Sunday, January 30, 2022

Are Floaters in Eyes Normal? - When they are Serious in Eyes

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Hey guys! today we are going to be talking about floaters if you have had flutters before you know that they can be a little bit of a nuisance as they kind of float around your visual field. Sometimes they can be a sign of something more substantial like a retinal tear or a retinal detachment.

So we are going to talk about what floaters are? When they are normal and when do you need to worry about them? So I am Dr. Ruman from the swollen-eyelid.com website and today we will discuss floaters.

What are Eye Floaters?

Floaters are a super common symptom that probably most everybody will experience at some point in the course of their life. but what exactly are they? When you see floaters what do they look like?

eye-floaters

Floaters are just a little kind of grayish or black strands or little floating almost kind of mosquito-looking objects that are floating in your visual field.

You have probably noticed that they are more commonly seen when you are looking at something that has not very much detail like a blue sky or a white. You know a piece of paper or white background on your computer and what those floaters actually are little condensations in the vitreous gel in the back of our eyes.

cross-section-of-the-eyeball

What is the Vitreous Gel?

So this is our handy eye model and this is a cross-section of the eyeball. So in the cross-section where the cornea exists, the front surface of the eye directly behind that is the iris the colored part of the eye the lens and then this entire space is a huge open cavity. That's occupied by this substance called the vitreous gel.

At what age does Vitreous Detachment Occur?

The vitreous gel is very formed when we are in our teens and 20s kind of early in life. It's really solid almost like jello and it barely moves at all. So that's why in those years we really don't see floaters because the vitreous is just very firm but as we start to age in our 30s and 40s and definitely 50s, 60s and beyond. All of those collagen bonds that make up the vitreous gel start to break down and the vitreous starts to liquefy you will get these little clumps that form in the vitreous little condensations.

That is going to be suspended you know intermittently throughout the vitreous and so what we actually see as floaters is a shadow cast on the retina. When the light comes through the eye hits, that little condensation and then casts a shadow on the retina.

We are not actually seeing the condensations ourselves because they are in the eye. They are too close to our retina for us to perceive them. we can see that shadow that's cast on the retina and that's why you notice them more when it's a white lighting setting.

Are Floaters in Eyes Normal?

If you are in a dark room, you know there is something else for your brain to look at. If you are looking at a complex image, you are not going to see those floaters as much as you will. If you are looking at that bright blue sky.  If you are having those kinds of occasional floaters that start in your 30s and 40s, they are usually not worrisome.

But occasionally as the vitreous gel starts to liquefy it will actually pull away from some of its attachments in the back of the eye. The vitreous is attached very firm to three different locations in the back of the eye. It's attached to the optic nerve which is right here and as the nerve comes into the back of the eye.

We can see that in the above cross-section a little circle, it's attached to the retinal blood vessels and it's attached to the very far periphery of the retina. Where the retinas kind of stretched out to their thinnest point and so as that vitreous is starting to pull away.

It can pull a little piece of tissue off the optic nerve and you actually see this little ring-shaped area of tissue we call a Weiss ring so this is called a posterior vitreous detachment. 

What is a posterior vitreous detachment?

A posterior vitreous detachment is a normal process of aging and it just means that vitreous gel is going to be pulling away from the back connections to the optic nerve and to the retina patients will typically say when they present with this.

You know I have had floaters for many years but all of a sudden I just had really a big floater and it was in the shape of a ring or some semblance of a ring. Because we can actually see that little piece of tissue that's been pulled off from the optic nerve.

What Causes a Posterior Vitreous Detachment?

So the reason that we make a big deal about this is that 10 to 15 percent of people who have a posterior detachment will have a retinal tear associated with that and the reason for that is as we are talking about earlier the retina is one of the things that the vitreous is very closely adherent to and so as the vitreous is pulling away from the retina.

If it pulls a little tear in the retina that can lead to a retinal detachment which of course you know we don't want to happen. So if that were to happen we could, of course, treat that but we want to get you in and get you seen as soon as possible.

