Retinal Tear: Symptoms, Causes, Laser Treatment and Follow-Up

Author: Dr Val Phua
Estimated reading time: 20 minutes

A retinal tear is a full-thickness break in the retina—the thin layer of light-sensitive nerve tissue lining the inside of the back of the eye.

Retinal tears commonly develop when the vitreous gel pulls strongly on a small area of the peripheral retina as it separates with age. They may also occur because of:

Eye trauma
High myopia
Lattice degeneration
Previous eye surgery
Abnormal vitreoretinal attachment
Inherited vitreoretinal conditions

A retinal tear is important because liquefied vitreous can pass through the opening and collect beneath the retina. This may cause a rhegmatogenous retinal detachment, in which the retina separates from the tissue supporting it.

The principal warning symptoms are:

A sudden increase in floaters
A shower of black dots
Cobwebs or strands
Flashes of light
A curtain or shadow
Missing peripheral vision
Sudden blurred vision

Retinal tears are usually painless.

A prospective study of patients presenting with flashes or floaters found a retinal tear or detachment in approximately one in ten eyes with an acute posterior vitreous detachment. A complete peripheral retinal examination—including indirect ophthalmoscopy and scleral indentation—is therefore essential when symptoms begin.

Most acute symptomatic horseshoe tears should be treated promptly with laser retinopexy or cryotherapy. Treatment creates a scar around the tear to reduce the risk of fluid passing beneath the retina.

Laser greatly reduces the risk of retinal detachment, but it does not eliminate it. New retinal tears may develop elsewhere, and an incompletely surrounded tear may require additional treatment. Long-term follow-up and continued awareness of warning symptoms remain important after successful laser.

The Quick Answer

What Is a Retinal Tear?

A retinal tear is an opening through the full thickness of the retina.

It most commonly forms when the vitreous gel pulls on the peripheral retina during a posterior vitreous detachment.

A tear may allow fluid to pass underneath the retina and produce a retinal detachment.

Is a Retinal Tear an Emergency?

A newly symptomatic retinal tear requires urgent treatment.

Seek same-day ophthalmic assessment for:

New flashes
A sudden increase in floaters
A shower of dark spots
Cobwebs
A curtain or shadow
Sudden loss of side vision
Sudden blurred vision

The treatment may not always need to be performed within minutes, but the eye should be examined promptly because a tear can progress to retinal detachment without pain.

Does Every Retinal Tear Need Laser?

No.

Treatment depends on:

Type of break
Presence of symptoms
Whether vitreous traction remains attached
Presence of fluid beneath the retina
Location and size
Lattice degeneration
Previous retinal detachment
Condition of the other eye
Ability to attend follow-up

Acute symptomatic horseshoe tears are usually treated promptly.

Many asymptomatic atrophic holes or operculated holes without traction may be safely observed. Current guidance does not recommend automatically treating every retinal hole or area of lattice degeneration.

Can Eyedrops Heal a Retinal Tear?

No.

Eyedrops cannot:

Seal the retinal opening
Release vitreous traction
Create a protective retinal scar
Prevent fluid passing through an untreated high-risk tear

Treatment, when required, usually involves:

Laser retinopexy
Cryotherapy
Retinal-detachment surgery if fluid has already spread significantly beneath the retina

Can Laser Guarantee That the Retina Will Not Detach?

No.

Laser substantially reduces the risk but does not provide a complete guarantee.

In a 2026 study of 600 eyes treated for symptomatic retinal breaks:

7.2% later developed a rhegmatogenous retinal detachment.
11% required additional laser treatment.
Risk was higher with multiple tears, vitreous haemorrhage and pseudophakia.

These findings reinforce the importance of follow-up and returning immediately if symptoms worsen.

Understanding the Retina

What Is the Retina?

The retina is the thin nerve layer lining the inside of the back of the eye.

It contains:

Rod photoreceptors
Cone photoreceptors
Retinal nerve cells
Supporting cells
Retinal blood vessels

The retina converts light into electrical signals that travel through the optic nerve to the brain.

The Peripheral Retina

The peripheral retina provides much of the side visual field.

Most retinal tears develop in the peripheral retina rather than at the centre.

A peripheral tear may therefore be present while:

Central visual acuity remains 6/6
Reading vision remains clear
There is no pain
The patient notices only floaters or flashes

The Macula

The macula is the central part of the retina responsible for:

Reading
Recognising faces
Driving
Colour vision
Fine visual detail

A peripheral retinal tear does not initially affect the macula.

If the resulting detachment spreads to the macula, central vision may deteriorate permanently.

Understanding the Vitreous

What Is the Vitreous?

The vitreous is the transparent gel filling most of the eye.

In youth, it is relatively firm and attached to the retinal surface.

With age, it gradually:

Becomes more liquid
Shrinks
Separates from the retina

This process is called a posterior vitreous detachment, or PVD.

