Floaters

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Nearly every day in clinic I have at least one patient mention that they see floaters in one or both of their eyes. I’ve heard them described as cobwebs, gnats or even TV static that moves around in their vision, and they are often more prominent in bright backgrounds. I want to take some time to discuss how floaters can form and when you should be concerned about them.

Inside of our eyes, there is a clear, jelly-like structure called the vitreous composed largely of water as well as hyaluronic acid, collagen, and proteins. Over time, those proteins can start to clump together and form these “floaters” in our vision that we as eye care providers can see upon examination as well.

Vitreous fluid with floaters
Floaters in vision

A few floaters that are longstanding with no other symptoms are typically harmless. However, floaters may warrant an immediate eye exam if any of the following is true:

  1. They are sudden in onset and/or there are quite a few floaters
  2. The floaters are accompanied with flashing lights in your vision
  3. Part of your vision is missing as if there is a black curtain or veil in your vision

These could be the early symptoms of a retinal detachment and need to be evaluated and treated immediately.

What is a retinal detachment?

Retinal Detachment

The retina is a thin, neurological tissue in the back of your eye that allows you to see. This is one of the many things we examine when we dilate your eyes and why dilation is so important. For many different reasons, patients can develop a small hole or tear in their retina that can progress into a retinal detachment where the retina pulls away from the back of the eye. If it is not caught early, this can be permanently vision threatening.

What are risk factors for developing a retinal detachment?

  • High nearsightedness
  • Trauma
  • Prior eye surgery
  • Age

Sudden onset floaters with or without flashing lights is not necessarily something concerning. As mentioned before, the vitreous inside the eye has proteins that degenerate over time. Along with this degeneration, the vitreous starts to pull away from the retina, which can lead to a posterior vitreous detachment. This is extremely common in patients over the age of 60 and a natural process that occurs over time.

detached vitreous

In rare cases, the vitreous can pull off a piece of the retina during this process, so it is still very important to set up an appointment with your eye doctor if you think you may be experiencing a posterior vitreous detachment.

Finally, floaters can sometimes be accompanied with severe headaches. Patients who suffer from migraines with aura can have spots in their vision about 15-30 minutes prior to their migraine. They often occur in both eyes typically in the periphery and have a variety of presentations. These include zigzags, crescents or even colored shapes. The difference between these floaters and the ones mentioned previously is that we will not find them in the eye upon examination. It is an entirely neurological phenomenon and the aura should disappear.

Floaters can be concerning if you’ve never experienced them before, but thankfully a dilated eye exam can help us determine very quickly if there is any disease process that requires immediate attention.

Are you up to date on your eye exams? If you are due for an exam or have concerns, call us at (706) 546-0170