Flashes and Floaters

The sudden appearance of light flashes or floating spots can be a rather dramatic event occurring within the vitreous body of the eye. The vitreous is the jelly-like material which fills the large central cavity of the eye. It is 90% water with the remaining portion being fibrous proteins. These fibers are what give the vitreous a stiff consistency similar to gelatin. The vitreous has normal connections to the retina, the light sensitive layer lining the back of the eye.

As we age, there is shrinkage of the overall volume of the vitreous. With this comes a contraction of the fibrous elements away from the retina. This is called a POSTERIOR VITREOUS DETACHMENT. The resulting traction on the retina is responsible for the characteristic "flashes" which often accompany PVD's. The "floaters" are typically fibrous clumps within the vitreous. However, in some cases, they are actually from some fragments of retina which may have been dragged into the vitreous cavity by this separation.

It is important that all eyes with recent onset of flashes and floaters be examined carefully by an eye doctor. Most of the time, nothing unusual is found and simple reassurance is all that is needed. The flashes eventually go away, and the floaters diminish and become less bothersome with time; however, in some eyes with a posterior vitreous separation, a tear in the retina may occur. If left untreated, these tears may lead to a retinal detachment. A retinal detachment is a very serious sight threatening condition requiring a major surgical procedure to repair. Even in the best of hands, the results can be very unpredictable.

If retinal tears are found, treatment is much easier and more effective. They can be sealed off to prevent a retinal detachment. This is done either by "spot welding" several circles of burns around the tear with a laser, or by sealing it with a freezing unit. Both accomplish the same purpose with good results and low complications rates. The procedure is done on an outpatient basis under local anesthetic.

When flashes and floaters appear, it is important to examine the eye within a few days of their onset. Changes can occur rapidly, and time can be of the essence if a retinal detachment is present. If all is normal in the first occurrence, one cannot assume that subsequent occurrences will be harmless also. Each event should be carefully examined and treated if necessary.

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