Retinal Tears:
Caught Early, Sealed
With Laser

A retinal tear is a break in the retina, the thin light-sensitive layer that lines the inside of the eye. Most tears form when the vitreous, the gel that fills the eye, separates from the retina with age and pulls hard enough at a point of firm attachment to rip it. The tear itself does not blind anyone. The danger is what it allows to happen next. Fluid inside the eye can pass through the break, lift the surrounding retina off the wall of the eye, and turn a small tear into a retinal detachment, which is a surgical emergency.

Around 30 to 50% of untreated symptomatic tears progress to retinal detachment, and progression can happen within days. Laser treatment reduces that risk to under 5%. Few situations in ophthalmology reward early attention this heavily, and it is why I treat symptomatic tears urgently, usually at the same clinic visit where I find them.

How a tear becomes a detachment

From around age 50, the vitreous gel liquefies and eventually peels away from the retina. This is a posterior vitreous detachment (PVD), and it is the event behind the classic symptoms of new floaters and flashes of light. Most PVDs complete without harm. In around 10 to 15% of symptomatic cases, however, the separating vitreous tears the retina at a point where it is unusually adherent or thin.

Once a tear exists, the same vitreous traction that created it tends to hold it open. Liquefied vitreous fluid then tracks through the break and dissects under the retina. At that point the problem is no longer a tear but an advancing detachment, and the treatment changes from a 15-minute clinic laser to surgery in an operating theatre.

Warning signs

Retinal tears do not cause pain. They announce themselves through symptoms of the vitreous pulling on the retina, and these warrant a dilated examination within 24 hours.

Not every patient with floaters and flashes has a tear. Most have an uncomplicated PVD, which needs no treatment. The difficulty is that the two are indistinguishable by symptoms alone, and a tear can hide in the far periphery of a comfortable, well-seeing eye. This is why the examination matters more than the symptom severity. My guide to eye floaters covers the benign end of this spectrum in detail.

Who is at risk

Anyone can develop a retinal tear during PVD, but the risk is not evenly distributed.

• High myopia: longer, more stretched eyes develop PVD earlier and have thinner peripheral retina. Tears occur at younger ages, sometimes in the 20s and 30s
• Age 50 to 70: the peak years for posterior vitreous detachment
• Lattice degeneration: patches of peripheral retinal thinning, present in around 8 to 10% of the population, where tears preferentially form
• Previous cataract surgery: PVD is accelerated after lens surgery, and tear risk rises accordingly
• A tear or detachment in the other eye: the fellow eye carries a substantially higher lifetime risk and needs periodic examination
• Family history: a first-degree relative with retinal detachment increases personal risk
• Blunt eye trauma: injury can tear the retina directly, at any age

How I diagnose a tear

A retinal tear cannot be excluded by checking vision or looking at the front of the eye. The essential examination is a dilated fundus examination of the entire retina, out to the far periphery where most tears form. In my clinic this includes indirect ophthalmoscopy, examination with a widefield contact lens at the slit lamp, and scleral indentation where needed to view the extreme periphery.

I also perform widefield fundus photography on the ZEISS CLARUS in most cases. It documents the tear precisely, helps me plan the laser, and gives you an image you can actually see and understand. If bleeding in the vitreous obscures the view, ultrasound is used to check whether the retina behind it is attached.

Laser retinopexy: what actually happens

Laser retinopexy is an outpatient clinic procedure. There is no admission, no incision and no needle. The laser creates rows of small burns around the tear, and each burn matures into a scar that bonds the retina to the tissue beneath, like spot-welding around a crack. The tear itself is not closed. It is fenced off, so fluid can no longer pass under the surrounding retina.

After treatment

The two most common questions I am asked after laser are about floaters and about flying. The floaters remain. Laser prevents detachment, but it does not remove the vitreous changes that cause floaters, which usually fade from awareness over weeks to months. And flying is fine. No gas is used in laser retinopexy, so there is no altitude restriction, unlike after retinal detachment surgery.

I review patients one to two weeks after treatment to confirm the adhesion is forming, then over the following months. The fellow eye is examined too, since it carries a higher risk once one eye has torn. Between visits, the rule is simple, and I ask every patient to remember it.

Frequently asked questions

How quickly must a retinal tear be treated?

A symptomatic retinal tear should be treated promptly, ideally within 24 to 48 hours of diagnosis. Around 30 to 50% of untreated symptomatic tears progress to retinal detachment, and progression can occur within days. Laser treatment reduces that risk to under 5%. When I find a symptomatic tear in clinic, I usually treat it at the same visit.

Does laser treatment for a retinal tear hurt?

Most patients tolerate laser retinopexy well. Anaesthetic drops numb the surface of the eye, and the procedure takes about 10 to 20 minutes. You will see bright flashes of light, and some patients feel brief aching or pressure with individual laser pulses, particularly for tears located far in the periphery. No injections or incisions are involved.

Can a retinal tear heal on its own?

A retinal tear does not close on its own. Some small, asymptomatic tears found on routine examination develop a natural line of pigment around them and can simply be monitored. A tear causing new floaters or flashes is a different situation. The vitreous is still pulling on the retina, and treatment is recommended to prevent progression to retinal detachment.

Will my floaters go away after laser treatment?

No. Laser retinopexy seals the tear to prevent retinal detachment, but it does not remove floaters, which are caused by changes in the vitreous gel. Floaters usually become less noticeable over weeks to months as the brain adapts. A sudden increase in floaters after treatment is not expected and should be reviewed promptly.

Can I fly after laser treatment for a retinal tear?

Yes. Laser retinopexy does not involve a gas bubble, so there is no restriction on air travel. This is different from retinal detachment surgery, where flying is prohibited until any intraocular gas has fully absorbed. If you have travel planned soon after treatment, tell your surgeon so follow-up can be arranged around it.

How much does retinal tear laser treatment cost in Singapore?

Laser retinopexy is an outpatient clinic procedure and costs considerably less than retinal detachment surgery in an operating theatre. The exact fee depends on the number and extent of tears treated. Consultation and procedure fees are set out on my fees page, and MediSave and Integrated Shield plan coverage may apply depending on your policy. See also the insurance guide.

What happens if a retinal tear has already caused a detachment?

Once fluid has passed through the tear and lifted the surrounding retina, laser alone is no longer sufficient and surgery is required, either vitrectomy, scleral buckling, or both. Retinal detachment is a surgical emergency. If a shadow or curtain has appeared in your vision, seek same-day assessment. My retinal detachment guide covers the surgery and recovery in full.

Do I need follow-up after laser retinopexy?

Yes. I review patients one to two weeks after treatment to confirm the laser adhesion is forming well, then again over the following months. The fellow eye is also examined, because patients who develop a tear in one eye carry a higher risk in the other. New floaters, flashes, or a shadow at any point warrant immediate review rather than waiting for the next appointment.