If you are at risk for that the symptoms that people have if they are about to experience a retinal tear or they are experiencing a retina tear are that they will have these peripheral arc-like flashes of light and the flashes are typically split. Second a lot of times people wonder if they are even seeing if they feel like maybe a camera flash or you know something a reflection.

You know of off light or something was what they were seeing and they realized oh my God this is actually happening inside of my eye. The reason that we see that flash is that as the vitreous is tugging on the retina that traction on the retina is going to be perceived by us as a flash.

Most people will describe them out, in the temporal periphery but occasionally you can see them nasally as well. But they are almost always going to be in an arc shape split second and people describe them as kind of a white or silver flash.

The other thing that people frequently see with a retinal tear is a whole bunch of little tiny floaters. So I call them pepper dot floaters. Because people say it feels like somebody took a pepper shaker and just shook it in front of the eye and instead of a couple little you know big amoebas floating around.

When we have got hundreds of little tiny dots the reason that this is a symptom is that the retina is tearing. It will release the pigment from underneath the retina that pigment then scatters throughout the vitreous and we can see that. We will see all those little pepper dot floaters so our front desk knows that if somebody calls with flashes or pepper dot floaters.

Floaters are coming immediately but in general, we tell anybody who's having a new onset floater especially if it's large that they should come in because like I said you know 10 to 15 of people who have a posterior vitreous detachment are going to develop a tear.

So what will happen at your visit when you come in is we will get you in. we will get the eye dilated we are going to look all the way around the edges of that retina to make sure that there's not a tear.

If there is not a tear but I can see that somebody has developed a posterior vitreous detachment then I just give them those warnings that we were just talking about if you are having flashes of light.

If you are having pepper dot floaters come back and see me sooner and then I always follow up with them about two to three weeks after that initial visit. because this posterior vitreous pulling away from the retina is kind of a process in evolution.

So the highest risk for a tear is going to be in those first few weeks afterward we bring them back and check them all over again and make sure that the retina looks okay.

If there is a tear then the next step is to immediately get you to a retina specialist to treat that tear. So the tear itself can never be put back to place but what they can do is that the tear is way out here in the peripheral retina.

Treatment

They will use a laser to spot weld around that tear so that the two layers the retina and the choroid kind of you know spot weld together. they shrink together so that no fluid is allowed to come up underneath that retina which causes a rental detachment. This procedure is an outpatient procedure.

The retina docks are wonderful. they do these all day long. It takes a couple of weeks for that laser to really settle in so they tell patients to kind of take it easy for about a week or two after the procedure but the wonderful thing about this treatment is that it does not affect the vision and people preserve you know it preserves their vision for folks which is excellent.

When Floaters are Serious in Eyes?

If there were actually a retinal detachment that's a little big procedure and we can certainly talk about that in a different article but we definitely want to make sure that anybody with flashes or pepper dot floaters comes in immediately okay.

So let's summarize floaters a lot of floaters are just a normal process of aging so if you have noticed that occasionally you see a little mosquito flying through your field of vision. that's okay and if that comes and goes we are really not worried about those.

What's not okay is that if all of a sudden you notice these peripheral flashes of light or you have a whole bunch of new floaters especially if they are hundreds of little black pepper dot floaters.

At what point should you Call the Doctor?

You know patients are always kind of confused or wondering like when should I call my ophthalmologist and I always tell them If you are worried you call. we only have two eyeballs and so we really want to make sure that if there is something that needs to be seen.

We get you to see up again if you have a posterior vitreous detachment. there is an 85 to 90 percent chance you are going to be fine and nothing is going to happen at all. But considering almost all of us are going to get a posterior vitreous detachment 10 to 15 percent of all comers and this is a pretty big number.

So we want to make sure that you are seeing so never feel bad about calling our front desk and just front desks in general can kind of help evaluate that and give you some guidance but in general, we only have two eyes so if you are worried about them please come into us. So guys on floaters I hope you found this article helpful.

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