Dr Simon ChenCataract & Retina SurgeonWarning signs that need same-day attention, how tears and detachments are assessed, and what treatment and recovery involve.
A sudden shower of new floaters, new flashes of light, or a shadow or curtain spreading across your vision may mean a retinal tear or detachment.
Phone Vision Eye Institute the same day so the team can arrange prompt assessment. Do not wait for a routine appointment or a web form. If the clinic is closed or the change is severe and sudden, attend your nearest emergency department.
Call 02 9424 9999A tear can often be sealed with laser in the clinic. Once the retina detaches, an operation is needed, and timing matters, especially before the centre of the retina, the macula, is involved.
The retina is the thin light-sensing layer lining the back of the eye. The vitreous, the clear gel that fills the eye, sits against it.
With age the vitreous gel shrinks and separates from the retina, a normal event called posterior vitreous detachment. Usually it causes some floaters and settles. Occasionally the gel pulls hard enough to tear the retina. Fluid can then pass through the tear and lift the retina away from the wall of the eye: a retinal detachment. A detached retina cannot work, so vision is lost in the area affected, and the detachment tends to spread.
Short-sighted eyes, eyes that have had cataract surgery or an injury, and people with a family history of detachment are at higher risk, but it can happen to anyone.
A dark shadow that starts at one edge and spreads across the vision, like a curtain being drawn, is the classic sign of a detachment.
In a dark room a brief arc of light sweeps down the far edge of vision, with a few sparkles on it, like a camera flash or distant lightning. It comes from the gel tugging on the retina and is most noticeable at night or when the eye moves.
A sudden burst of many new floaters, sometimes with a haze like smoke or cobwebs, can mean a tear has bled. A single long-standing floater is different from a sudden shower.
New flashes, a sudden increase in floaters, or a shadow or curtain can each signal a retinal tear or detachment. Follow the urgent assessment advice above even if you have only one symptom.
None of these changes should wait.
Slide each picture to compare typical vision with the change described. Illustrations are indicative, not a diagnostic test or a prediction of vision after treatment.
The whole retina is examined through a dilated pupil, out to its far edge.
After drops to enlarge the pupil, the retina is examined with bright lights and lenses, sometimes with gentle pressure on the eyelid to bring the far edge into view. An ultrasound scan is used if bleeding hides the view, and an OCT scan (optical coherence tomography, a light-based scan of the retina) shows whether the macula is still attached. The examination takes time and can feel bright, but it is not painful.
Dr Chen decides on the spot whether laser in the clinic will do, or whether surgery needs to be arranged.
If the retina has torn but not detached, laser spots are placed around the tear in the clinic to seal it to the wall of the eye. The eye is numbed with drops; it takes minutes and you go home afterwards. Freezing treatment (cryotherapy) is an alternative for some tears.
The most common operation for a detached retina. Vitrectomy means removing the vitreous gel: through tiny openings, the gel is removed, the retina is flattened, the tear is sealed with laser, and the eye is filled with a gas bubble or, in some cases, silicone oil to hold the retina in place while it heals. Dr Chen performs this surgery under local or general anaesthetic, usually as day surgery.
For some detachments a scleral buckle, a silicone band placed around the outside of the eye, or a gas bubble injected in the clinic (pneumatic retinopexy) is more suitable. The choice depends on the type of detachment, the eye and the person, and is explained before surgery.
Suitability and the choice of operation are decided at the consultation. Every operation carries risks, which are discussed with you beforehand. General information, not a guarantee of outcome.
Recovery is measured in weeks, and a gas bubble changes what you can do for a while.
The retina can re-detach and further surgery is sometimes needed. How much vision returns depends on how much of the retina, and particularly the macula, was affected and for how long; some distortion or a blind area can remain. These points are discussed candidly before surgery.
General information, not a guarantee of outcome.
Bring these, and anything else on your mind. Write the answers down, or bring someone who can.
Long-standing, stable floaters are usually harmless. The concern is change: a sudden shower of new floaters, new flashes, or a shadow. Those need same-day contact.
Same day. A tear caught early can often be sealed with laser in the clinic; a detachment needs surgery, and the timing matters. Phone rather than wait for a routine appointment.
Many retinal operations are done under local anaesthetic with sedation. A general anaesthetic is used when it suits the person or the operation. The choice is made with you and the anaesthetist.
Vision is poor while a gas bubble is present and clears over weeks as the gas absorbs. Most people need time off work, longer for physical jobs. Head positioning, drops and reviews are explained before you go home.
The other eye is at higher risk, so it is examined too and any weak areas may be treated with laser. Knowing the warning signs matters for both eyes.
Appointments and enquiries through Vision Eye Institute, Chatswood.
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