What is an eye floater?
Most of the eyeball is filled with a transparent jelly-like material called the vitreous, which is located on the posterior part of the eye, between the lens and the retina. 98% of the vitreous consists water with the rest made of various salts, sugars, proteins and collagen fibers. In case of a healthy young people, the vitreous is almost completely clean, however over time, the gel material transforms and collapses. During this process (called syneresis) the gel liquefies, the collagen fibers clumps together to form point-like, strand or other irregular floating opacities, which are seen in the form of hairs, cobwebs or flying flies. These floating opacities within the eye’s vitreous body are called floaters.
How do floaters appear?
The liquefaction of the gel and the clumping of the collagen fibers forming the floaters are part of the physiological transformation of the vitreous body which comes with time. With eye movements these vitreous opacities will change their positions and can drift in and out from our line of vision. A sudden blurry vision or a sudden change in the number or size of these floaters most often indicates that the vitreous body has entered the liquefaction phase as it moves away from the retina. This process is called posterior vitreous detachment, which is most common in middle-aged people. Depending on their size and location, floaters can become distracting at a younger age too. The uncomplicated vitreous detachment itself is a harmless process and should not be confused with retinal detachment, which is medical emergency requiring surgery most of the time.
Why do we see the floaters?
These clumping of the vitreous gel projects disturbing shadows on the retina, which are perceived in the form of dots and spots, strands or rings that drifts away with eye movement.
Do eye floaters go away?
You can get used to the vitreous opacities, but they do not disappear without treatment.
How does your doctor see the floaters?
A healthy vitreous is transparent, but if this becomes hazy and floaters appear in it, your ophthalmologist will see them as gray dots, strings, veil or ring-like formations. With the exception of the larger opacities like the so called Weiss ring, the identification of the point-like or small and thin strands require special practice from your ophthalmologist as does the identification of their possible connection to the retina.
What types of vitreous opacities are there?
Vitreous opacities can be grouped by shape, origin, material and location.
Depending on their shape there are point-like, bundled, or network-like vitreous opacities. Within this, a special form is represented by the bigger haze named Weiss ring.
According to their origin vitreous opacities can be listed as inflammatory, hemorrhagic, degenerative (asteroid hyalosis), collagen fibrous or other tissue origin (ocular lens capsule, retinal operculum).
Their composition is varied as hydroxyapatite, cholesterol, protein or cellular origin can be distinguished.
Depending on their location, they can be separated into intragel or interface opacities.
Not all of the above mentioned opacities are eligible for treatment, so the separation of subtypes thereof is crucial.
Can we see floaters in other diseases too?
Symptoms similar to vitreous syneresis may occur in other diseases, such as in inflammatory eye diseases (uveitis), cancerous eye diseases or vitreous hemorrhage (bleeding). The latter most commonly is a result of a retinal tear, diabetic retinopathy or macular degeneration. In some cases, the detachment of the vitreous is prolonged or complicated, in which case flashes of light may occur and remain for many weeks. The sudden appearance of many small dots in the visual field can suggest retinal tear, the sudden onset of blurry or low vision suggest vitreous bleeding, whereas a significant visual impairment which starts as a black curtain after the previously mentioned signs means a retinal detachment. Because the origin of floater can’t be identified solely on the basis of symptoms, it is of paramount importance to have an ophthalmologic examination with dilated pupil as soon as possible after the onset, as the aforementioned conditions requires early treatment.
The floaters can be treated with laser.