Retinal break or tear

Description lesions A retinal break refers to a full thickness ● Subretinal fluid or elevation of more defect in the sensory retina. When a than one disc diameter break is associated with vitreous traction, ● Vitreous haemorrhage or ‘tobacco it is termed a retinal tear. Retinal breaks dust’ or tears are most often associated with: ● Retinal infections, high myopia, or ● Posterior vitreous detachment (PVD) other conditions associated with retinal ● Blunt or penetrating trauma. thinning. Retinal breaks may also be associated with developmental or degenerative Laser surgery retinal abnormalities causing retinal Laser photocoagulation, delivered with thinning, such as myopia or lattice either a slit lamp or indirect ophthalmo- degeneration. scopic system, may be the treatment of choice for smaller lesions. Therapy aims Symptoms to create an adhesion between the tissues Acute retinal breaks are usually associ- by causing RPE hyperplasia and a chori- ated with symptoms, with flashing Two retinal horseshoe tears (upper right) associated with oretinal scar. lights (photopsia), often in the periphery; retinal detachment one or more floaters of recent onset, or Incisional surgery or cryotherapy there may be a recent history of head or PREVALENCE Cryotherapy or retinal surgery may be ocular trauma. However, chronic retinal Uncommon in the general population indicated for larger lesions including breaks or atrophic holes may not cause (approximately 1/1,000). After a sympto- retinal dialysis or giant tears. symptoms. matic PVD, the prevalence of retinal tears is approximately a 15 per cent. Review Signs If symptoms do not accompany a retinal Breaks are red-coloured lesions, as the Significance break and there are no other risk factors, retinal pigment epithelium (RPE) and If a retinal break allows liquified vitreous the risk of RRD may be low enough choroid are not covered by the retina. to enter the subretinal space, the retina that observation is appropriate. Consider ● Flap (or horseshoe) tear: a tractional may separate from the RPE, causing a monitoring for the development of risk retinal tear where a flap of retina is created rhegmatogenous RD. factors in a binary schedule (six-week, in a triangular shape, with the base still three-month, six-month, 12-month). If attached. Flap tears have a greater risk DiffERENTIAL Diagnosis RPE hyperplasia or a chorioretinal scar than other breaks for retinal detachment Retinal detachment classification, Lattice forms around the break, the risk of RRD (RD) because the break is held open. degeneration. is much reduced. ● Operculated tear: A tractional retinal tear where an area of retina (an See also Advice operculum) is pulled completely free by Posterior vitreous detachment, Macular The likelihood of a retinal detachment the vitreous. Vitreous traction on the hole, Choroidal detachment, White associated with a retinal tear is great- surrounding retina is relieved. without pressure, Retinoschisis – est within the first few days of the ● Retinal dialysis: a dis-insertion or acquired degenerative. onset of symptoms. Patients at risk of tearing of the anterior retinal attachment retinal detachment are advised to attend near the pars plana. Retinal dialyses often Management immediately if they notice a peripheral arise from blunt trauma to the globe. vision change, shower of floaters, light ● Giant tear: a traumatic or spontaneous Ocular tests flashes or ‘spider webs’. tear stretching more than 90 degrees. Important techniques include indirect ● Retinal holes: Atrophic retinal holes ophthalmoscopy with scleral depression The full series of these articles is available in the book are the most common retinal break; these for both eyes, and slit-lamp examination Posterior Eye Disease and Glaucoma A-Z by Bruce AS, are round breaks without retinal traction. with a fundus contact lens. O’Day J, McKay D and Swann P. £39.99. For further They may be associated with peripheral information click on the Bookstore at opticianonline.net retinal degenerations such as lattice, Indications for treatment retinoschisis or white without pressure; Each case must be assessed individually, ● Adrian Bruce is a Chief Optometrist at the Victorian are usually chronic and the risk of RD is but treatment is usually recommended College of Optometry and a Senior Fellow, Department lower than retinal tears. for retinal breaks in association with any of Optometry and Vision Sciences, The University of Breaks are more frequent in the retinal of the following risk factors: Melbourne. periphery although they may occur ● Presence of symptoms, such as ● Justin O’Day is an Associate Professor in the anywhere. Signs associated with an acute photopsia or floaters, particularly with Department of Ophthalmology, The University of break may include PVD, the presence of flap or operculated tears Melbourne and Head Of Neuro-Ophthalmology Clinic, sub-retinal fluid, vitreous haemorrhage ● Recent ocular trauma, particularly Royal Victorian Eye and Ear Hospital. if the tear bridges a blood vessel, or with dialysis or giant tears ● Daniel McKay is a Medical Officer at the Royal pigment clumps (‘tobacco dust’) in the ● Aphakia or pseudophakia Victorian Eye & Ear Hospital. anterior vitreous. A ring of pigmentation ● Previous RD in either eye ● Peter Swann is Associate Professor in the School of (RPE hyperplasia) surrounding a retinal ● Forthcoming ocular surgery Optometry, Queensland University of Technology. break is suggestive of chronicity. ● Tractional tears at the edge of lattice opticianonline.net 04.04.08 | Optician | 47