Retinal Tear

*Please note that this information is for illustrative purposes only, providing a general overview on the topics listed. For any specific questions or concerns regarding your condition, please contact our office so that you can consult with the appropriate person or department to address your needs.

Retinal Tear & Detachment

A posterior vitreous detachment (PVD) is a condition, related to aging, which is caused by the separation of the vitreous gel from the retina.  Early in life the vitreous gel (analogous to the yolk of an egg) fills the entire inner cavity of the eye (like the yolk fills the eggshell). When you are young the vitreous gel is firmly adherent to the retina (the retina is analogous to the thin membrane on the inside of an eggshell). As you age the vitreous gel changes in composition from thick Jello-like gel to a more thin fluid-like gel. This change eventually leads to spontaneous separation of the vitreous gel from the retina.

In some patients the vitreous gel will begin to separate from the retina and cause a retinal tear, retinal hole or macular hole at an area of increased vitreoretinal adhesion. Typically, these tears form in the area called the vitreous base (similar to the equator on the globe but closer to the front of the eye) or at the posterior edges of thin areas of the retina called lattice degeneration.

During the development of a typical PVD, the vitreous will suddenly separate from the retina and optic nerve and continue to separate without tearing the retina, over the next few days to weeks. This is called an uncomplicated PVD.

In other patients the vitreous gel will begin to separate from the retina and optic nerve and there will be an incidental rupture of a blood vessel on the optic nerve or retina, without tearing the retina that will lead to the development of bleeding into the vitreous cavity. This is called a hemorrhagic PVD.

In less than 5% of patients, the vitreous gel will begin to separate from the retina and optic nerve and the strong adhesion between the retina and vitreous will cause a retinal tear, operculated hole or retinal detachment or a macular hole (see link to that section). This is called a complicated PVD and treatment will be needed to address these conditions.


The development of a posterior vitreous detachment (PVD) and/or retinal tear or detachment causes symptoms such as the sudden onset of floaters, flashing lights, an arc of light, or a shadow in your peripheral vision.


The development of a posterior vitreous detachment is a normal part of the aging process and, in most cases, requires no treatment other then repeated dilated retinal exams (for weeks or months) during when the patient is symptomatic (complaining of flashing light sensations or new floaters).
The vast majority of PVDs are benign and require no treatment. A small percentage of patients will develop a retinal tear or operculated hole, a macular hole or a retinal detachment. These conditions do require surgical treatment.

Surgical Treatment Options

Laser therapy or less commonly cryotherapy are the gold standard treatments for retinal tears or holes, operculated holes or small localized retinal detachments. Laser therapy is used in the vast majority of patients and is performed under topical or local anesthesia (if the patient requires more extensive treatment or complains of pain). Your physician will place two or three rows of laser around your retinal tear, hole or localized detachment.

Vitrectomy surgery (sometimes combined with a scleral buckle) with physical removal of the vitreous gel (and vitreous hemorrhage when present) is the most commonly used treatment to repair a retinal detachment. The procedure is performed under local anesthesia, in either one of our outpatient surgical centers or local hospitals (see link to our surgery centers and hospitals).

The surgery is performed through three 25-gauge ports (about the width of a wire paper clip). The surgery begins by placing an infusion canula, a light pipe & a vitrectomy cutter through each of the 3 ports. The infusion cannula keeps a constant pressure in the eye while the vitrectomy cutter removes the vitreous gel and vitreous hemorrhage. As the gel is removed, balance salt solution replaces the gel in the vitreous cavity. The gel that is adherent to the retina is gently lifted off the optic nerve and macula to separate the vitreomacular adhesions. The light pipe is used by the surgeon to visualize the vitreous gel and hemorrage as it is being removed inside the eye. After the hemorrhage and gel are removed, your physician will identify any retinal breaks, tears or detachments and surround them with laser. In the area where the detachment is present, the surgeon will drain out the fluid below the retina, to repair the detachment, and laser around any tears or holes. In these cases, an intravitreal gas bubble (C3F8 or SF6) or silicone oil will be used to hold the retina in place until the laser treatment forms a scar and adhesion around the tear(s) that caused the detachment.  After enough vitreous is removed the surgeon removes the surgical instruments and trocars (3 ports) and the operation is complete. No sutures are typically needed in up to 95% of cases. Antibiotic ointment and a patch are placed over the eye for one night and removed the following day by the technician in our office.

Scleral buckling surgery will be used by your physician to manage retinal detachments that have retinal tears located in the inferior part of the retina and usually to treat recurrent retinal detachments that are associated with proliferative vitreoretinopathy (PVR). PVR is scar tissue that forms 6-12 weeks after initial retinal detachment repair surgery and can contract and cause a secondary detachment of the retina (even after the first surgery was successful and repairing the initial retinal detachment).

