retinal defects. Retinal break. through rupture of the macula

- this is an acquired pathology of the organ of vision, which is accompanied by a violation of the integrity of the retina with a high risk of its further detachment. Clinical manifestations of the disease are photopsia, "flies" or "veil" before the eyes, central or peripheral scotomas. Diagnosis of retinal break is based on the results of ophthalmoscopy, visiometry, tonometry, biomicroscopy, fluorescein angiography, OCT, ultrasound in B-mode. With lamellar rupture, laser coagulation is recommended. An extensive lesion or penetrating macular hole is an indication for vitrectomy.

General information

A retinal tear is a linear or rounded retinal defect that occurs idiopathically or with specific triggers. The first description of a tear in the macula was presented in 1869 by the German ophthalmologist G. Knapp. In 2013, Russian ophthalmologists L. I. Balashevich and Ya. V. Baiborodov described clinical cases of the development of this pathology due to laser radiation. The disease is most common among women. It usually occurs after 60 years of age. Traumatic injuries are the main cause of development at a young age. The peculiarity of retinal rupture is that in 45% of patients, clinical symptoms do not correspond to true changes in the inner lining of the eye. Often this leads to underdiagnosis and late diagnosis.

Causes of retinal tear

The formation of a perforated gap may be due to peripheral retinal dystrophy. At the same time, in the zone of thinning, synechia is formed between the inner shell of the eyeball and the vitreous body. These adhesions can also provoke valvular ruptures. The pathogenesis is based on the penetration of colloidal masses from the vitreous cavity into the space between it and the retina. At the same time, pronounced synechia is a trigger for rupture and subsequent detachment. Violation of the integrity of the inner shell of the eye in the area of ​​the projection of the dentate line provokes eye injuries or iatrogenic damage.

Macular rupture of the retina of traumatic origin occurs when a shock wave passes through the longitudinal size of the eyeball. The etiological factor of this pathology may be non-compliance with medical recommendations in the postoperative period after the treatment of rhegmatogenous detachment. An important role in the mechanism of development of a retinal tear is played by atrophic changes in the area of ​​foveolar photoreceptors, an increase in intraocular pressure, and the formation of an epiretinal membrane. Also, the trigger of this disease is destructive changes in the vitreous body zone and central chorioretinal dystrophy.

Damage to the inner membrane of the eye in the macula appears against the background of early cystic sclerotic degeneration of the macular zone or retinal ischemia. Retinal breaks in the area of ​​the flat part of the ciliary body develop with a closed injury of the eyeball. In this case, the process is often aggravated by local contusion. The occurrence of this pathology is facilitated by increased physical activity, head injuries, psycho-emotional overstrain, increased intraocular pressure, and a history of myopia.

Retinal tear symptoms

There are complete and lamellar retinal breaks. With a complete rupture, damage to all layers of the inner shell of the eyeball occurs, with a lamellar rupture, a partial violation of the integrity of the surface sections is noted. The clinical symptoms of the disease are determined by the degree of involvement of the retinal layers in the pathological process and the localization of damage. In a number of patients, retinal rupture has a latent course for a long time or manifests itself only with increased visual loads. With a unilateral process, pathological symptoms can occur when the healthy eye is closed.

With a complete rupture of the retina, patients complain of the sudden appearance of "flashes of light" before the eyes. This symptom develops due to the tension of the inner shell of the eyeball or irritation of the optic nerve. Lamellar damage only in rare cases leads to the development of photopsies. At the same time, they often appear in a dark room or against the background of emotional overstrain. In most cases, patients cannot specify the exact time of retinal break. In rare cases, the disease is prone to self-regression with subsequent restoration of visual functions.

If the rupture of the retina is accompanied by a posterior detachment or hemorrhage into the vitreous body, patients note the appearance of "flies" or "shroud" before the eyes. Localization of the pathological process in the peripheral parts leads to the appearance of visual field defects. With macular retinal rupture, visual acuity decreases, which is associated with the accumulation of fluid in the subretinal space. Central scotomas occur only when the size of the lesion increases. At the same time, an increase in intraocular pressure provokes atrophy of the optic nerve, which can cause blindness. In the case of an eccentric location of the defect, visual acuity remains within the normal range. Complications of retinal tear: detachment, hyphema, hemophthalmos or optic nerve atrophy.

