Retinal Tear

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Symptoms

  • analogous to posterior vitreous detachment
  • flashes
  • mouches volantes / floaters, cobwebs, flies
  • blurred vision / haze, reduced visual acuity (with vitreous haemorrhage)
  • often asymptomatic with chronic / atrophic tears/holes

Findings

  • Tobacco dust? (=pigmented cells in the anterior vitreous), vitreous haemorrhage?
  • Fundus examination (with a three-mirror contact lens): Retinal tear/hole? Surrounding retina with subretinal fluid? Operculum?
  • In case of vitreous haemorrhage without sufficient fundus view: Ultrasound to exclude retinal detachment

Differential Diagnoses

  • Vitreous tuft (vitreoretinal traction)
  • Lattice degeneration

Treatment

  • Retinal laser
    • surround lesion with 3 rows of confluent (white) burns, indentation may be needed
    • continue laterally to ora serrata if an anterior row is not possible
    • consider cryotherapy if laser is not possible

Follow-up

  • after 1-3 days to retreat after incomplete laser sessions
  • after 7-14 days to check sufficiency (pigmented spots)
  • then check after 1, 3, 6, 12 months then every 6-12 months
  • Educate patients about symptoms of retinal detachment (flashes, floaters, curtain-like shadow, reduction in visual acuity)

Sources

  • EyeWiki Horseshoe or flap tear
  • The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease; Nika Bagheri MD, Brynn Wajda MD, et al; Lippincott Williams&Wilkins; 7th Edition (2016)
  • Kanski‚Äôs Clinical Ophthalmology: A Systematic Approach; Jack J. Kanski MD, Brad Bowling MD; Saunders Ltd.; 8th Edition (2015)