Most spots and floaters in the eye are harmless and merely annoying. But a sudden onset of flashes or many new floaters requires medical attention quickly.
Floaters and Flashes
You may sometimes see small specks moving in your field of vision These are called floaters. You may often see them when looking at a plain background, such as a blank wall or blue sky. You may at first mistake them for insects or dust floating in the air. They will appear to move as you move your eyes.
Floaters are actually tiny clumps of gel or cells in the vitreous, the clear, jello-like substance that fills the back chamber in your eye.
When floaters first appear, they may be accompanied by what appears to be flashes of light. These are most easily seen when in the dark, but may be bright enough to be seen even when out in sunlight. The technical name for these flashing lights is “photopsia.”
These objects can look like they are in the front of your eye, but they are actually floating inside. What you see are the shadows they cast on the retina, the nerve layer at the back of the eye that actually senses light. If you think of your eye as a camera, the retina would be the film in the camera. Floaters may have different shapes: little dots, circles, lines, clouds or cobwebs.
The new onset of floaters, particularly if accompanied by flashes, is a symptom which requires immediate evaluation.
New floaters or an increase in existing floaters may occur with shrinking of the vitreous gel away from the retina (called “posterior vitreous separations”). This usually is harmless, but in some people, the vitreous may be firmly attached to the retina in one or more places and here the retina may be torn as the vitreous pulls away. A torn retina will lead to retinal detachment if not corrected. If you have these symptoms, you should be seen by our office to be evaluated for retinal tears.
While floaters may remain in the vision, many of them will become less bothersome over time. Even if you have had floaters for some years, our office should be consulted if additional new floaters develop or if flashes develop.
When people reach middle age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. The vitreous gel then pulls away from the retina, causing a posterior vitreous detachment. This is a common cause of floaters.
Posterior vitreous detachment is more common for people who:
• Are nearsighted (have myopia)
• Have undergone cataract operations
• Have had inflammation inside the eye
• Have a family history of retinal detachment
Vitreous separation or detachment (PVD) is a normal event in the life of every eye. Your chances of having a PVD increase with age. Regardless of age, all people with new onset floaters or flashes, or a sudden increase in existing flashes or floaters, should be checked for torn retina by our office. This requires an examination with dilated pupils, using several different examination techniques and occasional wide field imaging. The reason this is important is that if caught early, a torn retina can be easily repaired in the office with a laser. If retinal detachment is allowed to develop, surgery becomes necessary.
Since most floaters are more aggravating than sight threatening, treatment for them is not needed. For severe cases where a large floater obstructs vision, a procedure known as vitrectomy can be performed. In this procedure, the vitreous is removed and replaced with a clear fluid. This procedure does have a risk and therefore, not appropriate for floaters that are merely annoying.