Retinal tear diagnosis

Diagnosis of retinal rupture is based on anamnestic data, results of ophthalmoscopy, visiometry, tonometry, biomicroscopy, optical coherence tomography (OCT), ultrasound examination (ultrasound) of the eyeball in B-mode. With the help of ophthalmoscopy, it is possible to detect a defect of a round or longitudinal shape with localization in the area of ​​the flat part of the ciliary body, the foveolar zone, or the peripheral parts of the retina. A retinal tear can have a different duration and depth. When penetrating through all layers at the bottom of the damage zone, a violation of the integrity of the pigment epithelium and dystrophic foci in the form of yellow dots are visualized. Along the periphery of the rupture, the retina has edematous edges.

Visiometry is used to determine the degree of visual acuity reduction. With an eccentric gap, visual functions are not impaired. Extensive retinal defects lead to blindness. Attachment of a hyphema or hemophthalmos stimulates an increase in intraocular pressure, which is confirmed by tonometry. Biomicroscopic examination reveals a zone of retinal tear with clear edges. In the subretinal space is determined by the accumulation of fluid. Above the damage zone, connective tissue is revealed, which over time can form a pseudomembrane. With a long course of the disease, cystic changes occur along the periphery of the gap, followed by hyperplasia or retinal atrophy.

With the help of OCT, the zone of retinal tear and changes in the surrounding tissue are visualized. This method makes it possible to determine the extent and depth of the defect, as well as assess the state of the vitreomacular surface. Ultrasound in B-mode allows you to detect a gap, examine the condition of the retina and vitreous body. An auxiliary diagnostic method in ophthalmology is fluorescein angiography, which helps to differentiate retinal tear from choroidal neovascularization.

Retinal tear treatment

Treatment tactics depend on the location, duration and depth of the retinal break. With minor damage to the inner shell or lamellar rupture, patients are recommended to have dynamic observation by an ophthalmologist, since these defects are prone to self-regression. In the absence of signs of regeneration, laser coagulation is performed. During the operation, an argon laser is used, the properties of which lead to a local increase in temperature with further coagulation. The surgery is performed under regional anesthesia. The advantage of this technique is the possibility of exposure to a limited area.

With a complete macular rupture of the retina, vitrectomy is advisable. During endoscopic surgery, three small incisions are made. Through the first incision, fluid is supplied to the eye to maintain intraocular pressure. The second access is necessary to provide lighting. The third incision is used to perform surgical procedures. Under multiple magnification, the vitreous membrane is removed using vacuum tweezers. At the final stage of the operation, the damaged area of ​​the retina is fixed with perfluorodecalin or other artificial polymers. This method avoids iatrogenic traction retinal detachment and restores visual acuity to some extent.

Forecast and prevention

Specific prevention of retinal tear has not been developed. Non-specific preventive measures are reduced to compliance with safety rules at work when working with materials that require the wearing of goggles or helmets. The prognosis for life and work capacity for retinal rupture depends on the extent of the lesion. With minor damage to the inner shell of the eyeball, independent regression is possible. Patients with this type of damage should be observed by an ophthalmologist. Timely diagnosis and treatment of other forms provide a favorable prognosis. In the absence of adequate therapy, there is a high risk of developing blindness and further disability of the patient.

In the process of life, a person receives strong loads on the eyes, as a result of which visual defects occur. Visual defects or refractive errors are optical disturbances affecting the human eye that prevent light rays from reaching the retina. The most common visual anomalies are defects in the retina and lens.

Causes of violations

Disorders of visual functions are a consequence of hereditary, congenital or acquired causes. Genetic pathologies of the organs of vision are transmitted between generations and are the least studied. In modern medicine, preventive methods for eliminating hereditary deficiencies have not been developed.

Congenital anomalies provoke certain factors that affect the intrauterine development of the fetus, for example:

• problems with the development of the visual system as a result of somatic weakening of the fetus;
• genetic defects;
• the occurrence of retinopathy in the process of premature birth;
• infectious diseases of the mother during pregnancy;
• trauma during childbirth;
• the use of antibiotics;
• bad habits of the mother during pregnancy (smoking, alcohol, drugs).

