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Eye floaters are specks or strings that appear to move through a person's field of vision but do not correspond to external objects. Floaters are common.
Eye floaters result when something besides light from the environment stimulates the retina, which is the light-sensing structure at the back of the eye. This stimulation causes the retina to send a signal to the brain. The brain may interpret the signal as an apparent object floating in the field of vision (floater) or as a simple, sudden flash of light that can look like lightning, spots, or stars (photopsia). Photopsias can occur when the eyes are rubbed.
The most common cause of eye floaters is
Between about age 50 to 75 years, the vitreous humor shrinks and tugs on the retina from time to time. These tugs stimulate the retina, giving the illusion of light or objects, seen as floaters. Such floaters (idiopathic vitreous floaters) are not harmful. Less often, the vitreous humor pulls completely away from the retina (vitreous detachment).
Less common but more serious causes include
Sometimes migraines cause vision symptoms. These vision symptoms may be white, jagged flashing lines that appear first in the middle of the field of vision and then spread across the entire field of vision (not single objects like floaters). They typically then resolve over about 20 minutes, disappearing first from the peripheral field of vision and last from the center of the field of vision. People may not have a headache with them. These symptoms are called ocular or visual migraine. People can also have similar symptoms or lose vision in part of an eye for about 10 to 60 minutes, often before a migraine headache begins (called migraine aura). In these cases, symptoms are caused by a phenomenon in the brain, not in the retina.
In people with floaters, certain symptoms and characteristics are cause for concern. They include
Although most often floaters are not serious, people who have warning signs should see an eye doctor as soon as possible. They may have a serious vitreous or retinal disorder, and waiting a few days, or sometimes even hours, may lead to a permanent loss of vision. People without warning signs who have begun to notice a few floaters should see a doctor when practical, although a delay of a few days or more is unlikely to be harmful. People who have had floaters for some time and have no other symptoms should have an eye examination at some point, but timing is not critical.
Doctors first ask questions about the person's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the floaters and the tests that may need to be done (see Table: Some Causes and Features of Eye Floaters).
Doctors ask the person to describe the floaters and then ask
When the person noticed floaters
What characteristics the floaters have (for example, shapes, movement, or whether they recur)
Whether floaters occur in one or both eyes
Whether the person sees flashing lights or whether any part of vision is missing or seems covered by a curtain
Whether the person has had an eye injury or eye surgery
Whether other symptoms (such as blurred vision, eye redness, eye pain, or headaches) are present
Whether the person is nearsighted
Whether the person has disorders that may affect vision, such as diabetes or immune system disorders (for example, AIDS)
The eye examination is the most important part of the physical examination. Doctors check sharpness of vision, eye movements, and the pupil's response to light. They also check the eyes for redness and the visual field for areas of vision loss.
Ophthalmoscopy is the most important part of the eye examination. Doctors first use drops to dilate the pupils. Then they use an ophthalmoscope (a light with magnifying lenses that shines into the back of the eye) to examine the inside of the person's eyes, including as much of the retina as possible. If one of the serious causes of floaters seems possible, an evaluation by an ophthalmologist is critical. An ophthalmologist is a medical doctor who specializes in the evaluation and treatment (surgical and nonsurgical) of eye disorders.
Pressure in the eye (intraocular pressure) is measured after a drop of anesthetic is put into the eye.
Doctors put a drop of fluorescein stain in the eye and then use a slit lamp (an instrument that enables a doctor to examine the eye under high magnification) to examine the entire eye.
Some Causes and Features of Eye Floaters
Doctors can often identify less serious causes of eye floaters during an examination, but if a serious disorder seems possible, doctors refer people to an ophthalmologist to make a diagnosis. Ophthalmologists are medical doctors who specialize in the evaluation and treatment (surgical and nonsurgical) of eye disorders. The ophthalmologist does more detailed ophthalmoscopy and may order testing. For example, for vitreous inflammation due to infection, testing to identify organisms suspected of causing infection may be needed.
Vitreous contraction floaters are floaters due to shrinking of the jellylike substance that fills the back part of the eyeball, called the vitreous humor, and require no treatment.
Sometimes if a person has many floaters that interfere with vision, doctors may use a hollow needle to remove the vitreous humor from the eye and replace it with salt water. This surgical procedure is called vitrectomy. However, many doctors think vitrectomy should not be done for floaters because the procedure may cause detachment of the retina or cataracts and because sometimes floaters remain afterward.
Other disorders causing symptoms are treated. For example, surgery is done to repair a detached retina. Antimicrobial drugs are used for infections causing vitreous inflammation.
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