The procedure is performed by placing a silicone band, called a scleral buckle, around the eye near the equatorial circumference of the eye to indent the sclera (outer wall of the eye). Once the buckle is tied into position and tightened it will bring the sclera and underlying choroid in closer proximity to the retina that has detached. Laser or cryotherapy is then used to form an adhesion between the choroid and the retina. The band or buckle is placed around the eye, under the rectus muscles and sutured into position or looped through partial thickness scleral tunnels. The ends of the buckle or band are typically sutured together to tighten the buckle and increase the scleral indentation.

Risks & Benefits of Surgery

The benefits of vitrectomy and scleral buckling surgery, in general, are the potential for improved vision, reduced distortion of straight lines (when present pre-operatively), elimination of the shadow in your peripheral or central vision and reduction or elimination of floaters.

Some of the risks of vitrectomy and scleral buckling surgery include but are not limited to:
• Sudden onset of cataract (usually when the patient fails to comply with face down positioning in the first week. This causes a typical posterior subcapsular cataract.
• More rapid cataract progression (in up to 20% of patients the lens may harden or become cloudy more rapidly after the vitreous gel is removed) that may require cataract surgery 1-2 years after the vitrectomy procedure.
• Temporary elevation in intraocular pressure (most commonly secondary to the expansion of the gas bubble)
• Vitreous or choroidal hemorrhage
• Retinal break or tear (less than 5%) or Retinal Detachment (less than 1%)
• Retinal or vitreous incarceration into sclerotomy site
• Subretinal hemorrhage
• Infection/Endophthalmitis (less than 1 in 500 patients)
• Permanent loss of vision/Blindness (approx. 1 in 10,000)
• These are some of the more common and serious side effects of surgery but there are additional risks of surgery not listed above.

Post-Operative Care

Patients are typically started on antibiotic and steroid eye drops the day after surgery. The frequency of these drops will be determined, by your surgeon, on the first post-operative day. Some patients have a temporary increase in intraocular pressure after even uncomplicated surgery and may require additional pressure lowering drops or oral medication.

Post-Operative Expectations

Vision is usually blurry the first three weeks after surgery (because the bubble is blocking the patient from seeing clearly) but typically improves about 4-6 weeks after surgery. Continued visual improvement often occurs even up to 6 months after surgery.

Patients will typically notice a horizontal curved line that begins to appear in their upper visual field a few days after surgery.  This line will represent the bottom edge of the gas bubble. As the bubble shrinks (the eye produces clear fluid to replace the bubble) the patient will notice the line begin to drop down in their visual field and the patient will begin to see “over” the bubble. The patient may also see a “reflection” off the surface of the bubble as well.  These symptoms are completely normal.

Patients typically experience little to no pain following surgery. Surface or external irritation (feeling of having something in your eye) is common. A deeper or more intense eye pain in not typical and may signal a more serious issue such as high intraocular pressure, serous or hemorrhagic choroidals or infection. A deeper or more intense eye pain needs to be reported to you physician immediately.

Post-Operative Restrictions

 Post-operative restrictions are for 4-6 weeks after surgery and include but are not limited to:
• No flying or travel to high altitudes (high altitudes can cause expansion of the intraocular gas bubble leading to increased intraocular pressure and patients should not fly until the gas bubble completely resolves)
• Some forms of anesthesia can cause rapid expansion of the gas bubble in your eye (you will be given a bracelet that should not be removed until the gas bubble resolves completely). If you require surgery for any other reason after your retinal surgery, it is very important to tell the anesthesiologist that you have a gas bubble in your eye and show him or her your bracelet.
• Face down positioning for one week.  If you do not comply with face down positioning you will increase your risk of a cataract, retinal tear or recurrent retinal detachment.
• No driving for 4 weeks (until the gas bubble completely clears away from your central vision.  Ask your surgeon when it is approved to resume driving.
• Anything that creates a Valsalva Maneuvers such as coughing, sneezing, blowing your nose, straining with bowel movements or exertion, and some of the following:
• Bending at the waist putting your head below your belt line (such as bending to tie your shoes).  Bending at the knees with your head up is allowed.
• Heavy lifting greater than 15-20 lbs.
• Strenuous activity (including lifting weights, running, yoga, pilates, aerobics, yard work, snow shoveling, laundry, housecleaning, sexual intercourse) is not recommended as it will increase your risk of developing a retina tear or detachment.  Walking, for exercise, after surgery is allowed (in patients who do not require post-operative head down position).
• Showering is allowed immediately after surgery but be sure to keep your eyes closed to prevent shower water from entering your eye.
• Swimming after surgery should be avoided for 4 weeks.  You should not go under water for the first 4 weeks after your surgery.
• Working restrictions are job dependent.  Patients with desk jobs or who perform light stationary office work may sometimes resume work 7-10 days after surgery.  Patients with jobs that require heavy lifting or strenuous activity may be required to be out of work for at least 3-4 weeks.  Ask your physician about your individual work restrictions.  We will be happy to provide you with a doctor’s note for your work and/or complete your temporary disability paperwork.

*Please note that this information is for illustrative purposes only, providing a general overview on the topics listed. For any specific questions or concerns regarding your condition, please contact our office so that you can consult with the appropriate person or department to address your needs.