To prevent visual impairment, reading lovers must keep a distance of 40-45 cm from the book to the eyes.

Acquired defects of the visual system in a person occur in the process of his life. These shortcomings arise under the influence of external causes, such as:

• tension of the muscles and nerves of the organ of vision as a result of mental activity;
• poor lighting of the room;
• long work at the computer;
• smoking and drinking alcohol;
• wrong position while reading;
• eye injury;
• stress;
• lack of minerals due to insufficient or malnutrition;
• abuse of watching TV;
• retinal changes with age.

Types and symptoms

retinal defects

• Daltonism. In most cases, this is a hereditary disease, as a result of which a person has an inability to distinguish certain colors. Most often it is red, green or blue.
• Scotoma. In this condition, there are areas of confusion in the visual field that are perceived as a dark spot at the edge of the eye that interferes with peripheral vision. The disorder is mainly characterized by one or more dark, light or blurry areas.

lens defects

farsightedness

A common vision problem affecting about a quarter of the population. It occurs when light rays are focused behind the retina rather than directly on it. People with farsightedness can see distant objects very well, but it is difficult for them to focus on objects that are near. Farsighted people complain of headaches or eye strain. The eye in children is slightly compressed horizontally, so many are already born farsighted. As the eyeball lengthens as it grows, the child's vision improves.

With such a pathology in humans, the focal point does not reach the retina, but is located in front of it.

Occurs when light rays are focused at a point in front of the retina rather than on its surface. It is difficult for myopic people to read road signs and see distant objects clearly, as images in the distance appear blurry. Other signs include strabismus, eye strain, and headaches. Feeling tired while driving or playing sports can also be a symptom of nearsightedness.

Astigmatism

Like nearsightedness and farsightedness, astigmatism is a refractive error. This is not an eye disease, but simply a problem with how the eye focuses light. With astigmatism, light cannot come to a single focus on the retina to produce clear vision. Instead, multiple focus points appear either in front of the retina or behind. The affliction usually causes vision to be blurred or distorted to some degree at all distances. Symptoms of uncorrected astigmatism are eye strain and headaches, especially after reading or other long visual tasks. Squinting is also a very common symptom.

Rupture of the retina in ophthalmology is considered one of the most severe conditions. Pathological changes in this element of the eye can lead to complete loss of vision, so it is important to respond to the symptoms in time.

Anatomical structure of the eyeball

The retina (retina) is the thinnest membrane of the eye, which serves to convert light rays into nerve impulses. The retina is called the primary analyzer of the optic nerve. This element of the eye is 0.3-0.6 mm in the thinnest part.

To understand the causes of a retinal tear, one must first study the anatomy of the eye. The human eyeball is spherical.

Shells of the eye:

1. The outer fibrous membrane consists of the stratum corneum and the sclera.
2. The middle vascular (choroid) includes the iris, the ciliary body, and the collection of vessels.
3. The inner shell is called the retina, it is responsible for converting light energy into impulses.

In front of the retina is a gel-like substance that fills the chamber of the eye. From the outer shell, impulses are transmitted along the neural circuit to the cerebral cortex. In the area of ​​the optic nerve, the retina connects with nerve fibers.

The retina lines the eyeball and is adjacent to the choroid, from which it receives substances for normal functioning. Therefore, the vessels of the eye shine through the retina and create a red reflex. The retina is fed from the central artery and vessels from the choroid.

The retina was fixed only in two places: near the optic disc and on the dentate line to the equator of the eye. The rest of the retina is held by the pressure of the vitreous body without fusion.

The macula or yellow spot is located in the center of the retina. This area includes the fovea and fovea, where photoreceptors are concentrated and there are no vessels. The dimple helps to perceive colors and provides visual acuity. The macula gives a person the ability to read, and images that are focused in this area are seen clearly.

What causes retinal tear

The retina is a very complex structure that includes ten layers. One of the layers contains photoreceptors (rods and cones) responsible for daytime and twilight vision. Often, retinal rupture occurs due to a violation of its structure and surrounding tissues.

