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Eye Flashes and Floaters

By

Christopher J. Brady

, MD, Wilmer Eye Institute, Retina Division, Johns Hopkins University School of Medicine

Last full review/revision Dec 2019| Content last modified Dec 2019
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NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
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Eye flashes are a person's perception of bright flashes of light, flickering lights, or streaks of light that do not correspond to external sources. Eye floaters are specks or strings that appear to move through a person's field of vision but do not correspond to external objects. Flashes and floaters are common.

Causes

Eye flashes 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 a simple, sudden flash of light that can look like lightning, spots, or stars (photopsia). Photopsias can occur when the eyes are rubbed.

Eye floaters are seen when an object in the eyeball casts a shadow on the retina, which is the light-sensing structure at the back of the eye. This is often interpreted as an apparent object or objects floating in the external field of vision. A person may think they are seeing a swarm of flies, gnats, or specks but then realize they are not actually present.

An Inside Look at the Eye

An Inside Look at the Eye

The most common cause of eye flashes and floaters is

  • Shrinking of the jellylike substance that fills the eyeball (vitreous humor)

In early adulthood people may notice occasional floating strands in the vision of one or both eyes relating to contraction of the vitreous humor. These types of floaters (called contraction or idiopathic vitreous floaters) rarely indicate anything harmful. Between about age 50 to 75 years, however, the vitreous humor continues to shrink and tugs on the retina from time to time. These tugs may stimulate the retina, giving the illusion of light, seen as flashes. Over time, the vitreous humor usually pulls completely away from the retina (vitreous detachment) as a normal part of aging.

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.

Flashes of light can also result from a blow to the back of the head ("seeing stars"), probably because of stimulation of the part of the brain where vision is interpreted.

Tumors (for example, lymphoma) of the eye and vitritis (inflammation of the vitreous humor) are rare causes of floaters. Foreign objects in the eye can cause floaters but usually cause other symptoms, such as vision loss, eye pain, or eye redness, that are more troublesome than floaters.

Table
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Some Causes and Features of Eye Flashes and Floaters

Cause

Common Features*

Diagnosis†

Eye disorders that are not worrisome

Vitreous contraction floaters (floaters due to shrinking of the jellylike substance that fills the back part of the eyeball, called the vitreous humor)

A few small, translucent clumps or strands that

  • Occasionally come into the field of vision

  • Move as the eye moves

  • May be more noticeable under certain lighting (such as bright sunlight)

  • May occur in both eyes, although not at the same time

No recent change in the number or type of floaters

No effect on vision

A doctor's examination

Detachment of the vitreous humor from the retina

A sudden increase in floaters, usually in older people

Floaters that resemble cobwebs

One large floater that moves in and out of the field of vision

Photopsias that come and go

Examination by an ophthalmologist

Eye disorders that are serious

Simple, sudden flashes of light that can look like lightning, spots, or stars (photopsias), that occur repeatedly or continuously

Loss of vision that affects one area, usually what is seen out of the corners of the eye (peripheral vision)

Loss of vision that spreads across the field of vision like a curtain

Sometimes in people with risk factors for detachment of the retina (such as a recent eye injury, eye surgery, or severe nearsightedness)

Examination by an ophthalmologist

A tear in the retina

Photopsias

Sometimes symptoms only in the peripheral field of vision

Examination by an ophthalmologist

Vitreous hemorrhage (bleeding into the vitreous humor)

In people who have risk factors for this disorder (such as diabetes, a tear in the retina, sickle cell disease, or an eye injury)

Usually loss of the entire field of vision (not in just one or more spots)

Examination by an ophthalmologist

Sometimes ultrasonography of the retina

Inflammation of the vitreous humor (as may occur when Toxoplasma parasites, fungi, or rarely cytomegalovirus infect the eye or caused by autoimmune disorders)

Pain

Loss of vision affecting the entire field of vision

Possibly affecting both eyes

In people with risk factors for these infections (such as AIDS, injection drug use, and other conditions that weaken the immune system)

Examination by an ophthalmologist

Sometimes testing to detect microorganisms suspected of causing infection

Disorders not related to the eyes

Ocular migraine (migraines that cause vision symptoms)

Jagged lines that appear first in the center of the field of vision, then spread outward, and disappear after about 20 minutes

Sometimes blurring of central vision

Sometimes a headache after the disturbances in vision

Sometimes in people known to have migraines

A doctor's examination

* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. Features occur in only one eye unless otherwise specified.

† Although a doctor's examination or an examination by an ophthalmologist is always done, it is only mentioned in this column if the diagnosis can sometimes be made only by the doctor's examination, without any testing. In other words, additional tests may not be needed.

Evaluation

Not every instance of eye flashes or floaters requires an immediate evaluation by a doctor. The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation.

Warning signs

In people with flashes or floaters, certain symptoms and characteristics are cause for concern. They include

  • Sudden increase in floaters

  • Repeated, often lightning-like flashes of light

  • Complete or partial loss of vision (often feeling like part of the vision is covered by a shade or curtain)

  • Recent eye surgery or eye injury

  • Eye pain

When to see a doctor

Although most often flashes and 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 flashes and 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 flashes or floaters for some time and have no other symptoms should have an eye examination at some point, but timing is not critical.

What the doctor does

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 flashes or floaters and the tests that may need to be done (see table Some Causes and Features of Eye Flashes and Floaters).

Doctors ask the person to describe the flashes and floaters and then ask

  • When the person noticed symptoms

  • What characteristics the flashes floaters have (for example, shapes, movement, or whether they recur)

  • Whether symptoms 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 flashes or 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.

Testing

Doctors can often identify less serious causes of eye flashes and floaters during an examination, but if a serious disorder seems possible, doctors refer people to an ophthalmologist to make a diagnosis. 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.

Treatment

  • For vitreous contraction floaters, no treatment

  • Sometimes vitrectomy

  • Treatment of other causes

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. Many flashes are also due to shrinking of vitreous substance and do not require 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.

Key Points

  • People who have flashes or floaters but no warning signs rarely have a serious disorder.

  • People with flashes or floaters and warning signs may need to be referred to an ophthalmologist.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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