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WHAT IS A HOLE IN THE RETINA? continued...

Both holes and tears are most often caused by direct trauma to the eye. In these instances, due to outside pressure, the eye is temporarily misshapen, and because the retina is delicately held in place by jelly within the eye, the subsequent pulling from different sides can cause the thin layer of tissue to tear. This type of injury is called a "closed globe injury" (wholly within the eye, with the eye remaining intact) as opposed to an "open globe injury" (in which something enters the eye; the eye has a perforating injury).

Tears are far more common than holes. In Watson's case, like most, the hole or tear is near the front part of the retina (called the ora). When the retina tears or is injured in any way, a patient might see a flash of light (called photopsia), and if there is a hemorrhage, could see "floaters" or splotches in his vision. After the event, the patient might see a black curtain across his vision that slowly moves to cover the entire line of sight, which could indicate that the retina has come off the back of the eye (retinal detachment).

DIAGNOSIS

Inner eye injuries are diagnosed by ocular exam. Doctors will examine the eye and search around the retina looking for inconsistencies, tears, and holes. Tears to ora are often quite difficult to find because doctors must peer almost perpendicularly into the eye. These exams are done using lights that enable the doctor to see into the eye and look very closely at the retina, pupil, lens, and ora of the eye.

TREATMENT

The standard treatment for minor defects in the retina is laser surgery. It works because the microscopic beams of light are shined into the eye, and are picked up by the pigments behind the retina. This controlled welding bonds the retina and the wall of the eye. Over about two months, the laser treatment develops into an "elegant little scar" that prevents the retina from detaching further. If the retina does detach completely, it can no longer be treated using laser surgery. In this case, incisional surgery is necessary to reflatten the retina because the pigment of the retina will not pick up the laser unless it is firmly in place against the back of the eye. The laser surgery is mainly a preventive procedure, protecting the eye from future injuries that would occur more easily if the eye were already damaged.

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