Common causes of retinal tear:

1. . This phenomenon leads to the appearance of perforated discontinuities. Dystrophic damage to the retina leads to a violation of the integrity of the periphery of the visual analyzer. This can occur for various primary and secondary reasons, not necessarily ophthalmic.
2. Fusion of the retina with the vitreous body. Rupture of the retina occurs in areas that cannot withstand sudden movements: when the position of the vitreous body changes, it pulls the retina along with it at the fusion sites. This phenomenon is called valve rupture.
3. Severe injury to the eyes or body. Even in a normal eye condition, the retina can still tear. This occurs during strong shaking, when the layer is torn in the area of ​​contact with the jagged line. A blow that can break a healthy retina is typical for accidents, falls from a great height, and industrial situations.

When the fusion of the vitreous and retina occurs to the macula, valve ruptures occur, but in this area they are much more dangerous. In this case, urgent treatment is required, otherwise the patient may quickly and permanently lose sight.

Symptoms of a retinal tear

The danger of this phenomenon lies in the fact that at first it does not manifest itself in any way or gives minor symptoms that are rarely paid attention to. If there is even one mild symptom, you should immediately contact an ophthalmologist.

Signs of a retinal tear:

1. Small flashes before the eyes that resemble lightning strikes. The symptom is aggravated by poor lighting.
2. The presence of flickering dark dots, lines and spots.
3. Sudden decrease in visual acuity.
4. Blurring of objects, regardless of the distance from the location.
5. Film effect on the eyes.
6. The appearance of dark spots that obscure the field of view. Usually the spot is one, but can have different sizes and be located anywhere. The growth of this spot indicates an increase in the gap.

Such symptoms may indicate a retinal tear or even the initial stage of retinal detachment. It is noteworthy that most often discomfort occurs already with detachment, since the gap does not have specific symptoms.

The appearance of a black area in the field of view indicates that the process of peeling off the retina has begun. In the blind area, the visual cells have already lost the ability to transmit information to the brain. The longer the retina flakes off, the less chance there is to restore visual function.

Consequences of rupture of the retina

The most dangerous consequence of a rupture of the retina can be considered its detachment. In this case, the contact between the retina and the choroid that feeds it is lost. Without communication with the blood vessels, the retina quickly dies, so in the absence of urgent treatment, you can become irrevocably blind.

As one of the severe complications of rupture, retinal scarring can be distinguished. This is fraught with contraction of the shell to the point of the defect, which increases the risk of detachment of healthy areas. In the presence of a rupture, bleeding often occurs. In this case, a hematoma begins to form, which provokes peeling of the retina throughout its entire length.

When there are signs of retinal tear or detachment, you should immediately seek help. Such phenomena require urgent treatment, otherwise loss of vision will inevitably occur. When choosing therapy for a rupture, the doctor must take into account the stage and type of the pathological process.

Diagnosis of rupture and retinal detachment

Timely diagnosis and treatment of the rupture increase the chances of retinal restoration and preservation of vision. Chronic defects are treated with difficulty, even operations are often ineffective.

You can confirm a retinal tear with the help of biomicroscopy (examination of the fundus with a slit lamp), sonography and ultrasound of the eyes. After establishing the diagnosis, the doctor specifies the localization of the defect, as well as its size and prescription. These indicators will determine the method of treatment.

Early diagnosis of a retinal tear is difficult, but is of paramount importance. In the process of examining a patient, they usually resort to the following methods:

• visometry (measurement of visual acuity);
• ophthalmoscopy (examination of the fundus of the eye);
• perimetry (study of visual fields);
• biomicroscopy (assessment of the anterior segment of the eyeball);
• (measurement of intraocular pressure);
• definition of entoptic phenomena.

If necessary, also appoint:

• ultrasound scanning in B-mode;
• laboratory tests.

Ophthalmoscopy should be of great importance in diagnosing a rupture. It will show the detachment, if any, and will allow you to assess the extent of the defect, assess the condition of the macula and find the rupture sites. It is recommended to combine fundus examination techniques in order to obtain all information about the state of the retina. Multiple fundus examinations can detect a retinal tear and choose a treatment technique.

