Floaters are like little goldfish in the aquarium, the cavity inside the eye. Sometimes they swim into view, but other times they hide in less conspicuous part of the aquarium. Floaters may disappear for a while, only to return. They may look like cobwebs, little dark specks, lines, an amoeba, or may be big enough of a clump to look like a veil in the vision.
In actuality, floaters are pieces of condensed gel, called the vitreous, that fills up most of the cavity inside the eye. A normally transparent semi-liquid like Jell-O, the vitreous condenses gradually into little chunks, becoming floaters. This process, which takes place to a variable degree with age, is called vitreous degeneration.
The vitreous is normally intimately glued to the retina, which resides on the inside wall of the cavity of the eye (like a wallpaper). With the passage of time, the vitreous may gradually peel away from the retina, a process called posterior vitreous detachment (PVD). A sudden PVD leads to rapid increase in the number of floaters, as well as the perception of flashes of light when the vitreous tugs on the retina. An on-going PVD may cause such episodes repeatedly, sometimes with weeks to months elapsing between episodes.
Floaters can be quite annoying. When they are big enough, they can interfere with vision at unpredictable times (usually when the patient wakes up), causing a lot of anxiety and frustration. Occasionally, patients get startled when they see something suddenly come into view. There is no generally accepted treatment, and most doctors advise leaving them alone. Most patients learn to live with them.
There is also no treatment for PVDs. However, when the vitreous pulls away from the retina, it can drag a little piece of the retina with it, causing either a tear or a hole in the retina. Liquid may go through the break, enter the space behind the retina, and peel it off like wallpaper. This is how retinal detachments usually begin.
If you see:
Call your doctor soon. You should be checked for a retinal hole or tears, which can be treated with laser in the office to prevent retinal detachment.
However, not all holes or tears are obvious, or they may occur after the examination. Therefore, every patient who has floaters or flashes should know the symptoms of retinal detachment:
Patients with these symptoms should go to the emergency room or call their eye doctors immediately. The earlier it is treated, the better chance they have in salvaging useful vision. Surgery is often necessary to correct retinal detachment, although occasionally the doctor may inject a small bubble into the eye in the office to re-attach the retina.
Floaters and flashes are annoying, and they may signify potentially serious problems. Therefore, they should always be treated with caution.