Is a PVD the Same as a Retinal Detachment?

No.

A PVD is separation of the vitreous gel from the retina.

A retinal detachment is separation of the retina from its supporting layer.

Most PVDs occur without retinal detachment. However, the vitreous may pull strongly enough to create a tear during the separation process.

Why Does the Vitreous Pull on Certain Areas?

The vitreous is not attached to the retina with equal strength everywhere.

Stronger attachment may occur:

Around retinal blood vessels
At the vitreous base
Around areas of lattice degeneration
Around previous scars or inflammation
At sites of congenital vitreoretinal adhesion

When the surrounding vitreous separates but remains attached at one focal point, traction may lift and tear the retina.

How Does a Retinal Tear Develop?

Step 1: The Vitreous Becomes More Liquid

Ageing and myopia accelerate vitreous liquefaction.

Step 2: The Vitreous Begins to Separate

The back surface of the vitreous detaches from the retina.

Step 3: Focal Traction Persists

A small area remains abnormally adherent.

Step 4: The Retina Tears

Continued pulling creates a full-thickness break.

Step 5: Fluid May Pass Through the Tear

Liquefied vitreous enters the space beneath the retina.

Step 6: A Retinal Detachment May Develop

The fluid spreads and lifts the retina away from its supporting tissue.

Without treatment, acute tractional tears have a substantial risk of progressing to retinal detachment. Retinopexy reduces this risk markedly, although published rates vary with tear characteristics and patient selection.

Symptoms of a Retinal Tear

A Sudden Increase in Floaters

Floaters may appear as:

Small dots
Threads
Rings
Cobwebs
Insects
Wispy strands
A cloud of spots

A few stable longstanding floaters are common.

The concerning pattern is:

A sudden onset
A clear increase in number
A shower of many small dots
Floaters accompanied by flashes
Floaters accompanied by blurred vision

A Shower of Black Dots

Numerous small dark spots may represent:

Pigment cells released through a retinal tear
Small amounts of blood within the vitreous
Debris associated with an acute PVD

Pigment cells seen during slit-lamp examination are sometimes called Shafer’s sign or “tobacco dust” and increase suspicion of a retinal break.

Flashes of Light

Flashes occur when vitreous traction mechanically stimulates the retina.

They may appear as:

Lightning streaks
Camera flashes
Sparks
Brief arcs
Flickering at the edge of vision

They are often most noticeable:

In a dark room
When moving the eye
At the temporal side of the visual field
During the early phase of a PVD

Cobwebs or a Moving Ring

A large ring-shaped floater may represent separation of vitreous tissue from around the optic nerve.

This is called a Weiss ring.

A Weiss ring supports the diagnosis of PVD but does not prove that the peripheral retina is intact.

Blurred or Hazy Vision

Blur may occur because of:

Vitreous haemorrhage
Numerous floaters
A developing retinal detachment
Inflammation
Another associated retinal problem

A Curtain or Shadow

A curtain, veil or missing area of side vision suggests that fluid has already spread beneath the retina.

This indicates retinal detachment rather than an isolated tear and requires emergency retinal assessment.

Retinal Tears Are Usually Painless

Do not wait for:

Eye pain
Redness
Discharge
Headache

Most retinal tears and detachments cause none of these symptoms.

Floaters and Flashes: When Are They Concerning?

Lower-Risk Features

Symptoms may be less concerning when:

Floaters have been unchanged for years.
The pattern is identical to previously assessed symptoms.
No flashes, blur or field defect is present.
A recent complete retinal examination was reassuring.

Even then, a definite change warrants reassessment.

Higher-Risk Features

Risk is greater when symptoms include:

Sudden numerous floaters
A shower of dots
Vitreous haemorrhage
Retinal haemorrhage
New flashes
Reduced vision
A field defect
High myopia
Lattice degeneration
Previous tear or detachment
Recent cataract surgery
Recent trauma

Vitreous or retinal haemorrhage is particularly important. Studies have found a strong association between haemorrhage and the presence of one or multiple retinal tears.

Types of Retinal Break

Horseshoe Tear

A horseshoe tear is also called:

Flap tear
U-shaped tear
Tractional retinal tear

The torn retinal flap remains attached to the vitreous.

This indicates persistent traction and is the classic high-risk retinal tear associated with acute PVD.

Acute symptomatic horseshoe tears are generally treated promptly with laser or cryotherapy.

Operculated Retinal Hole

An operculated hole forms when vitreous traction pulls a small circular piece of retina completely free.

The detached fragment is called the operculum.

Once the operculum has separated, active traction at the hole may be reduced.

Many asymptomatic operculated holes without surrounding fluid can be monitored, although treatment may be considered according to:

Symptoms
Residual traction
Fluid beneath the retina
Fellow-eye history
Other risk factors

Atrophic Round Hole

An atrophic hole forms through gradual thinning rather than an acute pulling event.

It is frequently associated with lattice degeneration.

