Treatment of retinal tears

Case History

Mary Jones is a 57 year old female who developed a new onset of flashing lights and floaters in the right eye.  She described the flashes as "lightening bolts" and the floaters as "a spider web."  The patient did not report vision loss or a curtain in her side vision.

Past ocular history:

Nearsightedness (myopia)

No eye trauma

Exam:

Vision is 20/40 in right eye, and 20/20 in left eye.

Visual fields are full bilaterally.

Dilating drops were given.

Dilated Retinal Examination:

Right eye:

Mild vitreous hemorrhage (blood)

Posterior Vitreous Detachment (PVD)

Optic nerve, macula, retina vessels are normal.

Periphery of retina has mild thinning due to myopic degeneration.

A retinal tear which is horseshoe shaped is detected superiorly.

A retinal vessel also is torn.

Left eye:

Vitreous is clear and attached to the retina.

Mild thinning of the retina is present in the periphery, due to myopic degeneration.

Impression:

Flashes and floaters caused by Posterior Vitreous Detachment (PVD)

Retina Tear

Vitreous Hemorrhage

Plan:

Laser Retinopexy to seal the retina to the eye wall, around the retinal tear.

Discussion:

Flashes and floaters are most commonly experienced when the vitreous gel separates from the retina.  This separation of the vitreous from the retina is called a Posterior Vitreous Detachment or PVD.  Most people who experience a PVD are suddenly aware of new floaters.  People often describe them as being like cobwebs, small flies, or a smudge in the vision which moves about.  Some patients experience flashing lights as a symptom of PVD.  Flashes are typically described as sparks or split second arc-like flashes off in the peripheral vision.  When a PVD occurs, it can pull too hard on a single spot creating a tear in the retina.  Laser treatment is usually recommended to seal the retina to the eye wall, surrounding the retinal tear.  This prevents the retinal tear from progressing to a retinal detachment.