachment, which is a sight-threatening emergency, as noted in the study by 1. The fluid inside the eye (vitreous) can seep through the tear and separate the retina from its underlying supportive tissue, leading to permanent vision loss if not treated quickly.
The goal of treatment for retinal breaks is to create a firm chorioretinal adhesion in the attached retina immediately adjacent to and surrounding the retinal tear using cryotherapy or laser photocoagulation surgery to halt the progression of subretinal fluid from detaching the neurosensory retina, as described in the study by 1. Treatment of peripheral horseshoe tears should be extended to the ora serrata if the tear cannot be surrounded using laser or cryotherapy. The most common cause of failure in treating horseshoe tears is failure to adequately treat the tear, particularly at the anterior border, as noted in the study by 1.
Some key points to consider when diagnosing and treating retinal tears include:
- At least half of untreated symptomatic retinal breaks with persistent vitreoretinal traction will lead to a clinical retinal detachment unless treatment is applied, as noted in the study by 1.
- Treatment by prompt creation of a chorioretinal adhesion around these symptomatic tears reduces the risk of retinal detachment to less than 5%, as described in the study by 1.
- The rate of successful retinal reattachment is higher and the visual results are better when repaired early, especially before the rhegmatogenous retinal detachment involves the macula, as noted in the study by 1.
- Patients presenting with an acute PVD and no retinal breaks have a small chance of developing retinal breaks in the weeks that follow, and should be asked to return for a second examination promptly if they have new symptoms or within 6 weeks following the onset of PVD symptoms, as described in the study by 1.
If you experience any suspicious symptoms, go directly to an emergency room, an ophthalmologist, or a retina specialist rather than waiting for a regular appointment. The longer a tear remains untreated, the higher the risk of detachment and permanent vision damage, as emphasized in the study by 1.
From the Research
Importance of Prompt Diagnosis
The need for a prompt diagnosis of a retinal tear is crucial to prevent further complications such as retinal detachment.
- A study published in 2022 2 found that symptom-based predictive factors for retinal tear/retinal detachment (RT/RD) include the presence of subjective visual reduction or subjective field loss, and the absence of either floaters or flashes.
- Another study published in 2024 3 investigated the incidence and outcomes of retinal tear and retinal detachment after cataract surgery in patients with a history of previous phakic retinal tears, and found that the overall incidence of RT and RD diagnosis after cataract surgery was 7.3%.
Time-Sensitive Diagnosis
While the exact time frame for diagnosis is not specified in the studies, it can be inferred that a prompt diagnosis is essential to prevent further complications.
- The 2022 study 2 found that patients with RT/RD were more likely to have significant differences in demographic and examination-based factors, highlighting the importance of a timely diagnosis.
- The 2024 study 3 found that the median time to a new RT or RD development after cataract surgery was 239 and 246 days, respectively, emphasizing the need for close monitoring and prompt diagnosis.
Risk Factors
Certain risk factors can increase the likelihood of a retinal tear or detachment, including: