Floaters and Flashes

It is common with growing up that the vitreous will change. In childhood, the vitreous, the gel inside the eye in front of the retina, is very homogenous, made up of finely spaced collaen tissue, a highly isotonic medium that supports water which makes up 98% of the vitreous. As we grow up, the vitreous also grows and it begins to contract. Strings, dots, and a few odd shaped floaters are noted to increase throughout life. At some point, usually between 20 and 120 years of age, the vitreous pulls away from its light attachments against the spoerior portions of the eye (i.e. the retina). This will typically result in a significant increase in the number of floaters (two or three are typical) and sometimes form a ring. This is described a s a web or veil over the vision. This too will sometimes result in flashes in the periphery due to the inertia of the vitreous with eye movements, usually seen in dimlight situations.

If floaters are first and new, particularly if there is a loss of side vision, with or without flashes, this would be a significant cause for concern. Approximately 10% of patients with acute posterior vitreous separation can have some peripheral traction resulting in a retinal tear which then could lead to retinal detachment. Numerous floaters (i.e. 20+) might represent a hemorrhge which may signal a retinal tear. However, sometimes they can occur silently. Since the vitreous separation is more a process than a single event, retinal breaks may develop later after the initial vitreous separation (i.e. days, months or even years).

With the initial posterior vitreous separation, examination by an ophthamologist or a retinal surgeon would be most appropriate. If there is history of myopia, family history of retinal detachment, or prior history of lattice degeneration, surgery inflammation, etc., these can increase the risk of retinal breaks and/or detachment.

David V. Poer, M.D., F.A.C.S.