Giant retinal tears are critical eye injuries that can lead to severe vision loss if untreated. Practices listed with Specialty Vision have dedicated retina specialists ready to provide expert care and timely diagnosis.
Giant retinal tears are serious eye injuries that involve a full-thickness break in the retina spanning more than 90 degrees, or about 3 clock hours of its outer edge. Though rare (about 0.09 cases per 100,000 people), GRTs are a vision-threatening emergency that requires quick diagnosis and expert care. Our retina specialists are here to support you through every step of diagnosis and treatment.
A GRT is not your typical retinal tear. It’s a large, crescent-shaped break that runs around the outer edge of the retina. Unlike smaller tears, GRTs involve a wide section of the retina and can lead to rapid and severe vision loss if left untreated.
These tears often begin with a posterior vitreous detachment, a process where the gel inside the eye (the vitreous) pulls away from the retina. In some cases, the separation is so forceful that it creates a large tear, especially where the vitreous is already liquefied or densely attached. This can cause the retina to rip open in a zipper-like pattern.
Here’s the thing: the development of a giant retinal tear is not random. It is largely driven by the forces exerted on the retina by the vitreous gel. Consider the vitreous as a supportive, jelly-like substance that fills the eye and helps keep the retina in place. When a posterior vitreous detachment occurs, it creates traction, particularly where the vitreous is firmly attached to the retina near the vitreous base.
This traction is compounded by two key processes: the condensation of the vitreous in its periphery and the liquefaction of its central portion. As the vitreous separates, a transvitreal contraction of what is known as the cortical gel occurs. This contraction can pull on the retina in such a way that it tears progressively along the intact vitreous base, similar to unzipping a seam. In some cases, instead of a single tear, multiple small horseshoe-shaped tears can merge to form one giant retinal tear.
A unique aspect of these tears is their relationship with the vitreous gel. In giant retinal tears, the vitreous remains attached to the anterior flap of the torn retina. This is different from retinal dialysis, where the attachment is to the posterior flap. This subtle difference is important because it influences how the retina behaves after the tear and helps determine the appropriate management strategy.
Understanding what increases the risk of a giant retinal tear can help with early detection and prevention. Risk factors generally fall into two categories: eye-related (ocular) and whole-body (systemic).
High Myopia (Severe Nearsightedness)People with very nearsighted vision often have longer eyes, which can stretch and thin the retina, making it more vulnerable to tears.
Eye Trauma (Closed Globe Injury)Blunt injury to the eye can create stress that leads to a tear, especially in the outer areas of the retina.
Younger AgeGRTs tend to occur in younger patients more often than many other retinal conditions.
Connective Tissue DisordersGenetic syndromes like Stickler, Wagner, Marfan, and Ehlers-Danlos can weaken the eye’s internal structure and increase the risk of a retinal tear.
In many cases about 54% giant retinal tears occur without any known cause. These are called idiopathic GRTs. While that can be unsettling, the good news is that early diagnosis and treatment greatly improve the chances of protecting your vision.
Sudden, brief flashes especially in the side vision, can occur as the retina is tugged by the separating vitreous gel.
Patients may notice a sudden increase in floaters, small dark shapes like spots, strands, or cobwebs moving across the field of vision. This may be due to blood or pigment cells released from the torn retina.
A dark shadow or curtain may move across the visual field. This is often a sign that the retina is starting to detach and should be treated as an emergency.
If the central retina (macula) is involved or affected by shifting fluid, vision may become blurry or warped.
GRTs often start at the edge of the retina. As the tear progresses, people may begin to lose their side vision.
If you suspect you have symptoms of a giant retinal tear, it’s crucial to seek immediate attention from a specialized retina doctor. Practices listed with Specialty Vision offer experienced retina specialists ready to assist you in protecting your vision. Find a top optometrist or ophthalmologist near you today!
In some cases, fluid under the retina may shift when you move your head, causing changes in how the shadow or distortion appears.
In some cases, a giant retinal tear might be detected before it leads to a retinal detachment. Here’s the thing: early intervention can often prevent further complications and stabilize the condition. When no retinal detachment is present, laser photocoagulation is frequently employed as a preventive measure.
