Flashes & Floaters
Flashes and floaters of the eye are usually the result of age-related changes to the vitreous, which is the thick gel firmly attached to the retina from birth. During the aging process, however, the vitreous becomes thinner and more watery, and at some point pulls away from the retina. This is known as a posterior vitreous separation or detachment (PVD). During PVD, tissue debris that was once secure in the firm vitreous gel loosens and moves around, casting shadows on the retina.
When this occurs, patients experience visual disturbances in the form of flashes of light, or floaters (specks or strands across the field of vision). These symptoms are not typically a reason for undue concern, but should, nonetheless, be evaluated by an ophthalmologist.
Causes of Flashes & Floaters
Flashes occur as a result of pressure on the retina, the bundle of nerves in the back of the eye where images are detected and transmitted to the brain. Such pressure causes patients to see either flashing lights or lightning streaks. Floaters occur when collagen fibers move across the vitreous and into the field of vision, causing patients to see specks, strands, webs or other shapes as the fibers cast shadows on the retina. Flashes and floaters are most visible when looking at a plain, light background.
Beyond simple aging, floaters or flashes appear most often in eyes that are injured, inflamed or nearsighted, and can be a result of the following:
- Cataract or YAG laser surgery
- Nearsighted vision
- Eye infections
- A blow to the head
- Injury to the eye
- Spasm of small blood vessels
The spasm (sudden constriction) of small blood vessels in the brain is also associated with migraine headaches.
Can Flashes and Floaters Cause Permanent Loss of Vision?
Flashes and floaters are signs of other conditions. As we age, all of us have an increase in floaters in our visual field as our vitreous transforms from being jelly-like to more liquid. Floaters are actually shadows cast by tiny clumps of gel or cells in the vitreous on the retina in the back of the eye. Flashes happen when the vitreous rubs or pulls on the retina. As the vitreous pulls away from the back of the eye with PVD, both of these signs are common.
However, if these are signs of a retinal tear leading to retinal detachment, this can lead to permanent vision loss if left untreated by a pars plana vitrectomy.
Can Eye Drops Help with Flashes and Floaters?
How Long Does it Take for Flashes and Floaters to go Away?
Flashes usually occur when vitreous body fibers pull on the retinal nerve cells, causing a sensation of a flash of light. It can be a small flash in just one spot or several flashes across a wider area. New floaters can accompany flashes. As long as the retina isn’t detaching, flashes are usually temporary events. Floaters take longer to go away, as the clumps break up. This can take weeks or even months. Some floaters may remain.
Diagnosing Flashes & Floaters
Most people who develop PVD do not suffer further complications. For a small percentage of people, however, PVD is caused by retinal tears. A retinal tear is quite dangerous because it can lead to retinal detachment, which can seriously threaten vision. Sudden onset of symptoms, or momentary blindness in one section of the field of vision, is cause for concern. Patients who experience either should seek immediate medical attention.
Because symptoms may be the same regardless of the cause of the problem, it is important that anyone experiencing unfamiliar disturbances in vision have an examination in which the pupils are dilated; this is the only way in which a retinal tear can be accurately diagnosed. This is one of the reasons that it is crucial for patients to undergo thorough eye examinations on a regular basis.
For patients initially diagnosed as having uncomplicated PVD, a small percentage will go on to have retinal tears within 6 weeks, so it is important that they follow up with their doctors. For patients with underlying causative conditions, such as illness or injury, other treatments may be necessary.
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Treatment of Flashes & Floaters
Although flashes and floaters are usually harmless and do not need treatment aside from regular monitoring, patients bothered by disturbances in their vision, or those experiencing significant visual interference, require medical intervention.
When treatment is necessary to reduce the appearance of flashes and floaters, it requires surgery to replace the vitreous gel. This procedure, known as a pars plana vitrectomy, removes the natural vitreous and replaces it with fluid.
In the case of a retinal detachment, emergency treatment is necessary to prevent serious complications. With treatment, most patients, even those with retinal tears, are able to maintain healthy vision.
What is the Pars Plana Vitrectomy Procedure?
These surgeries are generally performed with the patient under IV sedation and local anesthesia for the eye. The eye is dilated and then three tiny incisions are made in the pars plana, a safe area in the white part of the eye (the sclera). This is located just behind the iris but in front of the retina, so it provides excellent access to the back of the eye.
Instruments are passed through the three incisions:
- Light pipe —This serves as a microscopic, high-intensity flashlight for use within the eye.
- Infusion port — This is used to replace the fluid in the eye with a saline solution and to maintain proper eye pressure.
- Vitrector — This is a cutting device that removes the eye’s vitreous gel in a slow, controlled fashion. It protects the delicate retina by reducing traction while the vitreous humor is being removed.
- Endolaser — This laser probe will be used to seal retinal tears or remove any abnormal blood vessels in the eye.
Once the vitreous gel is removed, the eye is filled with a sterile saline solution or with a vitreous substitute such as a gas bubble or silicone oil. When a vitreous substitute is used, a period of post-operative positioning, typically face down, by the patient helps the retina heal.
What are the Risks of Surgery as a Treatment for Flashes or Floaters?
Most people who develop occasional flashes and floaters due to posterior vitreous separation don’t need treatment, other than keeping an eye on the retina for possible detachment. However, if the patient suffers a retinal tear, surgery is necessary.
Thanks to advances in instrumentation and techniques, vitrectomies are very successful procedures with low risk. These surgeries have over a 90 percent success rate for the different conditions they treat.
These are possible side effects of vitrectomies:
- Bleeding inside the eye
- Redness, swelling, and pain
- Increased intraocular pressure
- Reduced intraocular pressure
- Cataract formation or increased progression
- Swelling of the central part of the retina
- Change in vision
- Loss of night vision, blurriness, or depth perception problems
- Double vision
- Macular pucker (wrinkle) in the retina
- Loss of vision
- Retinal detachment
What is Recovery Like After a Pars Plana Vitrectomy?
The removal of the vitreous has little effect on the health of the eye. The saline solution or gas bubble that is used to replace the vitreous is gradually replaced by the eye’s own fluids (the aqueous humor).
After this procedure at our Physicians Eye Clinic surgery center, most patients can return home in an hour or even less. This may be a little longer if we fill your eye with a gas bubble or silicone oil, as you’ll need to lay face down for a while to keep the bubble in place initially. You’ll need someone to drive you home. If a gas bubble/silicone oil has been used, we’ll give you instructions on head positions and such.
We’ll provide antibiotic eye drops for about one week, and anti-inflammatory eye drop medications to keep intraocular eye pressure down for several weeks. You may have a sensation that there is something in your eye, but pain is not severe. You also may notice a decrease in vision quality for a few days following the procedure, but that will resolve quickly.