Many atrophic holes:

Cause no symptoms
Remain stable
Do not require treatment

Selected holes may cause a slowly progressive retinal detachment, particularly in younger myopic patients.

Retinal Dialysis

A retinal dialysis is a tear at the front edge of the retina, near the ora serrata.

It is commonly associated with blunt trauma.

The resulting detachment may:

Develop slowly
Remain unnoticed initially
Present months or years after injury
Occur in a child or young adult

Retinal dialysis often requires scleral-buckle or other retinal-detachment surgery rather than simple office laser when significant detachment is present.

Giant Retinal Tear

A giant retinal tear extends through at least 90 degrees of the retinal circumference.

It is a complex condition associated with:

Trauma
High myopia
Stickler syndrome
Certain inherited vitreoretinal disorders
Previous eye surgery
Spontaneous vitreous change

It requires urgent specialist retinal surgery.

Macular Hole

A macular hole is an opening at the centre of the retina.

It causes:

Central distortion
Blurred central vision
Missing letters
A central grey spot

It is different from a peripheral retinal tear and is treated using vitrectomy and macular membrane surgery rather than ordinary peripheral laser retinopexy.

Lattice Degeneration

What Is Lattice Degeneration?

Lattice degeneration is an area of thinned peripheral retina.

It may appear:

Linear
Oval
Pigmented
Associated with white retinal vessels
Associated with atrophic holes
Associated with abnormal vitreous attachment

Is Lattice Degeneration a Retinal Tear?

No.

Lattice is a peripheral retinal degeneration that may increase the risk of a retinal tear or detachment.

Most people with lattice degeneration never develop retinal detachment.

Does All Lattice Need Laser?

No.

Routine laser is generally not recommended for every asymptomatic area of lattice degeneration.

Observation is often appropriate when there is:

No symptomatic tractional tear
No progressive subretinal fluid
No relevant high-risk fellow-eye history
No specific inherited vitreoretinal condition
Reliable patient awareness and follow-up

The decision becomes more individualised when the patient has:

Previous detachment in the other eye
High myopia
Aphakia
Multiple retinal breaks
Strong inherited risk
Poor access to urgent care
Planned intraocular surgery
High-risk lattice features

Evidence for prophylactic treatment of asymptomatic lattice remains more limited than the evidence supporting treatment of acute symptomatic horseshoe tears.

Risk Factors

Increasing Age

Ageing causes vitreous liquefaction and posterior vitreous separation.

Retinal tears associated with acute PVD become more common in middle age and later life.

Myopia

Myopic eyes—particularly highly myopic eyes—may have:

Longer axial length
A thinner peripheral retina
Earlier vitreous liquefaction
Earlier PVD
More lattice degeneration
Greater risk of retinal tears and detachment

In prospective studies of symptomatic PVD, myopia has been associated with a higher likelihood of retinal breaks or delayed tears.

Cataract Surgery

Cataract surgery alters the vitreous environment and may be followed by PVD, retinal tears or detachment.

Risk is higher in selected patients, including those who are:

Younger
Male
Highly myopic
Long in axial length
Affected by lattice degeneration
Complicated by posterior capsule rupture or vitreous loss

Large registry data estimated that rhegmatogenous retinal detachment occurred in approximately one in 500 cataract operations among patients older than 40 during the first postoperative year, although individual risk varies substantially.

Previous Retinal Tear

A tear in one part of the retina indicates a vitreoretinal environment capable of producing additional breaks.

New tears can occur:

Before laser scars fully mature
During the continuing PVD process
Months later
In another quadrant
In the fellow eye

Previous Retinal Detachment

A previous detachment increases the risk of a tear or detachment in:

The repaired eye
The fellow eye

Lattice Degeneration

Lattice is an important risk factor for delayed retinal tears after symptomatic PVD.

Vitreous Haemorrhage

Blood in the vitreous substantially increases the likelihood of a retinal tear.

A dense haemorrhage may prevent the tear from being seen and require:

Repeated examination
Ultrasound
Early vitrectomy in selected cases

Eye Trauma

Blunt or penetrating injury may cause:

Horseshoe tears
Retinal dialysis
Giant retinal tears
Vitreous haemorrhage
Retinal detachment

Symptoms may occur immediately or after a delay.

Family History

A family history may reflect inherited tendencies towards:

High myopia
Lattice degeneration
Abnormal vitreous
Stickler syndrome
Other vitreoretinal disorders

Inherited Conditions

Risk may be particularly high in conditions such as:

Stickler syndrome
Marfan syndrome
Familial exudative vitreoretinopathy
Certain collagen disorders
Previous retinopathy of prematurity

Previous Intraocular Surgery

Risk may be altered after:

Cataract surgery
Vitrectomy
Glaucoma surgery
Lens surgery
Retinal procedures
Eye trauma repair

Can a Retinal Tear Occur Without Symptoms?

