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Flashes and Floaters

Flashes and Floaters/Retinal Tears and Detachments

It is very common for people to see tiny floaters from time to time. They become evident when you look at a uniform surface, especially white or blue (for example while looking at the sky). These common and occasionally seen floaters are of no concern.

The eye is hollow like an egg. Within the hollow center of the eye is a gel called the vitreous. The vitreous is analogous to the white of an egg. Just like all gels, the solid component of the gel can form areas of coagulation. These small areas of more solid vitreous float in the gel and are what causes the occasional floater to be noticed. In addition, you can actually occasionally perceive blood cells flowing through the tiny vessels of the retina which can also result in the floaters you see. This is called an entoptic phenomenon.

A key warning sign of potential trouble is when you see a sudden onset of floaters. This is even more concerning when the sudden onset of floaters is dramatic and associated with hundreds and hundreds of floaters (a “shower of floaters”) as if someone was shaking a pepper shaker in front of your eyes. Other significant warning signs of trouble include associated flashes of light and/or loss of peripheral (side) vision. Most often a sudden onset of floaters results in seeing only one or a few floaters. Typically they appear like a “cob-web” or “spider-like”. This type of experience may be associated with some flashes of light for the first day or so only, but typically not associated with peripheral vision loss or hundreds of floaters. This very common condition is called Posterior Vitreous Detachment (PVD)

This is a condition when the more solid portion of the vitreous separates from the watery or “aqueous” portion of the vitreous. PVD’s are usually very frightening to patients when they occur due to a fear of retinal detachment. Fortunately the vast majority of PVD’s are benign and become less bothersome (in terms of noticing the floaters) over time. Virtually all persons will eventually have PVD. Not everyone perceives the symptoms of PVD, but it occurs with greater frequency with advancing age. It occurs at earlier ages in nearsighted (myopic) patients and with blunt eye trauma as well. Unfortunately a small percentage of PVD’s are associated with retinal tears (less than 1%). There can be traction on the retina as the more solid vitreous moves forward with PVD. This traction may result in a break in the retinal surface. The danger of a retinal tear is that fluid from the vitreous can seep under the tear and cause a retinal detachment, which is a very serious condition. It is very difficult to differentiate a PVD without break from a PVD with retinal break without performing an extensive examination of the vitreous and retina. Thus, if you have symptoms of any sudden onset of floaters or flashes you must be examined immediately. Vision Care Consultants’ doctors are on call 24-7 and can always be reached via our office number.

Retinal tears can occur due to PVD’s, or other factors such as: retinal thinning disorders like “lattice degeneration of the retina”, blunt trauma to the eye, and nearsightedness (Myopia). Retinal tears are very treatable and once treated are no longer a risk for detachment. Symptoms of a “shower of floaters” where hundreds of tiny dark spots are acutely perceived are common with retinal tears. The multitude of spots is actually blood cells that have leaked into the vitreous due to a break in tiny retinal blood vessels associated with the retinal tear. A retinal detachment is a condition where the retina separates from its connection to the deeper layers of the eye. When a detachment occurs the blood supply to the retina is compromised and the retinal cells eventually die with associated loss of vision. Depending on the location of the detachment, a person may lose only peripheral (side) vision, central vision (with “macular detachment”), or in the worst cases there can be a total loss of vision if the entire retina is detached. Early diagnosis and appropriate treatment is absolutely critical to preserving vision in cases of retinal detachment.

Signs and Symptoms

Posterior Vitreous Detachment (PVD): sudden onset of a single or a few floaters. Typically web-like in shape. Possibly associated with some peripheral light flashes, which represent the more solid vitreous component “bumping” into the retina. The flashes commonly go away after a day or so as the vitreous moves forward. Peripheral vision is generally not affected, vision generally is clear, and there is no pain felt. If you experience these symptoms you must be evaluated immediately to rule out an associated retinal tear.

Retinal Break (tear or hole): sudden onset of a “shower of floaters”. Hundreds of tiny dark spots will be seen. Flashes are common and typically persistent due to the torn retina being stimulated by the traction of the vitreous. If not associated with detachment, then peripheral vision will be normal. Only macula retinal holes are associated with loss of central vision. If you experience these symptoms you must be evaluated immediately. Treatment involves the use of a retinal laser or a Cryo (freezing) probe to seal the break in the retina and prevent secondary retinal detachment.

Retinal Detachment (RD): loss of peripheral vision, as if a dark, blurry curtain was progressing from the side. Since most RD’s are associated with breaks in the retina, the “shower of floaters” is also a common symptom as well. If the macula is affected then central vision may be very blurry as well. This is a true ocular emergency and must be seen the same day. New surgical methods have made the treatment of retinal detachments highly successful. The key however still remains early diagnosis and treatment.

Risk Factors

  • Nearsightedness (Myopia)
  • Blunt eye trauma
  • Peripheral retinal degenerations (lattice, snail track, etc.)
  • Diabetic Retinopathy (proliferative form)
  • Cataract surgery
  • Capsulotomy laser treatment (YAG) following cataract surgery

LASIK surgery to treat nearsightedness (Myopia) only reshapes the surface of the cornea. It has no effect on the back of the eye. Nearsighted eyes are at higher risk for retinal tears and detachments due to the longer axial length and secondary retinal thinning that occurs. Following LASIK these factors remain the same. Therefore, if you have had LASIK, keep in mind that your retina is still just as nearsighted as before the surgery. You are still at the same risk level for retinal problems and as such should have annual eye health examinations (including retinal examinations) even if your vision without glasses is 20/20!