11.1 Features
Retinal breaks are any full thickness disruption in the sensory retina providing a conduit for fluid to enter the potential space between the sensory retina and retinal pigment epithelium (RPE). Sometimes retinal holes and tears are asymptomatic; however, the sudden appearance of flashes and floaters may indicate a hole or tear. The most common cause of retinal tears is vitreous detachment/separation from the retinal surface.
11.1.1 Common Symptoms
Photopsias, floaters, and shade/curtain over central vision if progression to retinal detachment.
11.1.2 Exam Findings
Pigment in the anterior vitreous, also known as tobacco dust or Shafer’s sign, is a strong indicator of a potential retinal break (i.e., approximately 90%, ▶ Fig. 11.1). Posterior vitreous detachment with or without vitreous hemorrhage (VH) is often present and is generally identified by the presence of a Weiss ring. Bridging vessel involvement at the area of the tear can result in VH (▶ Fig. 11.2a). Horseshoe/flap retinal tears have a base toward vitreous base and apex of flap points toward posterior pole (▶ Fig. 11.2a). For round holes with operculum, traction with or without subretinal fluid (SRF) may remain on the edges of the hole despite operculum (▶ Fig. 11.2b). An increase in pigmentation suggests chronicity. Atrophic breaks with/without lattice may have minimal traction (▶ Fig. 11.2c). Retinal dialysis is associated with retinal trauma and represents the separation of the sensory retina from the RPE occurs at the ora serrata, most commonly inferior temporal in the eye (▶ Fig. 11.2d).
Fig. 11.1 Slit-lamp photograph demonstrating Shafer sign with pigment in anterior vitreous noted with the slit beam focused behind the intraocular lens.
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