Floaters

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Introduction

Introduction

Floaters are small shapes that some people see floating in their field of vision.

They can be different shapes and sizes and may look like:

  • tiny black dots  
  • small, shadowy dots  
  • larger cloud-like spots 
  • long, narrow strands

You may have many small floaters in your field of vision or just one or two larger ones. Most floaters are small and quickly move out of your field of vision.

Floaters are often most noticeable when you're looking at a light-coloured background, such as a white wall or clear sky.

Do floaters affect vision?

Floaters sometimes occur without a person noticing them. This is because the brain constantly adapts to changes in vision and learns to ignore floaters so they don't affect vision.

Floaters are usually harmless and don't significantly affect your vision. However, it's important you have your eyes checked by an optician regularly (at least once every two years).

Larger floaters can be distracting and may make activities involving high levels of concentration, such as reading or driving, difficult.

Find an optician near you.

What causes floaters?

Floaters are small pieces of debris that float in the eye's vitreous humour. Vitreous humour is a clear, jelly-like substance that fills the space in the middle of the eyeball.

The debris casts shadows on to the retina (the light-sensitive tissue lining the back of the eye). If you have floaters, it's these shadows you'll see.

Floaters can occur as your eyes change with age. In most cases, they don't cause significant problems and don't require treatment.

In rare cases, floaters may be a sign of a retinal tear or retinal detachment (where the retina starts to pull away from the blood vessels that supply it with oxygen and nutrients).

Read more about the causes of floaters.

Floaters can't be prevented because they're part of the natural ageing process.

When to seek medical help

Visit your optician immediately if you notice an increase or sudden change in your floaters, particularly if you notice white flashes and some loss of vision.

Your optician may refer you to an ophthalmologist (a specialist in diagnosing and treating eye conditions) who can check your retina for tears or retinal detachment.

Even though floaters are usually harmless and don't significantly affect your vision, it's important you have your eyes checked regularly by an optician (at least once every two years).

Read more about diagnosing floaters.

Treating floaters

In most cases, floaters don't cause major problems and don't require treatment. Eye drops or similar types of medication won't make floaters disappear.

After a while, your brain learns to ignore floaters and you may not notice them.

If your floaters don't improve over time, or if they significantly affect your vision, a vitrectomy may be recommended. This is a surgical operation to remove the vitreous humour in your eye along with any floating debris and replace it with a saline (salty) solution.

If your retina has become detached, surgery is the only way to re-attach it. Without surgery, a total loss of vision is almost certain. In 90% of cases, only one operation is needed to re-attach the retina.

Read more about treating floaters.



Causes of floaters

Causes of floaters

Floaters are caused by small pieces of debris that float in the vitreous humour of the eye.

They occur behind the lens and in front of the retina. The lens is a small clear structure that focuses light as it enters the eye. The retina is the light-sensitive tissue lining the inside surface of the back of the eye.

Vitreous humour is a clear, jelly-like substance that fills the space in the middle of the eyeball. It is mostly (99%) made up of water.

Floaters occur as part of the natural ageing process. Some people may have posterior vitreous detachment (PVD), where the vitreous jelly comes away from the retina (see below). This may cause a sudden increase in the number of floaters.

Ageing process

As you get older, your risk of developing floaters increases. They tend to occur in people over 40 years of age, and are most common in those in their 60s and 70s. However, some younger people may also develop floaters.

As you get older, the vitreous humour in the middle of your eyeball can become softer, and strands of a protein called collagen may become visible within it. The collagen strands may appear to swirl as your eyes move.

Normally, light travels through the clear layer of vitreous humour to reach the retina. The light-sensitive layer of cells at the back of your eye that form the retina transmit images to your brain via the optic nerve. Any objects in the vitreous humour, such as floaters, will cast shadows onto the retina.

Posterior vitreous detachment (PVD)

Floaters can be a symptom of PVD. This is a common condition that occurs in around three-quarters of people over 65 years of age. PVD can occur as a result of changes to the vitreous humour as the eye gets older.

As your eye ages, the central part of the vitreous humour becomes more liquid, and the outer part, known as the cortex (which contains more collagen), starts to shrink away from the retina. Floaters develop as a result of the collagen thickening and clumping together.

As well as floaters, flashing lights can be another symptom of PVD. This can occur if the outer part of the vitreous humour pulls on the light-sensitive tissue of the retina. The pulling stimulates the retina, which causes your brain to interpret it as a light signal and create the sensation of flashing lights.

The RNIB has more information about PVD

Retinal tears

In about half of all people, the vitreous humour has separated from the retina by the time they're 50 years old. This doesn't usually cause any problems and most people aren't even aware it's happened.

In a few cases of PVD, when the vitreous humour pulls on the retina, it can cause the tiny blood vessels in the retina to burst and bleed into the vitreous humour. The red blood cells may appear as tiny black dots or they may look like smoke. However, as the blood is absorbed back into the retina, these floaters tend to disappear over the course of a few months.

In some cases, the vitreous humour remains attached to parts of the retina and tears the retina as it pulls away. If the retina tears, retinal pigment cells that escapes into the vitreous humour can cause a shower of floaters all at once. You may also see flashes of bright, white light in your field of vision that look similar to lightning streaks.

