The vitreous is a translucent jelly that fills the interior of the eye between the retina and lens. It is approximately 4.0 mL in volume, consists of over 98% water, and hyaluronic acid, collagen ( a type of protein) and ions.
In youth, the vitreous is clear , but as age progresses , collagen starts clumping together and this is perceived as floaters by patients . They will have feeling of seeing something small black objects floating in front of the eye. This occurs due to light getting bounced off from its surface . Eventually as age progresses , vitreous gets separated from the retina called as “posterior vitreous detachment “.
What usually happens
In most of the patients , floater remain as single black object floating in front of the eye and in some it could be multiple objects floating . Patient needs to see a Retina Specialist for this problem
Retina specialist scans entire retina to look for any hole / tear in the retina which can develop when vitreous exerts traction on the retina while getting separated . Sometimes patients also complain of seeing flashes of light which occurs due to separating vitreous causing pull in the retina.
If some hole / tear is noted , then laser treatment is advised to seal the the hole with laser . If not done , fluid can seep behind the retina and can eventually cause retinal detachment which will cause reduced vision and requiring surgery
If no tear/ break is noted , the patient needs to be followed up for 2 months because it usually takes 1-2 months for vitreous separation from the retina
Edit 1 – Eye floaters are also common post cataract surgery because vitreous start getting separated after cataract surgery. It annoys people for few months then it slowly resolves because floater moves forward and does not causes a shadow.
Distance between floaters and retina should be more than 4 mm for it to not cast shadows
When to see eye doctor immediately
- If you notice a sudden increase in black spots or floaters
- Flashes of light
- Loss of side vision
Treatment of floaters
In most of the cases , retina specialist advises patients to just ignore it and nothing needs to be done.
If patients is really bothered about it , then laser treatment or surgical treatment can be planned .
Laser treatment is called as “ Laser vitreolysis” in which laser energy is focussed on the floater and is evaporated. It will either undergo disintegration or may get moved away from centre causing less disruption of incoming light . This treatment is most effective if the floater is central and well organised and away from the retina to avoid laser induced retina damage.
Complications of laser treatment –
Worsening of floaters
Retinal haemorrhage, retinal breaks, and damage to retinal pigment epithelium which is the outer most layer of retina
Elevated eye pressure
Although above complication are rare to occur but yes , it can occur
Surgical treatment / Vitrectomy
Vitrectomy is a procedure in which , tiny incisions are made through white part of the eye and instruments are inserted inside the eye to clear the clumped up collagen fibres which are causing problems. Surgery usually lasts 30 min to 1 hour . Although this procedure provides the best result with success rates between 80-90% , but it is associated with its own set of complications . These are- Vitreous haemorrhage (blood inside the eye ) , retinal detachment , holes or break formation , cataract formation , macular hole formation , retinal edema .
Eventually the patient should make an informed decision based on whether living with the functional consequences of a non-blinding condition outweighs the option of a highly efficacious but not risk-free procedure.
Other causes of floaters-
- Vitreous haemorrhage – Called as blood inside the eye which can give a feeling of floater .
Causes of vitreous haemorrhage –
Diabetes (Diabetic Retinopathy)
Hypertension ( Hypertensive Retinopathy)
Retinal break involving vessel
Inflammation of retinal vessels (Vasculitis)
Blood coagulation disorders
- Asteroid hyalosis – It is a degenerative condition of the eye in which very small refractive bodies made up of calcium , phosphorus compounds
- Eye Lymphoma – It’s a type of blood cancer which can involve the eye . Subjects with decreased immunity eg -AIDS , people taking drugs to prevent the organ transplant rejection , are at risk of lymphoma.
- Infectious causes – Cysticercosis a kind of worm infection can form cyst inside eye and can present as floater .Toxoplasmosis , a kind of parasitic infection of eye can present as floaters due to intense inflammation inside the eye.
- Brain tumour – Tumour involving the occipital lobe , which process the light information , can have floaters like symptoms
A case report also mentioned , patient seeing floater after brain irradiation.
- Amyloidosis – It’s a rare disease characterised by abnormal deposition of protein. Can affect any organ and eye is also spared. Vitreoretinal involvement can present as floaters.
Do see your eye doctor . Don’t ignore floaters .