Most retinal tears happen when the gel-like substance inside your eye shrinks and pulls away from the retina, tugging hard enough to rip the tissue. This process, called posterior vitreous detachment, is the single most common cause and becomes increasingly likely as you age. But nearsightedness, eye injuries, prior surgery, and pre-existing weak spots in the retina can all set the stage for a tear as well.
How the Gel Inside Your Eye Causes Tears
Your eye is filled with a clear, jelly-like substance called the vitreous. It’s firmly attached to the retina, the thin layer of light-sensing tissue lining the back of your eye. Over time, the vitreous naturally shrinks and becomes more liquid. As it contracts, it starts to peel away from the retina’s inner surface.
In most people, this separation happens without any problems. The vitreous pulls free cleanly and the retina stays intact. But in some cases, the vitreous is stuck more firmly to certain spots on the retina. When it pulls on those spots, the traction can be strong enough to tear the tissue. That torn area then allows fluid to seep underneath the retina, which is what eventually leads to a retinal detachment if left untreated. This vitreous separation is extremely common after age 60, which is why retinal tears are predominantly a condition of aging.
Nearsightedness Raises the Risk Significantly
If you’re significantly nearsighted (myopic), your eyes are physically longer than average. That extra length stretches the retina thinner and makes the vitreous more likely to pull away from it. The numbers reflect this clearly: the incidence of retinal detachment in highly myopic eyes (greater than -6.00 diopters) is about 3.2%, compared to 0.71% in eyes with normal vision. At extreme levels of myopia, between -15.00 and -20.00 diopters, the risk jumps to 15 to 110 times higher than in non-myopic eyes.
Even moderate myopia matters. The yearly incidence of retinal detachment rises from about 0.015% in eyes with mild myopia to 0.07% in eyes with -5.00 to -9.75 diopters. These numbers may sound small in any given year, but they accumulate over a lifetime, which is why eye doctors monitor myopic patients more closely for retinal changes.
Weak Spots in the Retina
Some people have areas of thinning in the peripheral retina known as lattice degeneration. These patches are characterized by retinal thinning with unusually strong vitreous adhesions at their edges. When the vitreous eventually pulls away, those firm attachment points concentrate the pulling force on already-weakened tissue, making a tear more likely.
Lattice degeneration is found in roughly 6% to 8% of the general population. The good news is that the actual risk of a tear developing at a lattice lesion is low: about 1% over ten years in one long-term study. Still, if you have lattice degeneration along with other risk factors like high myopia, the combined risk is worth paying attention to. These lesions are detected during a dilated eye exam, where an eye doctor uses indirect ophthalmoscopy, sometimes pressing gently on the eye wall to get a better view of the far edges of the retina.
Eye Injuries and Blunt Trauma
A hard blow to the eye or face can cause a retinal tear without any pre-existing weakness in the tissue. When a blunt force hits the eye, the eyeball briefly deforms. That rapid compression and rebound sends a shockwave through the vitreous, which yanks on the retina. Sports injuries, car accidents, falls, and even being struck by an airbag are all common scenarios.
Blunt trauma can damage nearly every structure in the eye. The posterior segment, where the retina sits, is vulnerable to vitreous hemorrhage (bleeding into the gel), direct bruising of the retina, and tears at the retinal periphery where the tissue is thinnest. One challenge with traumatic tears is that bleeding inside the eye can obscure the view of the retina, making diagnosis harder. In those cases, doctors use ultrasound imaging to check for tears or detachments when they can’t see through the blood.
Previous Eye Surgery
Cataract surgery is the most common intraocular procedure in the world, and it carries a small but real risk of retinal tears afterward. Removing the natural lens changes the dynamics inside the eye, which can accelerate vitreous separation.
A 2024 study in the American Academy of Ophthalmology’s journal looked specifically at eyes that had already been treated for retinal tears before cataract surgery. In that higher-risk group, 7.3% developed a new retinal tear or detachment after the procedure, with most events occurring within the first year (5.6% incidence at one year). Younger patients, men, and those who had a shorter gap between their initial laser treatment and cataract surgery faced higher odds. For patients without a prior history of retinal tears, the risk is considerably lower, but it’s still something surgeons monitor in the months following the procedure.
Warning Signs of a Tear
Retinal tears are painless, which makes the visual symptoms all the more important to recognize. The hallmark signs include:
- Sudden increase in floaters: small dark specks, dots, or stringy shapes drifting across your vision, far more numerous than any you’ve noticed before
- Flashes of light: brief, lightning-like streaks or flickering in the same eye as the floaters, caused by the vitreous physically tugging on the retina
- A shadow or curtain: a gray or dark area creeping into the edge of your vision, which suggests fluid is already collecting behind the retina
Floaters on their own are common and usually harmless. The red flags are a sudden shower of new floaters, flashes of light accompanying them, or any loss of peripheral vision. These symptoms can indicate a tear that’s actively progressing, and they call for an urgent eye exam, ideally the same day.
How Tears Are Diagnosed and Treated
An eye doctor diagnoses a retinal tear with a dilated retinal exam, using a bright light and magnifying lenses to inspect the entire retina, including its outermost edges. If bleeding inside the eye blocks the view, ultrasound imaging provides an alternative way to detect tears and detachments.
The vast majority of retinal tears are treated with laser photocoagulation. The laser creates small burns around the tear, forming scar tissue that seals the retina to the underlying tissue and prevents fluid from traveling underneath it. The procedure is done in-office, is relatively quick, and effectively stops most tears from progressing to a full detachment. In cases where the tear is in a hard-to-reach location, a freezing treatment called cryotherapy is used instead, which achieves the same sealing effect through a different mechanism.
Both treatments work by creating a barrier around the tear rather than repairing the tear itself. The goal is containment: keep the tear from becoming a detachment, which is a much more serious condition requiring surgery and carrying a greater risk of permanent vision loss.