It's important to be aware that flashes in your vision aren't necessarily a sign of retinal tears or retinal detachment (see below). They may have another cause, such as a migraine with aura (a headache with a zigzag pattern across your field of vision).

Floaters and flashes don't usually cause long-term visual impairment. However, if you experience them, you should visit an optician to have your eyes examined.

Find an optician near you.

Retinal detachment

If you have a retinal tear, you'll need to be treated as soon as possible, because tears can lead to retinal detachment. This is where the retina separates from the wall at the back of the eye, which can damage your sight.

Retinal detachment is rare, affecting about 1 in every 10,000 people each year. It's more common in people with short-sightedness (myopia).

After the light has passed through the eye and reaches the retina, the retina changes the light into meaningful electrical signals. The signals are sent through the optic nerve to the brain, where they're translated into the images you see.

If the retina is damaged, the images received by your brain will become patchy or may be lost completely.

In rare cases, floaters may be a sign of retinal detachment. If your retina is detached, you'll usually experience:

  • a large number of floaters
  • bright, flashing lights
  • some loss of vision

If you think you may have retinal detachment, seek immediate medical attention from either your GP or optician.

Read more about retinal detachment.

Other causes

If you've had eye surgery, such as cataract surgery, you're more likely to experience floaters, PVD and, more rarely, retinal tears and retinal detachment. In some cases, floaters may also be caused by: 

Floaters are also more common in people who have:

  • short-sightedness (myopia) - where distant objects appear blurred, while close objects can still be seen clearly
  • diabetes - a lifelong condition that causes a person's blood sugar level to become too high

As floaters and flashes can be caused by a number of eye conditions, some of which can affect your vision, it's always best to have your eyes checked by an eyecare specialist. You should also visit a specialist if you have floaters or flashes that get worse.

Read more about how floaters are diagnosed.



Diagnosing floaters

Diagnosing floaters

Although floaters are usually harmless and don't significantly affect your vision, you should have your eyes checked by an optician on a regular basis (at least once every two years).

You can use the postcode search facility to find opticians in your local area.

Tell your optician if you think you may have floaters. They may ask about your:

  • symptoms - including how long you've had floaters
  • medical history - for example, whether you've previously injured your eye or had eye surgery

Visit your optician immediately if a new floater suddenly appears or if there's a rapid increase in the number of floaters you can see. They may refer you to an ophthalmologist (a specialist in diagnosing and treating eye conditions).

In rare cases, floaters may be a sign of retinal tears or retinal detachment. The ophthalmologist will check for this by examining your retina (the light-sensitive layer of cells lining the back of the eye).

Examining the retina

By looking through your pupil, the ophthalmologist will be able to see a small part of your retina. The pupil is the hole at the front of your eye that increases and decreases in size, depending on the light conditions.

If the ophthalmologist needs a clearer view of your retina, a procedure known as dilation may be used. This is where eye drops are used to widen your pupil so the whole of your retina can be examined.

The ophthalmologist may use an instrument called a slit lamp to examine your eyes. A slit lamp has a lens and a bright light to enable the inside of your eye to be examined. After the examination, your vision may be a little blurry and your eyes will be sensitive to light for a few hours. You should avoid driving while your eyes remain dilated.

Other tests

To get a better understanding of your eye symptoms, the ophthalmologist may also carry out other tests. For example, they may:

  • ask you to look in different directions
  • push on your eye using a special instrument
  • examine your retina more closely using a bright light

Eye pressure test (tonometry)

An eye pressure test (tonometry) uses an instrument called a tonometer to measure the pressure inside your eye (intraocular pressure).

During the test, a small amount of anaesthetic and dye will be placed onto your cornea (the transparent layer of tissue that covers the front of the eye).

A blue light from the head of the tonometer will be held against your eye to measure the intraocular pressure.



Treating floaters

Treating floaters

In most cases, floaters don't cause significant problems and don't require treatment.

Eye drops or similar types of medication aren't effective and won't make floaters disappear.

After a while, your brain may learn to ignore floaters and you may not notice them.

Monitoring your condition

If you have floaters, your optician may ask you to return for a follow-up appointment two to six months after your symptoms begin, to check that your retina is stable. The retina is the light-sensitive layer of cells that line the inside of the back of your eye.

If your vision is unaffected and your floaters aren't getting any worse, you may be advised to have an eye appointment every one to two years. However, if your symptoms worsen at any time, you should seek immediate advice from either your GP or optician.

Vitrectomy

A vitrectomy is a surgical procedure to remove the vitreous humour in your eye, along with any floating debris, and replace it with a saline (salty) solution.

A vitrectomy may be recommended as a possible treatment option if you have floaters that don't improve over time, or if they significantly affect your vision. However, vitrectomies are rarely carried out due to risks associated with eye surgery, and the procedure may not be available on the NHS.

Before having a vitrectomy, your eye will be numbed with a local anaesthetic. During the procedure, the vitreous humour will be removed from the vitreous body of your eye and replaced with saline solution.

As the vitreous humour is mostly made up of water, you won't notice any difference to your vision after having a vitrectomy. However, possible complications may include: