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Retina, Vitreous and Floaters

The retina is the light-sensitive tissue lining the back of our eye. The retina converts the light rays into impulses that travel through the optic nerve to our brain, where they are interpreted as the images we see. A healthy, intact retina is key to clear vision.

Floaters look like small specks, dots, circles, lines or cobwebs in your field of vision. They originate from a gel like substance that fills the inside of the eyeball behind the lens called vitreous. As we age, our vitreous gel starts to thicken or shrink, forming clumps or strands in it that appear as small, occasional floaters. These floaters are most notable in bright light. 

If the vitreous gel collapses and completely pulls away from the back of the eye, it is called posterior vitreous detachment ( PVD) . More sudden onset of larger floaters usually happen with posterior vitreous detachment. It can also be associated with flashes of light or lightning streaks in your field of vision. Flashes happen when the vitreous rubs or pulls on your retina.

Retinal tear and retinal detachment

Usually, the vitreous moves away from the retina without causing problems. But sometimes the vitreous pulls hard enough to tear the retina in one or more places. Fluid may pass through a retinal tear, lifting the retina off the back of the eye — much as wallpaper can peel off a wall. When the retina is pulled away from the back of the eye like this, it is called a retinal detachment.

The retina does not work when it is detached and vision becomes blurry. A retinal detachment is a very serious problem that almost always causes blindness unless it is treated with detached retina surgery.

You will need a dilated eye exam if you have new onset of or changes in floater size or quantity or if you see flashes of light. You need a dilated exam right away if 

  • a shadow appears in your peripheral (side) vision

  • a gray curtain covers part of your vision

 

Please call now to schedule an appointment to be evaluated for flashes or floaters.

People with the following conditions have an increased risk for retinal detachment:

  • Nearsightedness;

  • Previous cataractglaucoma or other eye surgery;

  • Glaucoma medications that make the pupil small (like pilocarpine)

  • Severe eye injury;

  • Previous retinal detachment in the other eye;

  • Family history of retinal detachment;

  • Weak areas in the retina that can be seen by an ophthalmologist during an eye exam.

 

A retinal tear or a detached retina is repaired with a surgical procedure. 

Torn retina surgery

Most retinal tears need to be treated by sealing the retina to the back wall of the eye with laser surgery or cryotherapy (a freezing treatment). Both of these procedures create a scar that helps seal the retina to the back of the eye. This prevents fluid from traveling through the tear and under the retina, which usually prevents the retina from detaching. These treatments cause little or no discomfort and can be performed in the office.

Detached retina surgery

Almost all patients with retinal detachments must have surgery to place the retina back in its proper position. Otherwise, the retina will lose the ability to function, possibly permanently, and blindness can result. The method for fixing retinal detachment depends on the characteristics of the detachment. 

Scleral buckle
This treatment involves placing a flexible band (scleral buckle) around the eye to counteract the force pulling the retina out of place. We also drain the fluid under the detached retina, allowing the retina to settle back into its normal position against the back wall of the eye. This procedure is performed in an operating room.

Pneumatic retinopexy
In this procedure, a gas bubble is injected into the vitreous space inside the eye in combination with laser surgery or cryotherapy. The gas bubble pushes the retinal tear into place against the back wall of the eye. Sometimes this procedure can be done in our office. We will ask you to constantly maintain a certain head position for several days. The gas bubble will gradually disappear. Do not fly in an airplane or travel at high altitudes until you are told the gas bubble is gone. A rapid increase in altitude can cause a dangerous rise in eye pressure.

Vitrectomy
This surgery is commonly used to fix a retinal detachment and is performed in an operating room. The vitreous gel, which is pulling on the retina, is removed from the eye.

Gas or oil bubble is used  after surgery to keep the retina in place. Your body’s own fluids will gradually replace a gas bubble. An oil bubble will need to be removed from the eye at a later date with another surgical procedure. Sometimes vitrectomy is combined with a scleral buckle.

If a gas bubble was placed in your eye, We will ask you to constantly maintain a certain head position for several days. The gas bubble will gradually disappear. Do not fly in an airplane or travel at high altitudes until you are told the gas bubble is gone. A rapid increase in altitude can cause a dangerous rise in eye pressure. With an oil bubble, it is safe to fly on an airplane.

Please call now to schedule an appointment to be evaluated for flashes or floaters.