Retina Holes

Retina Holes

The eyes are made up of different parts, the cornea, iris, lens, optic nerve, and retina. The retina is the light sensitive tissue lining the back of the eyes.  It covers about sixty five percent of the eye’s interior surface.  The retina is located in the back of the eye by the optic nerve.  The retina receives the light that the lens has focused, then converts the light into neural signals.  It then will send the neural signals to the brain for visual recognition.   Damage to the retina such as tears or holes in the retinal tissue can cause the retina to detach which can lead to blindness.

Causes

Holes in your retina can occur from nearsightedness, eye injuries, cataract or other certain types of eye surgery. Having a history of retinal tears or someone in your family having retinal tears increases the odds of an occurrence.  

Symptoms

A hole in your retina is just a small break in the lining. Small tears can have no effect.  Sometimes you may have symptoms such as floaters, cloudy, wavy or blurry vision, or dark shadows in your peripheral vision.  Tears can cause fluid from the center of your eyeball to leak behind the retina.  If enough fluid gets behind the retina it can cause the retina to detach.  Retinal detachment can lead to blindness if not treated right away.  

Even if you don’t have symptoms you can still have tears in the retina.  During a normal eye exam if the doctor dilates your eyes and looks at them with the ophthalmoscope they will be able to determine if there are any tears.  

Retinal holes can be treated if they are severe.   

Treatment Options

Sometimes laser photocoagulation can close up the lining so the tears won’t get any larger and the retina won’t detach completely. Laser photocoagulation is when a laser is used to cauterize ocular blood vessels, it will weld or seal the retina to the underlying eye wall.  This procedure is done in the eye doctor’s office.  You would be awake, but given eye drops to numb your eye.  The procedure is usually painless and will only last about thirty minutes.  After the procedure is done you will be discharged immediately but you will not be allowed to drive.    

Another treatment is cryopexy, which is when intense cold is used to induce a chorioretinal scar and to destroy retinal tissue.  A chorioretinal scar is an area of pigmentary change or fibrosis.  The procedure is done under local anesthesia and you will have to be in recovery for roughly thirty minutes after the procedure.  The procedure consists of a metal probe being put against the eye.  The probe becomes cold and stimulates scar formation.  The scar formation makes the retina seal against the lining underneath it to close the tear or the detachment.  

Diathermy can also be used in closing the holes.  Which is the use of heat to seal the retina back to the underlying tissue.  It is similar to cryopexy, but it just uses heat from an electric current through a needle to seal up the tear.  

Prevention

There is no way to make sure you are guaranteed to not get retinal tears. Trying to avoid eye injury is the best thing to do. You can make sure that once you are diagnosed with them that you take care of your eyes.  If playing a contact sport eyewear can prevent any injuries to the eye that can cause the retina to detach. Make sure to contact your doctor immediately if you have any extreme symptoms.

Retinal Detachment

A retinal detachment is when the retina pulls away from its normal position.  This is an  emergency situation.   Retinal detachment is more common in people over the age of forty, and more common in men than women. That does not mean it can’t happen to anyone though.  The longer the retina is detached it increases the chances of vision loss.  Doctor’s describe the main symptom of retinal detachment as though a dark curtain is being pulled down over your vision.  Sometimes you can just have an increase in floaters or flashes.  Call your doctor immediately because there are things that can be done to fix a detached retina. Over ninety percent of retinal detachments can be successfully treated if caught soon enough.  

Treatment for Retinal Detachments

Scleral buckle surgery can be used to fix a detached retina. The sclera is the white of the eyes, the outer layer.  The scleral buckle surgery closes the breaks and flattens the retina.  The scleral buckle can be a piece of silicone sponge, rubber, or semi hard plastic.  The buckle is  placed against the sclera or outer surface of the eye and sewn into place.  The buckle then squeezes the sclera towards the middle of the eye relieving the pull on the retina.  This allows the tear to settle against the wall. Cryopexy or photocoagulation is used to scar the area around the tear.  The scleral buckle will usually stay around the eye forever after the surgery.  The surgery is done under local or general anesthesia and can take between one to two hours.  More complex surgeries or if this is a second surgery the procedure could take longer.  Your doctor may recommend you wear an eyepatch over your eye after the surgery.  Eye drops to prevent infection may be prescribed as well.

Vitrectomy surgery is also used with retinal detachments.  In a vitrectomy the vitreous gel is removed from the center of the eye.  This allows the eye doctor to get a better look at the back or your eye.  The vitreous gel can also be removed if the blood in the gel will not go away on its own. The procedure consists of the doctor using small instruments to cut and remove the vitreous gel.  After the gel has been removed the doctor can then get to the retina to use photocoagulation or one of the other minor retinal fixing surgeries.  After that is done then a silicone oil or gas bubble is injected into the eye to push the retina up against the wall of the eye.  You will need a second surgery following this to remove the oil from the eye.  This surgery is a two to three hour procedure that sometimes consists of an overnight stay in the hospital but can be done as an outpatient procedure as well.  

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Pneumatic retinopexy is a two step procedure that can also be used for retinal tears or breaks.  The first step is a gas in injected into the center of the eye.  Your head will be tilted so that the gas will push down on the torn part of the retina.  Then the doctor will use cryopexy or photocoagulation to close up the tear.  The bubble of gas will last for about one to three weeks to flatten down the retina.  You will have to keep your head in a certain position for one to three weeks while sleeping to make sure that the bubble is pushing down on the right position.  Your doctor will inform you in what position to be in.  There are risks to pneumatic retinopexy such as new tears or breaks forming, fluid persisting, or the gas bubble never being absorbed.  

Sometimes one of these procedures is not enough, you may have to have multiple procedures done to fix the detachment completely and regain the most of your vision.

Prevention – Regular Checkups

There isn’t anything to do to completely avoid these retinal tears.  The avoidance of eye injury of course is a big help.  That can’t always happen though, eye injuries do happen.  The best thing to do is to get your eyes checked regularly to make sure that if you have any holes or tears in your retina you are conscious on what to look for so that complete blindness does not occur.  Complete retinal detachment does not always occur from just having holes.  If you are diagnosed with holes in your retina your doctor will be sure to inform you on what to do, and what consists of an emergency.  All holes and tears may not be sever enough to fix but there are now many options on how to fix the holes or to fix a complete detachment.  Remember the first sign of your retina detaching is a dark shadow coming across your peripheral like a curtain.  Sometimes the detachment cannot be avoided, but to doing the small fixes of seeing your doctor and wearing protective eyewear if necessary can save your vision.  Your vision is worth looking out for.  

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