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What are eye floaters?

Eye floaters are spots that appear in a person's field of vision. They are usually small and semitransparent and are most noticeable when you look at a white background. When you move your eyes, spots and floaters seem to scoot rapidly along with them. When the eyes are still, the spots appear to drift slightly. They may be visible when the eye is in some positions but not in others.

Floaters come in different sizes and shapes and are most

common in nearsighted and older people. Some people see only a few spots, while others see many. Spots and floaters are usually harmless, particularly if they appear as small, elusive specks.

What causes eye floaters?

Floaters are caused by defects in the vitreous body — a clear, gel-like fluid that fills the eyeball. Normally, the vitreous body is uniform and transparent. Debris floating in the vitreous fluid or a thickening of the fluid itself blocks the incoming light rays and casts a shadow on the retina. This shadow is perceived as a floating spot in the field of vision.

Floaters that are present from birth appear when minute embryonic structures enter the vitreous body. In the elderly, particularly in people over 65, a normal shrinkage of the vitreous fluid tends to cause them. In early life, the vitreous is a solid gel that has direct contact with the retina, which lines the back of the eyeball. By middle age, however, the gel may pull away from the retina and cast shadows on the light-sensitive retinal cells, causing the appearance of numerous floaters.

Sometimes, fibers of connective

tissue or other debris may be present in the vitreous body for years but remain unnoticed until the vitreous gel collapses with age. The changing shape of the vitreous body can move this debris into the field of vision and create floaters.

As the vitreous body shrinks, it pulls on the retina and causes it to tear, creating a hole. Retinal holes usually form toward the outer edges of the eyeball. When the retina tears, its debris — blood cells and retinal pigment cells — enter the vitreous body and lead to the sudden appearance of numerous floaters.

A retinal hole can precipitate retinal detachment— the separation of the retina's light-sensitive inner surface from its outer layers. The first symptoms of retinal detachment are bright flashes of light accompanied by floaters at the edge of the field of vision.

Sometimes, floaters may be caused by vitreous hemorrhage —bleeding in the vitreous body generally due to a rupture of blood vessels in the eye. In such cases, the floaters appear as brown or red spots. The blood may float in the vitreous body and blur the vision, appearing as a clump or spot.

Another cause of floaters is inflammation of the retina or the uvea, the middle membrane of the eye that contains numerous blood vessels and gives the eye its color.

How are eye floaters diagnosed and treated?

To establish the cause of eye floaters, the doctor examines your eyes. The retina and the vitreous body are usually examined after pupil-dilating drops are administered. The doctor performs the examination with an ophthalmoscope — a deflected prism or a perforated-angle mirror that makes it possible to view the entire retina and the vitreous body.

What can I do myself?
There is no self-treatment for eye floaters.

When should I see my doctor?
See a doctor if eye floaters appear suddenly, if they turn brown or red, if their number increases abruptly, or if they interfere with your vision.

What will the doctor do?
The doctor will examine your eyes and test your vision. The goal of the examination is to establish whether eye floaters are due to a cause that requires treatment, such as bleeding, retinal detachment, or inflammation of the uvea.

If floaters are not due to such conditions, no treatment is required. In most cases, the floaters are harmless and require no treatment. If treatment is required, it depends on the underlying cause.

The course of eye floaters

Floaters present from birth usually remain stable throughout life, while those that appear later in life due to changes in the vitreous body may diminish or disappear within weeks or months. If the floaters are caused by mobile particles or debris, their location may change with time and the visual disturbance they cause may disappear. Some floaters, however, remain indefinitely, although with time people tend to notice them less.

When floaters are caused by a tear in the retina, they may last only several days until the debris from the tear is cleared. Sometimes, however, they may persist for months.

If the retina is becoming detached, vision eventually begins to disappear, usually starting at the edges of the visual field and gradually contracting. The loss of sight may not begin until several days or even a few years after the floaters first become apparent.

Are eye floaters dangerous?
In the vast majority of cases they are not. However, they may be a sign of a condition that warrants prompt medical intervention.