Yes.

An asymptomatic break may be discovered during:

Routine dilated examination
Myopia screening
Cataract assessment
Examination of the fellow eye
Follow-up after retinal detachment
Diabetic retinal screening

The absence of symptoms does not by itself determine whether treatment is needed.

The tear type, traction and surrounding fluid are more important.

How Is a Retinal Tear Diagnosed?

Symptom History

The ophthalmologist will ask about:

Time of onset
Number of floaters
Flashes
Blurred vision
A curtain or shadow
Previous similar symptoms
Myopia
Trauma
Previous surgery
Previous tear or detachment
Family history

Visual-Acuity Testing

Central vision may remain normal with an isolated peripheral tear.

Reduced acuity may suggest:

Vitreous haemorrhage
Macular involvement
Retinal detachment
Another ocular condition

Pupil Examination

A large retinal detachment may produce an abnormal pupil response.

An isolated peripheral tear usually does not.

Slit-Lamp Examination

The anterior vitreous is examined for:

Pigment cells
Blood
Inflammatory cells
Evidence of an acute PVD

Shafer’s sign strongly increases suspicion of a retinal break.

Dilated Retinal Examination

The pupil must generally be dilated to examine the peripheral retina adequately.

The ophthalmologist may use:

Slit-lamp retinal lenses
Indirect ophthalmoscopy
Scleral indentation
Wide-field photography as an adjunct

Scleral Indentation

Scleral indentation involves gently pressing the outside of the eye while examining the peripheral retina.

This brings the far peripheral retina into view and can reveal:

Small horseshoe tears
Retinal dialysis
Multiple breaks
Anterior tears hidden near the vitreous base

A prospective PVD study emphasised that some tears were detected only through indented indirect examination.

Wide-Field Photography

Wide-field imaging may document:

Tear location
Laser treatment
Lattice degeneration
Associated haemorrhage

It does not reliably replace a complete examination with scleral indentation.

Very anterior tears may fall outside the photographed area or be obscured by eyelids, eyelashes or poor image quality.

Ultrasound B-Scan

Ultrasound is useful when the retina cannot be seen because of:

Dense vitreous haemorrhage
Cataract
Corneal opacity
Small pupil
Severe inflammation

Ultrasound may identify:

Retinal detachment
Vitreous haemorrhage
Posterior vitreous separation
Intraocular mass

A negative ultrasound does not always exclude a small retinal tear, so repeat examination remains necessary when suspicion is high.

Why Can Tears Be Missed During the First Examination?

The Tear Is Very Peripheral

Small anterior tears may be difficult to visualise without indentation.

Vitreous Haemorrhage Obscures the Retina

Blood may block the view.

The PVD Is Still Progressing

A new tear may develop after an initially normal examination.

The Pupil Does Not Dilate Well

A small pupil limits peripheral examination.

Cataract or Corneal Disease Reduces the View

Media opacity may obscure a retinal break.

More Than One Tear Is Present

Finding one tear should not end the examination.

The entire peripheral retina must be checked because multiple breaks may coexist.

Delayed Retinal Tears After PVD

A Normal First Examination Does Not End All Risk

In one long-term study, 7.39% of eyes with an acute symptomatic PVD but no tear at the initial visit later developed a retinal tear.

Half occurred within approximately 4.6 months, but some occurred substantially later. Lattice degeneration was the strongest identified risk factor.

Who May Need Closer Follow-Up?

Closer or extended follow-up may be appropriate for patients with:

Vitreous haemorrhage
Retinal haemorrhage
Numerous floaters
Persistent flashes
Lattice degeneration
Myopia
Pseudophakia
Fellow-eye tear or detachment
Incomplete peripheral visualisation

Large database analyses similarly show that a clinically relevant proportion of PVD complications are diagnosed after the initial presentation.

Return Earlier if Symptoms Change

Do not wait for the scheduled review if there is:

A new shower of floaters
Increasing flashes
Sudden haze
A curtain
Missing peripheral vision
Reduced central vision

Which Retinal Tears Are Usually Treated?

Acute Symptomatic Horseshoe Tears

These are generally treated promptly because persistent vitreous traction increases the risk of retinal detachment.

Tears With Subretinal Fluid

Fluid extending beneath the retina suggests that the tear is already allowing separation.

Treatment urgency depends on:

Amount of fluid
Progression
Location
Proximity to the macula

Tears Associated With Vitreous Haemorrhage

These are higher-risk and require careful examination for:

Multiple tears
Retinal detachment
Inadequate visibility

Tears With Persistent Traction

Active pulling at the tear increases risk.

Selected High-Risk Asymptomatic Tears

Treatment may be considered according to:

Tear configuration
Fellow-eye retinal detachment
High myopia
Aphakia
Inherited vitreoretinal disease
Inability to recognise symptoms
Access to urgent care
Planned ocular surgery

Which Retinal Breaks May Be Observed?