It is also worth doing research on entoptic phenomena. They help to determine the presence of detachment with clouding of the lens or hemorrhage into the vitreous body (conditions in which it is impossible to study the fundus). In these cases, ultrasound in B-mode is also prescribed.

If a detachment is suspected, electrophysiological tests are sometimes prescribed to assess the functionality of the retina. Laboratory tests are needed before surgery (blood and urine tests, testing for HIV, hepatitis and syphilis, x-rays of the chest and nose). Before the operation, you must also obtain permission from the therapist, dentist and otolaryngologist.

In the case of rapid progression of detachment, emergency hospitalization of the patient is necessary due to the risk of damage to the macular area. Hospitalization does not require all the tests, a blood test is enough. This increases the risk of complications, but will speed up the operation.

Surgical repair of retinal tear

When a retinal tear is not accompanied by detachment, laser coagulation is most often recommended to correct the pathology. During the operation, the defective area is isolated and the spread of the rupture is blocked, especially to intact areas. Cryosurgical therapy works similarly, only the procedure uses not a high-temperature laser, but low temperatures.

If the retinal tear is combined with detachment, surgical restriction is ineffective, especially when the defect is located in the macula. Complicated damage requires additional pressure on the retina during surgery.

A similar effect can be achieved using . This procedure involves replacing the vitreous body with "heavy water". The substance helps to press the retina against the choroid. A similar procedure is filling the sclera with a silicone sponge. Patients with a retinal tear, even after treatment, should be regularly examined by an ophthalmologist, because this pathology often recurs.

The coagulation procedure is performed for retinal dystrophy, as well as vascular defects that are caused by the development of a tumor. The operation helps to prevent retinal detachment and stop dystrophy of the fundus.

Surgical treatment is the only true one for rupture of the retina. Laser photocoagulation is an outpatient procedure for which local anesthesia is sufficient. It takes about 20 minutes, and after the examination, the patient can go home. The operation is safe for people of all ages, does not harm the cardiovascular and other systems.

The treatment involves the use of a laser that raises the temperature of the tissues and causes them to coagulate (clotting). This principle ensures the bloodlessness of the operation.

A high-precision laser is used in the treatment of a retinal tear. It creates adhesions between this and the choroid, and a special lens is inserted into the eye to filter the radiation. The progress of the operation is monitored through a microscope.

Advantages of laser coagulation:

• no need to open the eyeball;
• bloodlessness, respectively, prevention of infection;
• local drip anesthesia;
• efficiency;
• fast recovery.

Cryocoagulation of retinal tear

Cryotherapy of the retina allows you to create a chorioretinal focus using low temperatures. The result of the treatment has the same properties as laser coagulation.

Cricoagulation is performed on an outpatient basis using local drip anesthesia. The procedure is carried out with a cryoapplicator, which allows you to influence the oval areas (6 by 2 mm). First, the applicator is immersed in liquid nitrogen (-196°C).

Ultra-low temperatures during the operation of the organs of vision provide good penetrating power. Cryotherapy does not affect muscle fibers and sclera.

Vitrectomy for retinal detachment

Vitrectomy is a microsurgical operation that involves the removal of the vitreous body of the eyeball. The indications for surgery are such pathologies: tension, retinal detachment or rupture, hemorrhage and visual impairment provoked by it, the presence of a foreign body, trauma, vitreous opacity, proliferative.

Vitrectomy involves the gradual removal of the vitreous body using the finest instruments. After removal of the element, laser endocoagulation of the retina is most often additionally performed. The doctor removes fibrous and scar tissue, straightens the retina and removes the resulting holes. To restore pressure in the eye, a balanced saline solution, silicone gas, or oil is injected instead of the vitreous.

Only an experienced ophthalmologist can trust vitrectomy. It is desirable that the doctor specializes in microsurgical treatment of the retina.

Often the operation is done on an outpatient basis, although sometimes the patient still needs to be hospitalized. The procedure usually takes 1-3 hours under local or general anesthesia. After a vitrectomy, it takes some time to keep the head in a certain position, but in general, rehabilitation does not require much effort.

Possible complications:

• increased intraocular pressure;
• prolonged bleeding;
• corneal edema;
• recurrence of detachment;
• eye infection.

