Eye Floaters - Causes and treatment 1

Eye floaters are spots in the vision that are common as you get older. They are often harmless but can sometimes be a sign of more severe eye diseases.

Find out more about what causes eye floaters, when to seek professional help and the treatment options available below. If you have questions about eye floaters and the options that are available for you, please call us on 0203 369 2020, or request a call back.

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What are eye floaters?

Eye floaters are spots in the vision that can look like cobwebs, black or grey dots or lines that take on various shapes or flies. Hence they are also called “muscae volitantes”, or Latin for “flying flies”. They tend to move or float in the vision.

Floaters are common with increasing age and tend to be harmless. They can sometimes interfere with vision, and affect one’s daily quality of life. Occasionally, eye floaters can be a sign of more worrying eye disease that can lead to permanent loss of sight.

Symptoms related to eye floaters

Urgent:

See an eye doctor immediately if you notice one or more of the following symptoms:

Sudden onset of new eye floaters
Sudden onset of lots more eye floaters
Loss of peripheral vision, like a grey curtain coming across your vision
Flashing lights

Any of the above symptoms can indicate a retinal tear or retinal detachment, which could lead to permanent blindness.

Non-urgent:

If you have persistent eye floaters that have not changed but interfere with the clarity or quality of vision, see one of our retinal surgeons to establish a diagnosis, and understand the treatment options that may be available to improve your sight.

What causes eye floaters

In the eye there is a gel-like structure called the vitreous. At birth, the vitreous is completely clear and transparent. It is also fully attached to the retina, the delicate layer of cells at the back of the eye that captures external light, sending it to the brain, enabling sight.

Floaters are caused by changes to the vitreous gel, due to causes that include:

Age. This is the most common cause. The vitreous starts to change from a gel to a liquid. As it liquifies, ‘clumps’ can form in the vitreous gel, reducing its transparency and clarity. As light enters the eye, these ‘clumps’ can cast shadows on the retina – this is what you may perceive as floaters. Liquification of the vitreous gel is also known as vitreous syneresis or degeneration, and eventually leads to separation of the vitreous from the retina, called posterior vitreous detachment. Age-related eye floaters are very common. If you look at a clear blue sky, a few eye floaters can often be seen. The brain tends to do a very good job of adapting to and ignoring them. In some people, floaters remain visible and can interfere with the clarity of vision and affect daily life. They can be visually quite troublesome.
Myopia or short-sightedness. This accelerates liquification of the vitreous gel.
Retinal tear or detachment. Occasionally, eye floaters that develop or change suddenly, particularly when associated with loss of vision, can be due to a more worrying problem like a retinal tear or retinal detachment that may require immediate assessment and treatment by a retinal surgeon.
Bleeding or vitreous haemorrhage. This is bleeding into the vitreous gel, associated with conditions such as diabetes or retinal vein occlusion
Inflammation of the eye. Intermediate or posterior uveitis can cause floaters.
Previous eye surgery. Any prior surgery in the eye, eg cataract surgery and YAG laser capsulotomy, can cause floaters.
Severe eye trauma.

Should I be worried about eye floaters?

This really depends on the reason eye floaters have developed. The most common cause is the normal ageing change of the vitreous gel, which is not dangerous.

However, there other causes that can lead to permanent loss of sight, sometimes within 24 hours, due to a retinal tear or retinal detachment.

Treatment options for eye floaters

Observation is appropriate if eye floaters are caused by age-related changes and are not interfering with the clarity and quality of vision.
YAG laser vitreolysis. This uses a laser that disperses a large floater into multiple smaller pieces, rather than removing it (see vitrectomy below). There are also multiple reports of complications and damage to the lens and retina following YAG laser. Therefore we do not recommend YAG laser for floaters.
If floaters are visually troublesome and affect your daily quality of life, surgical treatment can be considered. An operation called vitrectomy, can effectively clear floaters through removal of the vitreous gel. Interestingly, the main function of the vitreous is to help the eye develop when we are in our mother’s womb, and thus can be safely removed if needed. The risk of complication is relatively low, with less than a 1 in 1000 chance of severe infection of bleeding to cause loss of sight. A cataract can develop in some patients subsequently, which may require further treatment.