Observation may be appropriate for selected:

Asymptomatic atrophic holes
Operculated holes without traction
Stable holes within lattice degeneration
Longstanding pigmented breaks
Lesions with no surrounding subretinal fluid
Incidental breaks judged to have low detachment risk

Observation still requires:

Patient education
Appropriate follow-up
Immediate review if symptoms develop

Laser Retinopexy

What Is Laser Retinopexy?

Laser retinopexy uses focused light energy to create small controlled burns around the retinal tear.

These burns produce a chorioretinal scar that adheres:

The retina
The retinal pigment epithelium
The tissue beneath

The barrier reduces the risk of fluid passing through the tear and spreading beneath the retina.

Does the Laser Close the Opening?

The retinal opening remains anatomically present.

The treatment surrounds it with adhesive scar tissue.

How Is the Procedure Performed?

The eye is dilated.

Anaesthetic drops are applied.

Laser may be delivered using:

A slit-lamp contact lens
An indirect ophthalmoscope
An operating-room laser system

The ophthalmologist applies several rows of laser spots around the tear.

The exact pattern depends on:

Tear size
Location
Visibility
Presence of fluid
Nearby blood vessels
Ability to surround the anterior edge

What Will I Experience?

Patients may notice:

Bright flashes
Coloured lights
After-images
Mild stinging
Pressure from the contact lens
Brief sharp sensations

More peripheral or extensive laser may be less comfortable.

How Long Does It Take?

The laser application often takes several minutes.

The full visit is longer because of:

Pupil dilation
Examination
Consent
Anaesthesia
Post-treatment pressure or retinal checks

When Does the Laser Scar Become Strong?

The adhesion begins developing over the following days and continues strengthening.

This is why follow-up is required to assess whether:

The tear is fully surrounded
The laser uptake was adequate
Additional treatment is required
Subretinal fluid has progressed

Cryotherapy

What Is Cryotherapy?

Cryotherapy uses a freezing probe placed against the outside of the eye.

The freezing effect creates a controlled scar around the retinal break.

When Is Cryotherapy Used?

Cryotherapy may be chosen when:

The tear is extremely peripheral
Laser cannot reach the anterior edge
The view is partially obscured
The pupil is small
A contact lens cannot be used
Retinal-detachment surgery is being performed

What Is the Procedure Like?

Anaesthesia is required.

The patient may feel:

Pressure
Cold
Temporary discomfort
Eyelid swelling afterwards

Laser Versus Cryotherapy

Both aim to create retinal adhesion.

Laser is commonly preferred for accessible tears because it generally produces less external inflammation.

Cryotherapy remains valuable when the tear cannot be completely surrounded with laser.

Some retrospective evidence suggests that epiretinal-membrane formation may differ between cryotherapy and laser-treated eyes, although the choice is usually determined primarily by anatomy and access to the break.

What Happens After Laser Retinopexy?

Vision May Be Temporarily Blurred

Temporary blur may result from:

Pupil dilation
The contact lens
Corneal surface disturbance
Bright after-images
Existing floaters or haemorrhage

Mild Discomfort May Occur

The eye may feel:

Achy
Gritty
Light-sensitive
Tired

Severe or increasing pain is not typical.

Floaters May Persist

Laser does not remove vitreous floaters.

The original floater may:

Remain visible
Move differently
Become less noticeable with time

A sudden increase in floaters remains a warning sign even after treatment.

Flashes May Continue Temporarily

The PVD process may continue after the tear has been treated.

Flashes may gradually reduce as the vitreous completes separation.

Increasing or changing flashes require reassessment.

Activity After Laser Treatment

Follow the Treating Doctor’s Instructions

Recommendations vary according to:

Tear size
Amount of traction
Presence of subretinal fluid
Vitreous haemorrhage
Whether a detachment is beginning
Type of work or sport

Ordinary Visual Activity

Reading, watching television and using a computer do not usually pull a treated tear open.

Physical Activity

The surgeon may recommend temporarily avoiding:

Heavy lifting
Vigorous straining
High-impact exercise
Contact sports
Activities involving rapid acceleration
Eye trauma

These restrictions are usually precautionary and should be individualised.

Driving

Do not drive immediately after dilation if vision is blurred or light-sensitive.

Ongoing driving depends on:

Visual acuity
Floaters
Field of vision
Whether a detachment is present
Vision in the other eye

Flying

An uncomplicated external laser retinopexy does not place gas inside the eye, so flying restrictions related to gas do not ordinarily apply.

Flying may still be inappropriate when:

A retinal detachment is developing
Surgery is planned urgently
The treating specialist advises against travel
Follow-up access would be limited

Follow-Up After Laser

Why Is Follow-Up Needed?

Follow-up determines whether:

Laser scars are adequate
The anterior edge is fully treated
The original tear has extended
A new tear has developed
Fluid has progressed
Retinal detachment has occurred

Additional Laser Is Not Unusual

In studies of treated retinal breaks, additional laser has been required because of:

Incomplete initial treatment
Extension of the original tear
A new tear elsewhere
Continued vitreous traction

A large series found that approximately 19% of treated eyes received additional laser and approximately 6% later required retinal-detachment surgery.

More recent data similarly found that follow-up laser and retinal detachment remain uncommon but clinically important after initial treatment.

Treatment Does Not End Symptom Awareness

Return immediately for:

New floaters
More flashes
Sudden haze
A curtain
Missing side vision
Reduced central vision

Why Can Retinal Detachment Occur Despite Laser?

A New Tear Develops Elsewhere

The vitreous may continue separating and pulling on another retinal area.

The Original Tear Extends

Persistent traction can enlarge the break beyond the treated border.

The Anterior Edge Was Difficult to Reach

A tear close to the ora serrata may be difficult to surround completely.

The Laser Scar Was Inadequate

Possible reasons include:

Poor retinal visibility
Vitreous haemorrhage
Subretinal fluid
Lightly pigmented retina
Patient movement
Limited laser uptake

Fluid Was Already Progressing

A detachment may have begun before the laser was applied.

Multiple Tears Were Present

An additional tear may have been hidden or developed later.

Proliferative Vitreoretinopathy Develops

This is uncommon after simple isolated tears but can complicate established retinal detachment.

Possible Complications of Laser Retinopexy

Laser retinopexy is generally safe, but possible complications include:

Temporary blur
Discomfort
Inflammation
Small retinal or vitreous haemorrhage
Accidental laser to an unintended retinal area
Epiretinal membrane
Macular oedema
Additional retinal tears
Retinal detachment despite treatment
Rare visual-field effects with extensive treatment

The risk of treatment must be balanced against the risk of leaving a high-risk symptomatic tear untreated.

Retinal Tear After Cataract Surgery

Why Can Cataract Surgery Be Followed by a Tear?

Cataract surgery may accelerate vitreous separation.

The risk is influenced by:

Age
Myopia
Axial length
Lattice degeneration
Surgical complications
Previous retinal tear or detachment

How Long Does the Risk Last?

A tear or detachment may occur:

Soon after surgery
Months later
Several years later

New flashes, floaters or a curtain require assessment regardless of when the cataract surgery was performed.

Should Every Patient Receive Preventive Laser Before Cataract Surgery?

No.

Routine prophylactic laser for every asymptomatic peripheral lesion is not supported.

Treatment may be appropriate when examination identifies:

An acute symptomatic horseshoe tear
A high-risk untreated break
Progressive subretinal fluid
Another lesion with a specific significant risk profile

Retinal Tear After YAG Laser Capsulotomy

YAG laser capsulotomy treats clouding behind an intraocular lens.

It is performed at the front of the vitreous cavity rather than directly treating the retina.

Patients should seek urgent assessment after YAG if they develop:

New floaters
Flashes
A curtain
Sudden blur
Missing peripheral vision

The presence of a retinal risk factor does not automatically mean that necessary YAG treatment should never be performed. The risks and benefits should be individualised.

Retinal Tears After Eye Trauma

Blunt Trauma

Possible examples include:

Ball injury
Racquet or shuttlecock injury
Fist or elbow impact
Airbag injury
Fall
Workplace accident

The eye may rapidly compress and expand, transmitting force to the retina.

Symptoms May Be Delayed

A traumatic tear or dialysis may not cause an immediate curtain.

Retinal detachment can develop after:

Days
Weeks
Months
Occasionally years

Protective Eyewear

Appropriate polycarbonate protective eyewear should be used during:

Racquet sports
High-velocity ball sports
Industrial work
Construction
Activities with projectile risk

Retinal Tears in Children and Young Adults

Retinal tears are less commonly related to ordinary age-related PVD in children.

Possible causes include:

Trauma
High myopia
Stickler syndrome
Previous cataract surgery
Retinopathy of prematurity
Familial exudative vitreoretinopathy
Other inherited vitreoretinal disorders

Children may not clearly report:

Floaters
Flashes
A visual-field defect
Reduced vision in one eye

A child with unexplained reduced vision, trauma or a relevant genetic condition requires specialist assessment.

The Fellow Eye

Is the Other Eye at Risk?

Yes.

Many risk factors affect both eyes, including:

Myopia
Lattice degeneration
Abnormal vitreous
Family history
Inherited disease
Previous cataract surgery

Should the Fellow Eye Receive Laser?

Not automatically.

A complete dilated examination should identify:

Existing tears
Lattice degeneration
Atrophic holes
PVD status
High-risk abnormalities

Prophylactic treatment is considered individually.

Laser applied to visible lattice cannot prevent every future tear because a new tear may arise in previously normal retina.

Can Retinal Tears Be Prevented?

Not Every Tear Is Preventable

Age-related PVD may occur without warning.

Recognise Symptoms Early

Prompt assessment of flashes and floaters allows many tears to be treated before retinal detachment develops.

Use Eye Protection

Protective eyewear reduces trauma-related risk.

Control Myopia Progression in Children

Myopia-control treatment may reduce future high-myopia-related retinal risk, although it cannot completely remove inherited or structural susceptibility.

Attend Follow-Up

Patients with:

Recent PVD
Previous retinal tear
Previous detachment
High myopia
Lattice degeneration
Inherited vitreoretinal disease

should follow the recommended examination schedule.

Can Exercise Cause a Retinal Tear?

Ordinary Exercise

Routine walking, jogging and general exercise do not cause most retinal tears.

The principal mechanism is usually vitreoretinal traction during PVD.

Contact or High-Impact Activities

Eye trauma may cause retinal tears.

Patients with a newly diagnosed PVD, untreated tear, evolving detachment or recent retinopexy should discuss:

Contact sports
Heavy lifting
High-impact exercise
Roller coasters or rapid acceleration activities
Combat sports

with their retinal specialist.

Case reports suggest that extreme acceleration forces may trigger retinal events in structurally predisposed eyes, although this is uncommon and does not mean that all ordinary movement is dangerous.

Can Coughing, Sneezing or Bending Cause a Tear?

Routine coughing, sneezing or bending does not usually create a retinal tear in a healthy eye.

Symptoms may coincidentally become noticeable during an activity when a PVD and tear are already developing.

Patients should not blame themselves for ordinary movement.

Retinal Tear Versus Migraine Aura

Vitreoretinal Flashes

These are often:

Brief
Lightning-like
At the side of one eye
Triggered by eye movement
Associated with floaters

Migraine Visual Aura

Migraine aura commonly:

Appears in both eyes or the same half of vision in both eyes
Has a shimmering or zigzag pattern
Expands gradually
Lasts several minutes
May be followed by headache

Patients may find it difficult to distinguish them.

A new one-sided flash pattern—particularly with floaters—requires retinal examination.

Retinal Tear Versus Retinal Detachment

Retinal Tear

A retinal tear is an opening in an otherwise largely attached retina.

Possible symptoms include:

Flashes
Floaters
Mild haze

Retinal Detachment

Fluid has passed through the tear and lifted the retina.

Possible symptoms include:

A curtain
Missing peripheral vision
Increasing blur
Central visual loss when the macula detaches

A tear may often be treated with office laser.

An established spreading detachment usually requires:

Pneumatic retinopexy
Scleral-buckle surgery
Vitrectomy
A combination of procedures

Common Myths

“A Retinal Tear Always Causes Pain”

False.

Retinal tears are usually painless.

“All Floaters Are Harmless”

False.

Longstanding stable floaters are common, but sudden new floaters may indicate a tear or haemorrhage.

“Laser Removes the Floater”

False.

Laser retinopexy treats the retinal break. It does not remove the vitreous opacity causing the floater.

“Once Laser Is Done, No Follow-Up Is Needed”

False.

The tear may require additional treatment, and new tears may develop.

“Every Retinal Hole Must Be Lasered”

False.

Many asymptomatic atrophic or operculated holes can be observed.

“Every Area of Lattice Degeneration Must Be Treated”

False.

Management is risk-based.

“Reading or Using a Phone Will Make the Tear Open”

Ordinary visual use does not generally pull a treated retinal tear open.

“A Normal First Examination Means No Tear Can Develop Later”

False.

Delayed tears may develop as the PVD progresses.

“Laser Guarantees That Retinal Detachment Cannot Occur”

False.

Laser reduces risk but does not eliminate it.

“Good Central Vision Means the Retina Is Safe”

False.

A peripheral tear or detachment may be present while central acuity remains excellent.

Frequently Asked Questions

How Quickly Can a Retinal Tear Become a Detachment?

Progression is unpredictable.

It may occur:

Within hours
Over several days
More gradually
Not at all

This uncertainty is why a symptomatic high-risk tear is treated promptly.

How Soon Should Laser Be Performed?

An acute symptomatic horseshoe tear is generally treated as soon as practical after diagnosis.

Timing may depend on:

Whether retinal detachment has begun
Tear location
Visibility
Availability of the necessary equipment
Medical considerations

Is Laser Retinopexy Painful?

Most patients tolerate it with anaesthetic drops.

Peripheral treatment may cause brief stinging, pressure or aching.

Is One Laser Session Enough?

Often, but not always.

Additional treatment may be needed because:

Laser uptake was incomplete.
The tear extended.
An untreated gap remains.
A new tear developed.

Can the Laser Scar Be Seen?

The patient does not usually perceive the peripheral laser scars.

They are visible during retinal examination and may appear pale or pigmented as they mature.

Will My Flashes Stop Immediately?

Not necessarily.

Flashes may continue while the vitreous completes separation.

