Horseshoe tears are full thickness breaks in the neurosensory retina that occur due to vitreous traction during posterior vitreous detachment and can lead to rhegmatogenous retinal detachment.
They present as a flap of retinal tissue with a detached apex which always points to the posterior pole and a base attached to the retina.
When there is vitreous traction and a subsequent retinal tear, the tear is attached to the vitreous as it continues to detach. The vitreous detaches in the same direction from posterior to anterior. So when the vitreous detachment hits the base of the U or V tear, it will always tear towards the ora (anteriorly). So the ‘horseshoe’ always points to the posterior pole.
Floaters occur due to vitreous debris (thickened hyaloid membrane, a Weiss ring, hemorrhage, or retinal pigment epithelium cells)
Flashes of light occur due to persistent vitreous traction
For treatment of retinal breaks, AAO practice patterns can be followed (Swipe to the last picture)