Retinal Tears in Singapore
RETINAL TEAR
What is a Retinal Tear?
A retinal tear is a break in the retina, the light-sensitive layer of tissue lining the back of the eye.
Retinal tears most commonly occur when the vitreous gel inside the eye, which is firmly attached to the retina in certain areas, pulls away as part of a normal age-related process called posterior vitreous detachment (PVD).
In most people, this separation happens smoothly and without incident. However, if the vitreous is tightly adherent to a weak or thin area of the retina, the traction created during separation can cause the retinal tissue to tear.
A retinal tear is significant because it creates an opening through which fluid from the vitreous cavity can pass underneath the retina. If this happens, the retina can lift away from the underlying tissue, resulting in a retinal detachment.
Retinal Tear vs Retinal Detachment: What's the Difference?
This distinction matters because the treatment, urgency, and outlook differ:
Retinal Tear
A retinal tear (or retinal hole) is a break in the retina, but the retina itself remains in its normal position, attached to the underlying tissue.
Retinal Detachment
A retinal detachment occurs when fluid passes through a tear and separates the retina from the underlying tissue, causing it to lift away.
A retinal tear caught and treated before it progresses to a detachment can often be managed with a simple, in-clinic laser or freezing procedure. Once a detachment has occurred, surgery is required. This is why prompt assessment of new floaters and flashes is so important: identifying a retinal tear early can prevent the need for more invasive surgery later.
Symptoms of a Retinal Tear
A retinal tear itself may cause no symptoms at all, particularly if it is small and located away from the central retina. When symptoms do occur, they are usually related to the accompanying posterior vitreous detachment, and include:
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A sudden onset of new floaters, sometimes described as a "shower" of spots or cobwebs.
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Flashes of light, particularly in peripheral (side) vision, especially noticeable in dim lighting.
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Occasionally, a small amount of bleeding into the vitreous (vitreous haemorrhage) if a blood vessel is disrupted by the tear, which can cause a sudden increase in floaters or a reddish/smoky haze in vision.
Because these symptoms cannot be reliably distinguished from a benign PVD without an eye examination, a sudden onset of floaters and flashes should always be assessed promptly. For a broader explanation of these symptoms, see our Floaters and Flashes guide.
Who is at Higher Risk of Retinal Tears?
High myopia (short-sightedness): the retina is stretched thinner over a larger eye, particularly at the periphery, increasing susceptibility to tears.
Lattice degeneration: areas of thinning in the peripheral retina where the vitreous attachment is often abnormally strong
Previous retinal tear or detachment in the other eye
Eye trauma or injury
Previous eye surgery, including cataract surgery
Family history of retinal detachment
How is a Retinal Tear Diagnosed?
A retinal tear is diagnosed through a dilated fundus examination, where eye drops are used to widen the pupil and allow a detailed view of the peripheral retina, where most tears occur. Special lenses are used during this examination to examine the retina right up to its furthest edges.
If there is bleeding in the vitreous that obscures the view, or if the diagnosis is uncertain, ocular ultrasound (B-scan) may be used to assess whether the retina is still attached.
Treatment of a Retinal Tear
If a retinal tear is identified before the retina has detached, it can usually be treated promptly with one of the following in-clinic procedures:
Cryopexy (Cryotherapy)
A freezing probe is applied to the outer surface of the eye, over the location of the tear. Similar to laser treatment, this creates a scar that seals the retina around the tear. Both procedures are typically performed in the clinic under local anaesthetic (numbing eye drops), do not require an operating theatre, and have a short recovery period. The choice between laser and cryotherapy depends on the location and characteristics of the tear.
What Happens if a Retinal Tear is Left Untreated?
Not every retinal tear requires treatment. Some small, asymptomatic tears found incidentally, particularly certain types of retinal holes without associated traction, may simply be monitored.
The decision to treat or monitor depends on factors such as the type, size, location, and symptoms associated with the tear, and is made on an individual basis by your retina specialist.
However, a symptomatic retinal tear, or one with features that suggest a higher risk of progression, that is left untreated can lead to a retinal detachment, which requires more involved surgical treatment and carries a greater risk to vision, particularly if the central retina (macula) becomes involved.
For more on this, see our Retinal Detachment page.
FAQ
Frequently Asked Questions
