Vision and Eye Care

Vitreous Eye Floaters

A 50 year old woman calls our office complaining about little spots and fly like things floating in her vision and occasional flashing lights. We tell her to come in as soon as possible and we do a complete eye and retinal exam. She suffers from Vitreous Floaters, a normal condition.

A 50 year old woman calls our office complaining about little spots and fly like things floating in her vision and occasional flashing lights.

We tell her to come in as soon as possible and we do a complete eye and retinal exam. She suffers from Vitreous Eye Floaters, a normal condition.

This case scenario is played out many times every month, but should not be ignored if any one experiences these visual disturbances.

Eye Floaters are deposits of various size, shape, consistency, refractive index, and motility within the eye's normally transparent vitreous humour. They may be of embryonic origin or acquired due to degenerative changes of the vitreous humour or retina. They may appear as spots, threads, or fragments of cobwebs, which float slowly before your eyes.

Eye Floaters are particularly noticeable when looking at a blank surface or an open space, such as blue sky.

Many of these specks have a tendency to sink toward the bottom of the eyeball, in whichever way the eyeball is oriented.

The most common cause of eye floaters is shrinkage of the vitreous humour: this gel-like substance consists of 99% water and 1% solid elements. The solid portion consists of a network of collagen and hyaluronic acid, with the latter retaining water molecules.

In most cases this is a benign condition, but can represent a much more serious condition. These bits of retinal tissue may have come from an area that left a small retinal hole or tear behind and the floater is the result of the tear. In all cases when there are floaters a complete dilated retinal exam must be performed as soon as possible. That is the only way to properly evaluate the retina.

When there are flashes of light present as well the level of concern goes up since that may also indicate traction on the retina and can be more serious. If a hole or tear is discovered then usually laser treatment must be done in order to seal the anomaly and prevent further damage.

In some cases vitreous fluid or blood will fill the area where the eye floater originated resulting in a retinal detachment. This is a much more complicated condition and frequently requires retinal surgery to correct the problem. If left untreated it can result in total blindness in that eye.

Most often, the floaters either dissolve or reattach themselves some where in the eye and are no longer a visual issue. The problem is that over the course of our lives new ones are constantly forming. Thus even if one goes away, a new one is starting.

Floaters are often readily observed by a doctor with the use of an ophthalmoscope or slit lamp.

However, if the floater is a small piece of debris and near the retina they may not be able to observe it even if it appears large to the sufferer.

Increasing background illumination or using a pinhole to effectively decrease pupil diameter may allow a person to obtain a better view of his or her own floaters. The head may be tilted in such a way that one of the floaters drifts towards the central axis of the eye. In the sharpened image the fibrous elements are more conspicuous. (If the pinhole is kept moving slowly in small circles, the same technique evokes an interesting entoptic effect known as the vascular figure, which is a view of the blood vessels within one's own eye.)

Treatment for Eye Floaters

Normally, there is no treatment indicated.

Vitrectomy may be successful in treating more severe cases however, the procedure is typically not warranted in those with lesser symptoms due to the potential for complications as severe as blindness. Floaters may become less annoying as sufferers grow accustomed to them, even to the extent that they may no longer notice them.

There is also Sutureless Vitrectomy, as the standard vitrectomy involves cutting through the conjunctiva, or fleshy part of the front of the eye, and making openings in the pars plana area which require stitches at the end of the surgery. In the sutureless technique, small tubes or canulas or trochars are placed through the pars plana area and very tiny instruments are placed through these tubes. Once the surgery is complete, the tubes are removed and no stitches are needed. Only in certain cases can sutureless vitrectomy surgery be performed.

Vitrectomy may be successful in treating more severe cases, however, the procedure is typically not warranted in those with lesser symptoms due to the potential for complications as severe as blindness. Eye Floaters may become less annoying as sufferers grow accustomed to them, even to the extent that they may no longer notice them.

Another treatment is laser vitreolysis. In this procedure a powerful laser (usually a Yttrium aluminium garnet laser) is focused onto the floater and in a quick burst vaporizes the structure into a less dense and not as noticeable consistency.

In short, if an individual sees floaters he/she should see the eye doctor as soon as possible to rule out any retinal hole or tear. If there are flashes as well the level of urgency increases. A complete evaluation must include a dilated exam as well.

Dr. Jay B Stockman O.D. is a practicing doctor for newyorkvisionassociates.com/.

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