Vitrectomy is often the only way to preserve vision in case of retinal rupture and detachment. The operation allows you to stop the spread of pathology and even restore visual function during traction detachment. However, this method will be effective only if the defect has not touched the macula and central vision has been preserved.

This is a penetrating retinal defect of a linear or rounded shape that occurs idiopathically or against the background of provoking factors. Most often localized on the periphery of the retina, but can occur anywhere else. A retinal tear is harmless in most cases. Serious vision problems occur when the retina detaches, which can follow its rupture.

This pathology is classified depending on the location, causes, forms and size. Modern ophthalmology distinguishes the following types of it:

Perforated (atrophic)

Basically, these are small rounded formations that can be characterized as holes. The retina together with the defect is not soldered to the vitreous body, and the pathology itself occurs due to dystrophic changes in it. The most common are two types of dystrophies: lattice peripheral and "snail track".

Valve

Horseshoe valvular rupture - outwardly resembles a horseshoe, opening to the front of the eye. Adhesion of pathogenic areas of the retina with the vitreous body and their subsequent displacement relative to each other form a tear, functionally resembling a valve.

The gap with the "lid" differs from the horseshoe in that part of the retina is almost completely separated from the total surface of the retina. The process is caused by detachment of the vitreous body area, to which the affected fragment of the retina is soldered.

In the case of a rupture with a "cap", the retina is almost completely separated from the total surface of the retina.

Retinal dialysis - dentate line tear

Linear detachment of the retina from the flat part of the ciliary body. Occurs as a result of traumatic injuries of the eyes, traumatic brain injury or surgery. Most often localized in the lower temporal or upper nasal quadrant of the eyeball.

macular hole

Fovela defect - the central region of the retina of the eyeball. Usually small in size, round or elliptical in shape, outwardly resembles a hole. It happens through, when all layers of the retina are damaged and incomplete (lamellar). Common in people over 50, more common in women than men. More than 80% of cases are idiopathic in nature. The main causes of appearance: age-related changes, myopia, eye injuries, laser coagulation, surgery. Of all types of damage to the retina, this pathology is considered the most dangerous and requires complex therapeutic procedures, including surgery.

Depending on the pathogenesis, the following types of macular holes are distinguished:

• Traumatic. Occurs as a result of blunt trauma (contusion) of the eyeball.
• Myopic. Progressive myopia in severe form can provoke an incomplete (laminar) retinal tear. Without timely treatment, the pathology develops into a through macular hole.
• Postoperative. Operations on the eyeball, which are performed to eliminate retinal detachment (including laser photocoagulation) or epiretinal membrane (ERM) can cause tears in the macula of the eyeball. According to statistics, this side effect is observed in no more than 1% of operated patients.

Macular rupture is considered the most dangerous and requires complex therapeutic procedures.

Symptoms and signs of retinal tears

Small gaps may not manifest themselves in any way. As a result, the patient does not seek help until his condition worsens. Such asymptomatic ruptures can be detected, their number and area can be determined only during an examination of the fundus by an ophthalmologist. The most common diagnosis of a tear is through slit-lamp examination or an aspherical lens.

If the gap is extensive or accompanied by complications, the following signs can be observed:

• Light flashes, lightning (photopsies). Usually observed in the absence of lighting or its lack. This symptom is caused by stretching of the fundus due to traction interactions between the vitreous and retina. The cause of photopsias can only be a through gap, with lamellar ones, such effects are not observed.
• The appearance of flies in the field of view indicates a possible intraocular hemorrhage caused by damage to the blood vessel at the site of the rupture of the retina. Another reason for this symptom is the stratification of the vitreous body in the affected area.
• The distortion of the details of the surrounding space, as well as the narrowing of the field of view, indicates the localization of damage in the peripheral region of the eyeball (macular hole). In addition, there may be a noticeable deterioration in vision.
• A specific veil before the eyes. The appearance of this symptom indicates the beginning of the process of detachment of the retina. If a retinal tear has led to its detachment, timely seeking qualified help determines whether this will seriously affect visual function in the future. Delay threatens the patient with a complete loss of visual abilities.

Symptoms of retinal tear, disappearing after sleep, return when awake.

