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Cystic and Zonular Tufts

Dr Ben Wild

Overview

The retina is located at the back surface of the inside of the eye. Its main function is to detect and transmit the sensation of light to the brain for interpretation. Attached to the retina is the vitreous humor. The vitreous humor is a large scaffold of gel that helps keep the eye inflated and extends from the retina all the way to the lens of the eye.

Healthy eye

Sagittal view of a healthy eye.


A retinal tuft is an abnormality present at birth (congenital) that is often in one of two main forms; cystic and zonular tufts. Cystic tufts are seen as elevated white bumps in the peripheral retina in 5% of people and are formed of glial cells that are strongly attached to both the retina and the vitreous gel. Zonular tufts occur when a zonule, zonules being the cables that hold the lens of the eye in place, attaches to the retina instead of the ciliary body muscle. This attachment site usually leads to traction and pulling of the retina. Zonular tufts can be seen in up to 15% of people.

Eye with cystic and zonular tufts

A sagittal view of an eye with a zonular tuft (white line extending from the lens to the retina) and a cystic tuft (white spot on retina).

Signs and Symptoms

Signs

Cystic Tuft

White elevated bump on the retina, possibly surrounded by dark pigment.

Zonular Tuft

A long dark strand leading to an elevated white area of retina possibly surrounded by dark pigment.

Symptoms

Asymptomatic (no symptoms).

Causes and Risk Factors

Causes

Congenital abnormality.


Risk Factors

There are no known risk factors.

Prevention and Treatment

Prevention

There are no known preventative measures.


Treatments

· Close monitoring every 1-2 years for development of a retinal hole or tear.

· If a retinal hole or tear occurs; laser retinopexy surgery.

Prognosis

Cystic tufts cause 10% of all retinal detachments but the risk of a retinal detachment for a patient with a cystic tuft is under 1%. Regular eye exams can help detect any changes that may require surgery before a retinal detachment occurs. The vast majority of cases do not require any treatment and vision is never affected.


Zonular tufts have a 2% lifetime risk of developing into a retinal detachment. Regular eye exams can decrease the odds of this occurring.


For either tuft, seek medical attention same day with any new flashes of light, floaters or a veil appearance in vision.

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