Retinal tears

Retinal tears are a common diagnosis that we see in our practice.  Patients often wonder when they have flashes and floaters whether they have a retinal tear or detachment.  Many have researched these symptoms on the internet and see the words "retinal tear" and "retinal detachment" and, understandably, become concerned.

The retina is the inner lining of the back wall of the eye.  It is a 9 layered structure that "takes the picture" and sends it to the brain by way of the optic nerve.  The vitreous is a gel layer made up of collagen and other proteins as well as water that is between the lens, the focusing system of the eye, and the retina.  The vitreous is attached at the optic nerve, the macula, and the entire peripheral retina.  As we age, our vitreous becomes less gel-like and more liquid.  When this occurs, it begins to separate from the retina in stages.  When it separates from the peripheral retina, it can cause a retinal tear or hole.

Retinal holes and tears can have many symptoms.  Flashes and floaters are common with a benign vitreous detachment as well as a more serious retinal tear.  That is why we recommend patients with new flashes and floaters be evaluated by an eye care professional.  Some retinal tears have no symptoms and are discovered on routine exam.

A retinal tear is a serious condition because it can lead to a retinal detachment.  A retinal detachment occurs when the fluid of the vitreous tracks underneath the layers of the retina through the tear.

If a retinal tear is discovered, often it can be treated before it leads to a detachment.  The treatment involves a "welding" process where either laser or freezing is placed around the tear to "glue" it in place.  This is not a guaranteed fix because the tear can sometimes pull through the treatment and evolve into a detachment, but is often very successful.

If you have symptoms of a retinal tear please consult an eye care professional.

This blog is for informational purposes only and is not intended to be medical advice. Please consult an eye care professional for medical advice.

Fluoroquinolones and retinal detachment?

A recent patient brought to mind the possible link between fluorquinolone antibiotics (ciprofloxacin, moxifloxacin, levofloxacin, etc) and the risk of retinal tears or detachments.  Fluoroquinolones are one of the most often prescribed antibiotics, and if there is such a risk, could affect a large number of people.

An article posted in JAMA in April 2012 revealed a possible link between these antibiotics and retinal detachments.  The article was a case control study of 989,591 patients who took the antibiotic between 2000-2007. 4384 patients had experienced a retinal detachment. Statistically, current use of fluoroquinolones carried a higher risk of retinal detachment but recent use and past use did not.

This article does not prove that fluorquinolones were the cause of the detachments, but merely suggests that there might be a correlation.  The proposed mechanism is that the drug may have a destructive effect on collagen and connective tissue. In fact, there is a known risk between fluoroquinolone use and tendon rupture. Since the vitreous contains collagen, this could be the mechanism that leads to the increased risk of retinal detachment or tears.

So, what is the take home message of this possible risk? As a patient, be aware that there is a theoretical risk of retinal detachments with the use of this drug.  If you are a prescriber, educate your patients about the signs of retinal tears and detachment such as flashes and floaters.  If you are currently using a fluorquinolone antibiotic and experience flashes, floaters, or other symptoms of a retinal detachment, you should contact your physician and an eye care professional.  They will perform an dilated exam to look for retinal pathology.

This blog post is for informational purposes only.  It is not intended to medical advice. Please seek the advice of a qualified professional.

Flashes and Floaters

One of the most common complaints our patients have is flashes and/or floaters.  There are many reasons for these symptoms, but the most common is a posterior vitreous detachment or PVD.

The vitreous humor lies between the lens and the retina.  Early in life, the vitreous is a jelly-like substance.  With age, the jelly-like substance begins to liquefy.  This causes vitreous syneresis, one cause of vitreous floaters.

The vitreous is attached to the retina at the optic nerve, the macula, and the peripheral retina.  During the liquefication process, the vitreous begins to pull on the retina.  The pulling, or traction, on the retina creates flashing which is usually seen by the patient as a bright arc in the temporal visual field.

When the vitreous pulls away from the retina, it is known as a posterior vitreous detachment.  Usually this occurs without any consequences for the patient except for pesky floaters.  However, it can lead to a retinal tear or detachment. Retinal tears and detachments can be treated but should be addressed quickly. Therefore, we recommend that all patients with new floaters should be seen by an Optometrist or Ophthalmologist.


This post is for informational purposes. It does not constitute medical advice.  Please seek the advice of a qualified medical professional.


Please visit us at www.ncretina.com