Retinal tear symptoms may disappear for no apparent reason after a night's sleep. This effect is explained by a long stay in a horizontal position, during which the retina takes its natural anatomical shape. All symptoms reappear after some time of wakefulness.

Causes of retinal tear

Factors that can aggravate the overall clinical picture of the pathology and provoke subsequent detachment of the retina:

• Physical overexertion, heavy lifting;
• Mechanical damage to the eyeball;
• Prolonged stressful conditions;
• High blood pressure, hypertension in the acute phase (crisis);
• Age-related changes in the body after 50 years;
• Sudden movements - jumping, tilting;
• Pregnancy;
• Diabetes mellitus negatively affects the condition of the walls of blood vessels and other tissues of the retina, making it more susceptible to mechanical damage;
• Myopia in severe form is accompanied by deformation of the vitreous body, which contributes to the occurrence of retinal tears;
• Intraocular infections, viral inflammations;
• Tumor formations in the eyeball or in its immediate vicinity.

Diabetes can cause retinal tear.

Treatment

Treatment of a retinal tear depends on the depth of its lesion, the location and size of the pathology. If minor damage is found, it is enough to visit an ophthalmologist periodically, since such defects can regenerate on their own without additional treatment.

If the pathology is not prone to regression, it is possible to perform laser coagulation or cryopexy. These two methods are quite enough to eliminate uncomplicated tears of small and medium sizes, stop their increase and prevent retinal detachment.

When a macular hole is detected, vitrectomy is indicated. If the diagnosis is confirmed, therapeutic measures should be started immediately, otherwise the patient may spend the rest of his life in total blindness.

Treatment of a retinal tear involves exclusively surgical methods to eliminate the pathology. Any traditional medicine and attempts at self-treatment, at best, will not bring any result.

Laser coagulation allows you to achieve local fusion of the choroid and retina.

retinal surgery

Modern eye microsurgery uses the following options for surgical treatment:

• Laser coagulation. Influencing the retina with coagulant lasers, numerous microburns are created on it, through which local fusion of the choroid and retina is achieved. The procedure is carried out within 20-30 minutes, without anesthesia, under local anesthesia. Does not require subsequent rehabilitation therapy in the clinic.
• Cryopexy. The method is similar to laser coagulation, with the only difference being that the retinal adhesion is carried out using ultra-low temperatures. This option is used in cases where there is an opacity of the optical medium, the pupil diameter is insufficient for laser therapy, if the rupture is localized in the equatorial region of the eyeball, with serrated ruptures.

Surgery to rupture the retina of the eye in its foveal region. It is a very complicated procedure, demanding for the equipment and qualification of the personnel. It is indicated for macular ruptures, retinal detachment, post-traumatic conditions of the eyeball.

Vitrectomy is performed under local anesthesia.

Before the operation, a preliminary planned hospitalization is preferable, but as an exception, outpatient treatment is allowed. The essence of the procedure is the complete or partial removal of the vitreous body. After removal, the necessary manipulations are carried out to eliminate retinal defects (laser therapy, sealing and restoration of the retina).

Instead of the removed vitreous body, a special mixture is pumped into the eye cavity, the purpose of which is to ensure a snug fit of the retina to the vascular layer of the fundus. The duration of the procedure does not exceed 3 hours. Local anesthesia is used as painkillers, it is also possible to use parenteral anesthetics.

Recovery period after surgery

After the operation, a bandage is applied to the eye, which can only be removed the next day in the presence of a doctor. During some manipulations, gas tamponade is introduced into the eye cavity, which can significantly worsen vision. This process is temporary, and if there are no complications, then after 2 weeks the vision will return to normal.

If symptoms such as flashes of light, flies, veil before the eyes, severe pain in the operated area, sudden deterioration in vision appear, you should immediately contact your doctor.

The patient's actions in the postoperative period depend on the treatment performed and must comply with the recommendations of the ophthalmologist.

If the condition worsens after treatment, consult a doctor.

Prevention

There is no specially designed prevention of retinal tears. The following preventive measures will help reduce the likelihood of this pathology and protect against undesirable consequences:

• Avoid excessive physical stress.
• Do not expose your eyes to prolonged stress (sitting at a PC, reading).
• Avoid harmful effects on the eyes (exposure to direct sunlight, welding, strong wind, snow, sand).
• People suffering from hypertension and diabetes should constantly monitor the readings of pressure and blood composition.
• Take good care of your eyes. Observe basic safety rules, if necessary, use protective equipment.
• Lead a healthy lifestyle, observe sleep and nutrition.

