"Is there a bug in my eye?": Floaters explained

Eye floaters are small, typically benign specks, strands, or shapes that seem to drift across your field of vision. Although most floaters are harmless, a sudden increase in their number, particularly if accompanied by flashes of light, may signify a serious eye condition such as a retinal tear or detachment, necessitating prompt medical attention. 

Posterior Vitreous Detachment (PVD): A common cause of floaters

As you age, the vitreous — a jelly-like material inside your eyes — naturally liquifies and contracts. During this process, microscopic collagen fibers in the vitreous clump together. These scattered pieces cast tiny shadows onto your retina, which are known as floaters.

Eventually, when the vitreous contracts enough, the vitreal sac pulls itself off the retina, in a normal aging process called a posterior vitreous detachment (PVD). As posterior vitreous detachment advances, it can lead to significant changes in vision, including the emergence of grey or black specks or shadows and light flashes, typically in peripheral vision. Although PVD is a natural process, it is crucial to seek medical attention promptly if these symptoms arise suddenly, as they could signify a more serious condition, such as retinal detachment.

Besides the typical age-related changes in the vitreous gel, PVD may also occur due to eye injury, inflammation, or following eye surgery.

Retinal Detachment: A nefarious cause of floaters

Retinal detachment is a serious eye condition where the retina, the light-sensitive tissue at the back of the eye, pulls away from its normal position, potentially leading to vision loss if not treated promptly. 

Causes: Retinal detachment can occur due to various factors, including:

• Age: The vitreous gel inside the eye can shrink and pull on the retina as we age (PVD). 

• Eye injury: Trauma to the eye can cause a tear or detachment of the retina. 

• Eye conditions: Certain eye conditions, like diabetic retinopathy, can increase the risk of retinal detachment. 

• Prior eye surgery: Cataract surgery or other eye surgeries can sometimes increase the risk.

• Nearsightedness (myopia): People with high myopia are at a higher risk. 

  
  

Symptoms: Common symptoms of retinal detachment include:

• Seeing flashing lights 

• Seeing new floaters 

• A dark shadow or curtain in your vision 

• Sudden blurry vision 

Diagnosis of a PVD or Retinal Detachment

A comprehensive eye examination is crucial for diagnosing retinal detachment. Performed by an eye care professional, this examination involves the use of dilating eye drops to expand the pupil, allowing for a detailed assessment of the retina.

Other causes of floaters:

Bleeding in the vitreous can also cause floaters, and this can be caused by conditions like diabetic retinopathy, high blood pressure, or retinal tears. Additionally, infections or inflammation in the eye (like uveitis) can also lead to floaters and requires prompt attention.

What are the treatment options for floaters?

The typical approach to managing eye floaters is to simply observe them without any intervention. Although they can be irritating and disruptive, eye floaters are generally not harmful. Over time, they typically move out of your field of vision, and you become less aware of them. While this can be vexing for those who frequently see floaters moving across their vision, it remains the safest choice in most situations.

• Vitrectomy: A surgical option for floaters is known as a vitrectomy which involves the surgical removal of the vitreous gel from within the eye (after which the eye refills with a natural fluid the eye makes called aqueous humor). The risks of vitrectomy includes retinal detachment, retinal tears, macular pucker, macular edema, and cataracts.

• Vitreolysis: Another option for floaters that is sometimes available is laser vitreolysis, in which a laser is used to break up large floaters into smaller, less noticeable pieces. While laser vitreolysis can be effective, it may not eliminate all floaters, and some people may experience little to no improvement or, in fact, can include worsening of floaters in some cases. 

• Vitamins? There are some vitamins on the market purporting to help improve floaters, click the link here to learn more about current research on their efficacy.

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