Flashes, Floaters, and Retinal Tears

The eye is filled with a clear, jelly-like substance called the vitreous. Due to natural age-related changes in the vitreous, small clumping and liquefaction of the vitreous jelly causes the visual appearance of small dots, circles, lines, or cobwebs. These symptoms are often sudden in onset and frequently of little consequence and reflect normal aging processes in the eye.  When the vitreous gel has liquefied enough so the entire back surface of the jelly separates from the underlying retina, the separation is called a posterior vitreous detachment (PVD). Again, the frequency of PVDs increases with age and no treatment is necessary.

The symptom of flashes of light are due to sudden stimulation of the retina, usually due to traction from the vitreous jelly. Flashes frequently occur during or shortly after PVD. Other causes of ocular flashes of light can originate in the visual centers of the brain, such as what may precede a migraine headache.

While flashes and floaters usually reflect normal age-related changes in the eye, it is essential that the patient has a  dilated retinal evaluation to ensure there is no underlying retinal tears or holes. During or after a PVD, traction from the vitreous jelly can cause a tear in the retina and/or retinal blood vessels, which necessitates treatment. Tears in the retina are treated seriously, as they can predispose the patient to retinal detachments, and need to be sealed-off with either laser or a freezing therapy.

Floaters are frequently annoying and can be bothersome to the patient, as they can interfere with clear vision. Often, floaters will break-up or settle over time, making the less noticeable, but will persist in some fashion, throughout life. Only if the floater is debilitating and interfere significantly with a patient’s vision, should surgical intervention be employed to remove the vitreous gel.