What to Know About Eye Floaters

Floaters can be signs of a posterior vitreous detachment, in which the vitreous separates from the back of the retina — something relatively common after age 50. “All of a sudden, there will be a ton of new floaters or they’re much larger than the individual has ever been used to,” says Vivienne Hau, M.D., an ophthalmologist and retina specialist at Kaiser Permanente in Southern California. 

It sounds serious but usually isn’t a cause for concern: About 85 percent of patients who experience a posterior vitreous detachment never develop complications, Hau says, and “most symptoms subside within three months.”

On the other hand, a retinal tear or detachment is much less common but can become a serious problem.

Other causes of floaters include:

• Bleeding in the eye
• Eye infections
• Eye injury
• Inflammation of the eye called uveitis
• Solar retinopathy, which can occur from looking at a solar eclipse, exposure to bright lights, or prolonged reflection from snow

Who is at risk for eye floaters

People who are very nearsighted (myopic) are at higher risk for floaters: “The eyes of nearsighted people are longer than average,” Wang explains. “The vitreous then has to fill a larger space, which makes it more prone to developing the strands and liquid consistency sooner than those with smaller eyes.”

People who have uncontrolled diabetes are also at higher risk because they may have bleeding in the retina, which can manifest as floaters, explains Sean Ianchulev, M.D., professor of ophthalmology at the Icahn School of Medicine at Mount Sinai in New York City.

And trauma, such as a car accident or a punch in the eye, can cause a posterior vitreous detachment or a tear. Recent eye surgery, such as cataract surgery, can do the same.  

When to contact an eye care provider

If floater changes are minor or gradual, there is no need to be concerned. But if the changes are drastic — such as a dramatic increase in the number of floaters, the sudden onset of floaters, seeing something that looks like a curtain coming down over your vision, or any other decline in your ability to see — it can be a warning sign of a retinal tear or detachment. In this respect, “floaters are our friends,” Ianchulev notes. 

If you notice these signs, see an eye doctor right away or go to the emergency room. Ideally you will want to see a retinal specialist, “they are the most prepared specialists to diagnose and treat these problems and handle cases on an on-call basis,” Wang says.

Just be sure you receive a dilated eye exam. “Going for a quick vision check is not enough,” Ianchulev says. The doctor will place drops in each eye to widen the pupil (the opening in the center of the iris, the colored part of the eye), which allows more light to enter the eye. Then each eye is examined with a magnifying lens that provides a clear view of the back of the eye, including the retina, macula and optic nerve. The doctor will be able to see whether there has been a tear or a detachment. Neither one causes any pain because there are no pain receptors in the eye, so the exam is the only way to detect damage, Hau says. If you experience pain, that means there’s generally something on the surface of the eye, not within the eye.

While your eyes are dilated, your vision will be blurry and the effects may last for four to five hours. You should plan to have someone drive you home. And bring sunglasses: Your eyes will be sensitive to light.

Treatment for eye floaters

If eye floaters are not due to a retinal tear or detachment and are merely a minor annoyance in your vision, you do not need to get them treated. Symptoms often get better or floaters become easier to live with or ignore. However, there are two instances where you would need treatment–and that’s in the event of a tear or detachment or if floaters are seriously debilitating to your sight.

If you catch a retinal tear early enough, you can have a laser procedure to have it repaired. This can be done in a doctor’s office, and you’ll go home the same day.

With a retinal detachment, the retina separates from the back wall of the eye, like wallpaper peeling off a wall, according to the American Society of Retina Specialists (ASRS). This is an emergency situation and, if not treated promptly, can cause permanent vision loss. But if you act fast, you can save your sight. According to ASRS, retinal detachment repairs have a 90 percent success rate.

If your eye floaters are not caused by a retinal tear, detachment, or other serious eye condition but still impair your vision to the point that they affect your quality of life—such as making it difficult to drive safely or work effectively—your eye care provider may discuss two possible treatment options with you:

• Vitrectomy: An outpatient surgery involves removing the vitreous gel and replacing it with another fluid. Overtime, your body will make more vitreous to replace it. There are risks to this procedure, including retinal tears and detachment, so talk to your provider about the risks and benefits to help you make the best decision for your eyes, says the NEI.
• Laser vitreolysis: Also known as laser floater treatment, this procedure takes 10 to 15 minutes. After you receive numbing eye drops or local anesthetic, a device will hold your eye open as a laser focuses on the floaters and vaporizes them into a gas that is reabsorbed in the eye. Relief is expected within about 30 minutes. Risks are extremely rare but may include increased intraocular pressure, which can lead to glaucoma, cataracts, retinal tears, retinal detachment, retinal hemorrhage, and an increased number of floaters.