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Question:
What is the probability of developing retinal tears/detachment after onset of floaters and flashes (posterior capsule detachment) has occurred? Should I seek a second opinion?

Answer:
Flashes and floaters are symptoms of abnormal vitreoretinal activity. Most commonly they are associated with a posterior vitreous detachment, which is a normal condition which usually occurs spontaneously and resolves without treatment. Occasionally, these symptoms occur from infections, tumors and other serious conditions. Therefore, you should be examined thoroughly by a comprehensive ophthalmologist as soon as they begin. This is NOT something to be put off to see if it will go away.

Bleeding into the vitreous cavity can cause floaters and may be caused by diabetes, hypertension, trauma, retinal tears or retinal detachment. These conditions should be apparent to the ophthalmologist after examining you and cannot be treated over the telephone or by email. Having said all of this, at least 85 percent of patients having flashes and floaters will be fine with no treatment, if their examination fails to reveal a cause.

The ophthalmologist will look carefully for a tear in the retina or early retinal detachment. Most retinal detachments, left untreated, proceed to permanent blindness. Most often they are preceded by a retinal tear or tears. When caught at this early stage, tears (also sometimes called retinal breaks or holes) can easily be treated with laser or freezing, which are done in the ophthalmologist's office with eyedrop anesthesia. Not all tears need treatment. Retinal detachments require open surgery, but this is usually done as an outpatient today. If the macula (central vision) is detached, surgery can be done in a few days or even a week and the results will be as good as if done in an emergency. On the other hand, if the macula is attached, then surgery is an emergency to obtain the best possible postoperative vision.

I am troubled by your mention of the posterior capsule. If you meant a detached posterior vitreous, then everything which I have just told you is correct. However, if the posterior capsule has been ruptured or torn during cataract surgery, by trauma, or by a posterior capsulotomy, then the incidence of infection, retinal tear, retinal detachment, or vitreous hemorrhage is much higher and the patient needs to be monitored very closely. Please consult closely with you comprehensive ophthalmologist and discuss the advisability of consultation with a retina specialist.

Answered by: Richard G. Shugarman, MDDr. Richard Shugarman

Categories: Eye Diseases, Eye Injuries, General Eye Health

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Answered: May 21, 2012

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