Floaters and Flashes

Useful Terms

Floaters = small pieces of vitreous gel clumped together that float inside the eye and cause one to see small spots or specks that are moving within the field of vision

Flashes = those flashes of light or streaks of lightning seen when the vitreous space pulls on the retina of the eye; may co-occur with floaters

Common Symptoms

  • Loss of peripheral vision
  • The appearance of a curtain being drawn over the field of vision
  • Floaters

    • Seeing any small, dots, specks, spots, circles, lines, clouds, or cobwebs moving within the field of vision
    • Usually seen on a simple background, such as a bare wall or the blue sky
  • Flashes

    • Seeing any unexpected flashing lights or streaks of lightning even when there are no actual flashing lights
    • Usually seen during the nighttime or in a dark room
    • Seeing jagged lines or heat waves

Risk Factors

  • Advanced Age
  • Vitreous Gel Pulling on the Retina
  • Floaters

    • Severe nearsightedness (myopia)
    • Inflammation of the eye (s)
    • Recent intraocular surgery

Causes

  • Floaters

    • Advanced Age

      • Once people started to reach the middle aged stage of life, the vitreous gel within the eye starts to contract and clumps together or strands within
      • These clumps or strands block the light from being focused onto the retina and cast shadows onto the retina
      • Therefore, the small specks or dots or such being seen are the shadows caused by the suspension of the vitreous gel
      • These small floaters may permanently reside within the vitreous space and as time passes, they can be ignored
    • Red Blood Cells

      • When the vitreous gel pulls on the retina, there may be some bleeding from the blood vessels within, resulting in a minor hemorrhage
      • Consequently, there will be a leakage of red blood cells in the visual form of small black dots that look like smoke or a swarm of gnats
      • Any floaters that are caused by these red blood cells will eventually disappear over the period of several months as they are absorbed within the blood
    • Posterior Vitreous Detachment (PVD)

      • Throughout the aging process, as the vitreous gel shrinks, it may start to pull on or away from the retina
      • If detachment occurs, it will completely come away from the retina and debris will come into the vitreous gel and form into floaters
      • These floaters are usually larger than those floaters that are caused by other factors and manifest as cobwebs or a curtain that obscures the field of vision
      • The pulling on or away from the retina may also result in flashes
      • This condition is more common for those people who have the aforementioned risk factors associated with floaters
      • Usually, the separation of the vitreous from the retina will be a clean one that will not result in further complications
      • The flashes will progressively vanish entirely, while the floaters will continue, but become more inconspicuous within two to three months
  • Flashes

    • Migraines

      • Migraines are the result of a spasm of blood vessels within the brain
      • In those migraines without a headache, otherwise known as ophthalmic migraines, there will be flashes of light in the form of jagged lines or heat waves within both of the eyes
      • These usually occur for only ten to twenty minutes

Diagnosis

  • Dilated Eye Examination

    • Eyedrops are applied to the pupils to dilate them to allow the ophthalmologist a closer look at the retina and vitreous gel
    • The doctor will be able to use the ophthalmoscope in order to illuminate the various parts of the eye and magnify their images to check for signs of posterior vitreous detachment as the cause of the floaters
    • Blurred vision and increased light sensitivity are common side effects of this exam that may last for up to several hours afterwards

      • It is thus highly recommended to have someone who can drive the patient home, as well as to have the patient refrain from any activities that require good eye coordination for that amount of time
  • Scleral Depression

    • Anesthetic eyedrops may be applied to provide comfort
    • A cotton-tipped applicator or special blunt metal instrument called the scleral depressor is used to gently push on the eye in such a way that the ophthalmologist can thoroughly examine the retina from different vantage points, which cannot be done with any other method
  • Additional Eye Examinations

    • The doctor will utilize other tests, such as for visual acuity and clarity, pressure within the eyes, ultrasounds, and others, in order to rule out any potential causes

Treatment

  • There are no medications that can make floaters disappear
  • Most floaters either go away on their own in time or progressively become less of a nuisance to the point that no treatment is needed
  • For those floaters that appear directly within the line of vision, moving the eye (s) around often will help the vitreous gel swirl around, thus moving the floaters out of the way
  • Those floaters that significantly affect vision and do go away with the passage of time warrants a vitrectomy, which is useful for treating retinal detachment in particular
  • Instances of PVD that cause floaters necessitate surgery to fix them
  • Nevertheless, it is recommended to go to the ophthalmologist often to check on the current state of the floaters the patient currently has, as well as the condition of vitreous gel within the eye
  • The appearance of any significant increase of new floaters or the size of existing floaters, or some sudden light flashes warrants an immediate appointment with the ophthalmologist to see what caused it and determine its severity