If you’re of a certain age and grew up in the United States, the old adage “it’s all fun and games until someone loses an eye” probably sounds familiar. It was used by countless mothers to warn their children to be careful while playing with toys or objects that could result in eye injuries. According to the National Research Council, nearly 2.4 million eye injuries occur in the United States each year with blunt trauma accounting for nearly 25% of cases.
Unfortunately, that’s exactly what happened to NBC Today show host Savannah Guthrie on November 25, 2019, when her toddler threw a toy train that struck her right eye, resulting in a retinal tear – a potentially vision-threatening injury. Savannah described feeling pain after the blow but didn’t realize the gravity of her injury until she lost vision in her right eye 24 hours later. Ms. Guthrie’s ophthalmologist confirmed that the reason for her vision loss was that she had a torn retina and her eye was bleeding on the inside. Let’s review what we mean by a retinal tear.
What’s a retinal tear?
The retina is a very thin layer of light-sensitive tissue lining the inner wall of the back of the eye just like wallpaper. This layer is made of special cells that, when struck by light waves entering the eye, convert the light input into electrical impulses that travel via the optic nerve to your brain where they are interpreted as images. Pretty sophisticated wiring, no? The retina can be torn due to an injury (as in Ms. Guthrie’s case), but also due to anatomical changes associated with age, prior eye surgery, or high nearsightedness (myopia). This creates a situation in which the gel that fills the eyeball (known as vitreous gel, with the consistency of egg whites) can pull on the retina and accidentally tear it, causing the retina to separate from the inner eyewall much like wallpaper peeling off of a wall.
Because the retina gets oxygen and nourishment from blood vessels located within the eyewall, a retinal detachment can lead to vision loss if not treated in time. Learn more about non-traumatic causes of retinal tears here.
What are some symptoms of a torn retina?
One reason why Ms. Guthrie might not have initially thought she had a bad eye injury could have been because retinal tears are painless. Patients often don’t realize something is wrong until they experience one of the following symptoms:
- Sudden appearance of floaters or specks, dots or cobwebs floating through the visual field
- Persistent flashing lights
- Hazy vision or total vision loss
- A fixed shadow or dark spot in your vision
What’s the treatment for a retinal tear?
The treatment of a retinal tear is usually determined by its size and location. Small tears or ones that do not threaten central vision will often be treated initially in the office with a retinal laserthat precisely focuses light energy along the edges of the tear to weld the edges against the inner wall of the eye. This procedure is known as laser photocoagulation.
Sealing the retinal tear along its edges, prevents the fluid inside the eye from seeping through the opening created by the tear and further separating the delicate retinal tissue away from inner eye wall. The treated area will form a scar within a week or two that seals off the opening in the retina created by the tear, thus preventing further damage.
If laser treatment fails to effectively seal off the tear and there’s a risk of the retinal tear progressing to a retinal detachment, as seems to have been Ms. Guthrie’s case, then the next level of surgical intervention will be required to avoid permanent vision loss.
In the case of Ms. Guthrie, her retinal specialist performed an eye surgery known as a vitrectomy. In this surgery, the vitreous gel is removed from within the eye to allow the eye surgeon to reach the torn retina and suction off the fluid that has collected underneath it. With the fluid gone, the retina can be put back in place against the eyewall and an additional laser is then used to secure it.
Finally, a gas bubble is carefully placed inside the eye to help hold the retina in place while it heals (this is known as a gas tamponade). Imagine using a helium balloon to hold a piece of wallpaper against the ceiling until the glue dries. Over the next several weeks, the gas is absorbed and is gradually replaced by fluid which the eye is continually producing.
What’s recovery like after a vitrectomy with gas tamponade?
After a vitrectomy requiring a gas tamponade, the first two weeks of recovery are critical to healing the patient’s central vision, so it’s essential for patients to comply with their eye doctor’s post-op instructions.
In order to keep the gas bubble correctly positioned in the central vision area, the patient must maintain a face down posture for several days and up to a week after surgery. A cushioned headrest with an opening for the face helps keep patients correctly positioned. Not fun, but tolerable.
During the period that the gas bubble is inside the eye, vision from that eye is very limited (imagine looking underwater inside a swimming pool). As the gas is absorbed by the body, vision gradually improves. While the gas bubble is present inside the eye, flying or going to higher altitudes is not permitted in order to avoid the bubble from expanding inside the eye and causing irreversible vision loss. While successful retinal surgery repairs the retinal anatomy right away, it can take from six months to a year to achieve the final visual outcome after a retinal detachment. This is because the retina is made of a delicate network of visual nerve cells (called neurons) which heal very slowly.
What’s more, no two retinal detachments are alike, and the amount of vision recovery depends on the specific location of the detachment. If the detachment occurred at the central vision area of the retina, known as the macula, vision might not recover to the original level.
The good news for Ms. Guthrie is that her eye doctors felt that the location of her detachment was quite favorable for achieving a good visual outcome, although time will tell if she has permanent vision deficits as a result of this injury.
What are the risks of a vitrectomy with gas tamponade?
The vitrectomy procedure is very successful in repairing a detached retina, with a 95% to 98% single operation success rate. That said, complications can occur, including infection, bleeding or scar tissue formation that can cause re-detachment, which would require additional surgery. Fortunately, complications are quite rare.
A more common consequence of vitrectomy is the premature development of a cataract in the affected eye. This occurs as a result of the gas bubble coming into contact with the lens of the eye, causing it to become hazy. Nearly 80% of eyes that undergo a vision saving vitrectomy procedure will require cataract surgery within two years. The good news is that cataract surgery is highly successful in restoring vision in such cases.
Assil Eye Institute has retina specialists who are uniquely qualified to help.
Dr. Svetlana Pilyugina, or “Dr. P” as she’s known to her patients, is a Stanford trained ophthalmologist with fellowship training and board certification in diseases and surgery of the vitreous and retina. Dr. P has been performing retinal surgery and laser therapy for over a decade and has considerable experience in treating a wide range of retinal conditions.
If you are interested in establishing care with Dr. P, click here to schedule a consultation online or call us at 866-945-2745. If you are experiencing any concerning symptoms, contact us immediately to determine the best time to schedule an exam.
At AEI, you will experience a state-of-the-art health care facility that brings together revolutionary technologies with experienced vision care professionals. Our goal is to help you achieve your personal best vision.
At Assil Eye Institute we take our patients’ safety seriously. Our facility’s Covid-19 patient safety procedures exceed all CDC recommendations. Masks are required in our institutes at all times.
We are conveniently located for patients throughout Southern California and the Los Angeles area at locations in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles, to name a few.
As a member of an elite group of only 3000 retina-vitreous specialists in the United States, Stanford trained Dr. Pilyugina brings to AEI a unique skill set in the treatment and surgery of retinal disease. Her academic credentials include numerous research papers, conference presentations, medical publications, and clinical trials.
In recognition of her expertise, Dr. Pilyugina was asked to serve as Chief Editor for New Retinal Physician, a supplement published by the Retinal Physician Journal.
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