Laser photocoagulation involves using a focused laser beam to create small, controlled burns along the edges of the tear. These burns are intended to create a scar that acts as a barrier, helping to secure the retina back in place and prevent fluid from seeping underneath, which could lead to detachment. Often, cryotherapy may be used alongside the laser treatment to achieve the same goal.
The treatment strategy usually involves applying at least three concentric rows of overlapping white laser burns, stretching all the way to the orad edge known as the ora serrata. This extensive treatment reduces the likelihood of a retinal detachment developing later on. Additionally, our retina specialists meticulously inspect the entire retina to ensure there are no other breaks that might compromise the stability of the eye.
When a giant retinal tear is accompanied by a retinal detachment, the approach shifts to a more involved surgical management because the retinal tissue is not just torn but also displaced. Here, the strategy depends on the specific behavior of the torn retina.
If the retinal tear does not result in the retina folding over itself, a scleral buckle combined with cryotherapy might be sufficient to reattach the retina. A scleral buckle involves placing a flexible band around the eye to relieve the traction on the retina by indenting (or “buckling”) the wall of the eye. Cryotherapy is then applied to create adhesions, helping to secure the retina’s position.
However, if the detached retina has a configuration where the posterior flap is folded over, then this situation becomes more complex. In such cases, the treatment involves vitrectomy, a surgical procedure where the vitreous gel is removed from the eye, and the use of perfluorocarbon liquids (PFCLs). The PFCL is injected into the eye to help unfold and flatten the retina, making it easier for the surgeon to see the retina clearly and work on it. This liquid plays a crucial role in immobilizing the retina while the tear is being treated.
Perfluorocarbon liquids have become a central tool in managing giant retinal tears complicated by retinal detachment. Their high specific gravity allows them to gently press and flatten the retina against the underlying tissues. This is especially helpful in cases where the retina's posterior flap is mobile and at risk of folding over itself further during the surgical process.
During a vitrectomy, the surgeon carefully removes the vitreous gel that is abnormally adherent to the retina. A comprehensive shaving of the vitreous around the tear is vital because it relieves the traction on the retina and minimizes the chances of re-detachment later on. Our retina specialists often take special care during the air-fluid exchange phase a critical step that, while removing the PFCL from the eye, can sometimes lead to posterior retinal slippage. Various techniques such as meticulous drying of the retinal pigment epithelium (the layer below the retina) along the edges of the tear or a direct exchange with silicone oil instead of air are used to minimize this risk.
Long-acting gas tamponades, such as C3F8, are frequently employed following the procedure to keep the retina in place as it heals. However, it is important to note that keeping the gas bubble in the eye typically requires the patient to maintain face-down positioning, which can be challenging. In scenarios where posturing is difficult for a patient, silicone oil may be used as an alternative to provide the necessary support while the eye heals.
Whether to use a scleral buckle during vitrectomy for a giant retinal tear (GRT) remains a topic of debate. Some surgeons avoid it, citing a risk of retinal slippage during air-fluid exchange. Others support its use, arguing that a buckle helps reduce traction at the tear’s edges and adds support around the vitreous base.
When proliferative vitreoretinopathy (PVR) is also present a condition where scar tissue forms and contracts on the retina, the case for using both vitrectomy and a scleral buckle becomes stronger. PVR is a known complication in many GRT cases, especially when the detachment is traumatic or long-standing. In such situations, our retina specialists carefully assess each case to decide whether adding a buckle will improve the surgical outcome.
In patients who still have their natural lens (phakic), surgery must be handled with extra care. Thanks to advances in modern vitreoretinal tools, surgeons can now perform lens-sparing procedures, minimizing the risk of damage to the lens.
Key tools include:
If you suspect you have symptoms of a giant retinal tear, it’s crucial to seek immediate attention from a specialized retina doctor. Practices listed with Specialty Vision offer experienced retina specialists ready to assist you in protecting your vision. Find a top optometrist or ophthalmologist near you today!
Giant retinal tears are a serious vision-threatening condition. Find expert retina specialists listed with Specialty Vision to diagnose and manage your eye health.
