Acute retinal break: Flashes of light, floaters (“cobwebs,” “hair,” or “film” that changes position with eye movement) with or without visual acuity changes. Can be identical to PVD symptoms, though may be more substantial.

Chronic retinal breaks or atrophic retinal holes: Usually asymptomatic.

(See Figure 11.2.1.)

Figure 11.2.1: Giant retinal tear.

Critical

A full-thickness retinal defect, usually seen in the periphery.

Other

Acute retinal break: Pigmented cells in the anterior vitreous, VH, PVD, retinal flap,  subretinal fluid (SRF), or an operculum (a free-floating piece of retina suspended above an RT).

Chronic retinal break: Surrounding pigmentation ring or demarcation line between attached and detached retina and signs (but not necessarily symptoms) of an acute retinal break.

Predisposing Conditions

Lattice degeneration, high myopia, aphakia, pseudophakia, history of previous retinal break or detachment in the fellow eye, family history of retinal break or detachment, collagen vascular disorders, and trauma.

• Lattice degeneration

• White without pressure: Abrupt changes in retinal pigmentation that may mimic a break or SRF. Benign finding, etiology unclear.

• Choroidal rupture or retinal hemorrhage (all layers): May occur without retinal break or obscure retinal break.

• Meridional fold: Small radial fold of retina perpendicular to the ora serrata and overlying an oral tooth; may have small retinal hole at the base.

• Vitreoretinal tuft: Focal area of vitreous traction causing elevation of the retina.

Complete ocular examination with a slit lamp and indirect ophthalmoscopy of both eyes with scleral depression. After trauma, scleral depression may be gently performed once open globe injury has been ruled out. B-scan US may be helpful when the retina is not visible (e.g., VH, dense cataract, etc.).

In general, laser therapy or cryotherapy is required within 24 hours for acute retinal breaks. Treatment may be less urgent for chronic breaks. However, each case must be individualized based on patient risk factors. We follow these general guidelines:

1. Treatment is recommended for:

   • Acute symptomatic break (e.g., a horseshoe or operculated tear).

   • Acute traumatic break (including a dialysis).

   • Asymptomatic retinal break that is large (e.g., ≥1.5 mm), above the horizontal meridian, or both, particularly in the absence of PVD.

   • Asymptomatic retinal break in an aphakic or pseudophakic eye, a highly myopic eye, or an eye in which the involved or contralateral eye has had an RD.

1. Patients with predisposing conditions or retinal breaks that do not require treatment are followed at 3 months and then every 6 to 12 months if stable.

2. Patients treated for a retinal break are re-examined in 1 to 2 weeks, 4 to 6 weeks, 3 months, and then 6 months or so to ensure no new tears, no progression of previously treated tears, and for epiretinal membrane formation.

3. RD symptoms (a dramatic increase in floaters or flashing lights, worsening visual acuity, or the appearance of a curtain, shadow, or bubble anywhere in the field of vision) are explained and patients are told to return immediately if these symptoms develop.