Understanding what a retinal tear is, it is much easier to make the right decision for its timely elimination. Postponing a visit to an ophthalmologist, self-treatment attempts lead to the fact that there is a need for complex expensive treatment, not to mention the risk of permanent loss of vision.

Nov 20, 2017 Anastasia Tabalina

There is a macular rupture of the retina with a lack of vitamins, anomalies in the development of the eye, as well as after surgery or injury. In this case, a hole appears in the fundus of the eye, more often this happens in the central region and threatens with complete or partial loss of vision. Such damage disrupts the molecular layer of the macula, which is responsible for color perception.

Treatment of pathology is to perform surgical intervention.

Reasons for development

To provoke a rupture of the macula of the eye can be the impact on the human body of such factors:

Pathology develops against the background of mechanical damage to the eyeball.

• traumatic injury;
• myopia of a high degree;
• jumps in blood pressure;
• stress;
• overwork;
• lack of sleep;
• significant physical activity;
• consequences of surgical intervention;
• inflammatory diseases of the eye;
• congenital anatomical features of the eyeball;
• advanced age;
• smoking;
• alcohol consumption;
• malnutrition;
• lack of vitamins and minerals;
• exposure to ultraviolet radiation;
• diabetes;
• atherosclerosis;
• angiosclerotic changes;
• increased intraocular pressure.

Retinal damage occurs when the eyeball is exposed to various factors. Most often, the pathology is caused by trauma, the result of an unsuccessful surgical intervention, or a lack of vitamins and minerals. Macular tear can also be idiopathic, that is, occur for unknown reasons. In children, the disease is caused by congenital structural features of the eye.

Main symptoms

The image becomes fuzzy and blurry.

Macular retinal break causes the development of such clinical signs in a person:

• Pain in the eyes;
• blurred vision;
• changing the contours of objects;
• distortion of the surrounding world;
• inability to perform small actions;
• inability to read;
• a gray spot in front of the eyes or a scotoma area;
• violation of the perception of colors;
• irritability when exposed to bright light;
• lacrimation.

Rupture of the choroid and macula can be completely asymptomatic. In this case, the person does not have any manifestations of pathology. During damage, there is a disruption of the molecular relationship between the various layers and photosensitive cells. A hole in the retina can be through and incomplete. In this case, the tear is called laminar and affects only a few layers of the macula. In the place where the hole is located, a person loses the ability to see and a dark zone or scotoma appears.

Complications

A penetrating or lamellar retinal tear without the necessary treatment leads to complete loss of vision. Sometimes pathology provokes the occurrence of a loss of a portion of the visual field. The patient also complains of headache, dizziness and loss of consciousness. In addition, the patient is worried about the flickering of flies and the appearance of lightning before the eyes. Retinal tears as a result of trauma are very dangerous, as they can cause massive hemorrhage in the tissue of the eyeball.

How is the diagnosis carried out?

It is possible to suspect that a macular hole has formed by the presence of clinical signs characteristic of this pathology in a patient. In addition, patients are advised to conduct an ophthalmoscopic examination, with the help of which it is possible to visualize the state of the fundus and the formations located on it. It is important to examine the volumes of the visual fields and perform an ultrasound diagnosis of the eyeball. In a comprehensive study, magnetic resonance and computed tomography are shown. They give a general and biochemical blood test. The approach to the treatment of macular retinal rupture should be comprehensive and include the use of medications, surgical manipulations and alternative methods of exposure. This guarantees a positive effect of the treatment and a quick recovery of visual function. Surgical intervention will help to cure the pathology. For this purpose, the most commonly used method is cryosurgery and photocoagulation, which help to strengthen the edges of torn tissues in the right place in the fundus and at the same time minimize further damage and scarring. Drug treatment is used as a symptomatic therapy and is used in the postoperative period. The effectiveness of therapy depends on the speed of assistance, which should be provided in the first hours after the macular hole has occurred.