They should gradually improve.

A sudden increase or change requires review.

Will My Floaters Disappear?

Some become less noticeable as:

They move away from the visual axis.
The blood clears.
The brain adapts.

Laser itself does not remove them.

Can I Shower After Laser?

Ordinary showering does not usually affect an internal retinal laser scar.

Follow any specific instructions if a contact lens caused corneal irritation or another procedure was performed.

Can I Swim After Laser?

Swimming restrictions vary according to:

Whether only laser was performed
Corneal surface condition
Additional eye procedures
The clinician’s protocol

Retinal laser alone does not create an external wound, but strenuous swimming and delayed access to care may be discouraged during the initial observation period.

Can I Fly After Laser?

Usually yes, because no gas bubble is inserted during ordinary laser retinopexy.

Do not travel when:

A detachment is suspected
Urgent follow-up is required
Surgery may be needed
The retinal specialist advises against it

Can I Exercise After Laser?

Light ordinary activity is commonly permitted.

Temporary restriction of strenuous or high-impact exercise may be advised while the laser scar develops.

Can a Retinal Tear Heal Naturally?

The retinal opening usually remains.

An operculated or low-risk hole may remain stable without treatment, but a symptomatic tractional horseshoe tear should not be expected to seal safely by itself.

Can Laser Damage Vision?

Serious visual damage is uncommon when peripheral laser is correctly applied.

Possible complications exist, but the risk is usually much lower than the risk posed by an untreated high-risk tear.

Why Do I Need Repeat Dilation?

A repeat peripheral examination checks for:

New tears
Tear extension
Incomplete laser
Subretinal fluid
Retinal detachment

Can a Retinal Tear Recur?

The original tear remains anatomically present but is surrounded by scar.

A new tear may develop elsewhere.

Can Both Eyes Develop Tears?

Yes.

Symptoms in the other eye require a new urgent examination.

Should My Family Members Be Screened?

Routine screening of every relative is unnecessary.

Examination may be appropriate when there is:

Strong family history
High myopia
Stickler syndrome
Previous detachment at a young age
Another inherited vitreoretinal disorder

Can a Tear Cause Complete Blindness?

An isolated treated tear usually does not.

An untreated tear may progress to retinal detachment and severe permanent visual loss.

When to Seek Emergency Eye Care

Seek immediate same-day assessment for:

Sudden new floaters
A marked increase in floaters
A shower of black dots
Cobwebs
New flashes
Sudden haze
A curtain or shadow
Missing peripheral vision
Sudden blurred vision
Visual symptoms after trauma
New symptoms after cataract or YAG laser treatment

After retinal laser, return urgently for:

New or increasing floaters
Increasing flashes
A curtain
Missing side vision
Sudden visual deterioration
Significant pain or redness
Trauma to the eye

Do not drive yourself when vision is substantially impaired.

A Retinal-Tear Emergency Checklist

Report

Tell the ophthalmologist about:

When symptoms began
Whether floaters increased suddenly
Flashes
A curtain or field defect
Eye trauma
High myopia
Previous cataract surgery
Previous tear or detachment
Family history
Blood-thinning medication

Expect

Assessment may include:

Visual acuity
Pupil examination
Slit-lamp examination
Dilating drops
Indirect ophthalmoscopy
Scleral indentation
Wide-field photography
Ultrasound when the retina cannot be seen

Ask

Is there a retinal tear or detachment?
What type of tear is present?
Is vitreous traction still attached?
Is there fluid beneath the retina?
Is laser or cryotherapy required?
Is the tear fully surrounded?
When is the follow-up examination?
What activity restrictions apply?
What symptoms require immediate return?
Does the other eye have high-risk changes?

The Bottom Line

A retinal tear is a full-thickness break in the peripheral retina.

It commonly develops when the vitreous gel separates and pulls strongly on a focal area of retina.

The principal warning symptoms are:

A sudden increase in floaters
A shower of black dots
Cobwebs
Flashes of light
A curtain or shadow
Sudden blurred or missing vision

Retinal tears are generally painless.

The most important high-risk tear is an acute symptomatic horseshoe tear with persistent vitreous traction.

Treatment usually involves:

Laser retinopexy
Cryotherapy when laser cannot adequately reach the break

The treatment creates a scar around the tear to reduce the risk of retinal detachment.

Not every retinal hole or area of lattice degeneration requires treatment. Management depends on:

Symptoms
Tear type
Traction
Subretinal fluid
Myopia
Previous retinal detachment
Fellow-eye findings
Other individual risk factors

Laser greatly reduces the likelihood of retinal detachment but does not eliminate it.

After treatment:

The PVD may continue evolving.
A new retinal tear may form.
Additional laser may be required.
Retinal detachment remains possible.

The most important message is:

Sudden new floaters, flashes or a curtain over the vision require an urgent dilated retinal examination—even when there is no pain and central vision remains clear.

References

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