The eye works like a camera. It has two parts, a lens, and a film. The film layer lines the back wall of the eyes and is called the retina. The retina can be conceptualized like the wallpaper on a wall. It is normally devoid of any holes. Holes within wallpaper can allow moisture to collect and eventually cause the wallpaper to separate from the wall (retinal detachment). There are multiple types and subtypes of retinal holes, some of which require treatment, and some that do not.
Types of Retinal Holes or Tears
Atrophic holes are full-thickness holes within the retina. They occur in approximately 5% of individuals. They are generally very low risk for retinal detachment and generally require no treatment. Patients who are very near-sighted or patients in which fluid has collected around the hole are at much higher risk for retinal detachment. An in-office laser procedure is typically recommended for high-risk retinal holes.
Operculated tears occur in the context of a posterior vitreous detachment. A posterior vitreous detachment is when the gel(vitreous) pulls away from the back wall of the eye. The pulling force causes a tiny full-thickness piece of the retina to be separated from the back wall of the eye. Fortunately, this type of retinal tear is very low risk and generally requires no treatment.
Horseshoe tears occur in the context of a posterior vitreous detachment as well. In these tears, the vitreous remains tightly adherent to the retinal tear and can allow fluid to quickly collect under the retinal tear. Fortunately, these retinal tears may be treated with an in-office laser procedure to prevent retinal detachment. This type of tear causes the rapid accumulation of fluid and retinal detachment without treatment.
Giant retinal tears occur in the context of a posterior vitreous detachment. They occur when the vitreous pulls hard enough that it causes a tear in the retina spanning more than 25% of the circumferential retinal surface. This type of retinal tear generally requires prompt treatment in the operating room and is at high risk for requiring more than one surgical procedure.
When You Should Contact Retina Specialists of Tampa
The sudden onset of many new black spots in the vision or flashing white arc-shaped lights in the peripheral vision may be a sign of a retinal tear requiring treatment. Patients seeing a black curtain obstructing their vision may be experiencing a retinal detachment. These symptoms require patients to reach out to their retina specialist to determine if urgent evaluation and treatment are required.