Floaters, Flashes, and Retinal Tears

Floaters appear as small spots that drift through your field of vision. They can come in any shape or size but are commonly described as circular dots or squiggly strands or cobwebs. They are called floaters because they move around in your eye and tend to dart away when you try to focus on them.

Most floaters come from the natural collagen fibers in the vitreous which is the gel-like substance filling the core of your eye. They cast a shadow on your retina.  It is normal for people under the age of 50, especially, those who are near-sighted to see floaters chronically, and more so in certain lighting conditions.

However, when sudden onset of new floaters appear, it is usually due to a vitreous detachment which typically occurs at the ages of 50-75. This is a natural phase due to aging of the vitreous allowing the vitreous to suddenly pull away from the retina. The separation can be vigorous enough to cause flashing lights from electrical stimulation of retinal cells.

Sometimes the vitreous pulls and tears the retina. A retinal tear is considered an urgent condition requiring evaluation and treatment within twenty-four hours due to the risk of progression into a retinal detachment. Therefore, patients with new floaters and/or flashes should be evaluated within 1-2 days of onset to evaluate for the possibility of tears even though these symptoms are not usually associated with tears. There is no way to know if a tear is present without a careful examination by a qualified eye care provider.

Conditions that increase the risk of retinal tears include nearsightedness or myopia, previous ocular surgery such as cataract surgery, previous ocular injury, history of retinal detachment in the fellow eye, and family history of retinal detachment.

Early evaluation and treatment is critical as most retinal detachments can be prevented if tears are detected and treated early.  Treatment usually involves an in-office laser treatment which usually prevents a retinal detachment.  Unfortunately, most retinal detachments require surgery which likely could have been prevented with early detection.

Photo of retinal tear after laser treatment to prevent retinal detachment.

Photo of untreated retinal tear which led to a retinal detachment.