Floater (patient information)

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 * Assistant Editor(s)-In-Chief: Erin E. Lord

Overview
Floaters are little "cobwebs" or specks that float about in your field of vision. They are small, dark, shadowy shapes that can look like spots, thread-like strands, or squiggly lines. These floaters are bits of cellular debris that come and go without treatment.

What are the symptoms of a floater?
People with floaters notice small specks or "cobwebs" floating in their field of vision that are especially noticeable when looking at something bright, such as white paper or a blue sky. They move as your eyes move and seem to dart away when you try to look at them directly. They do not follow your eye movements precisely, and usually drift when your eyes stop moving.

Most people have floaters and learn to ignore them; they are usually not noticed until they become numerous or more prominent.

What are the causes of a floater?
Floaters occur when the vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape, slowly shrinks. As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina. These are floaters.

However, there are other, more serious causes of floaters, including infection, inflammation (uveitis), hemorrhaging, retinal tears, and injury to the eye.

Who is at highest risk?
Floaters are more likely to develop as we age and are more common in people who are very nearsighted, have diabetes, or who have had a cataract operation.

How to know you have a floater?
Floaters are often readily observed by an ophthalmologist or an optometrist with the use of an ophthalmoscope or slit lamp. However, if the floater is a small piece of debris and near the retina it may not be visible to the observer even if it appears large to the sufferer.

Increasing background illumination or using a pinhole to effectively decrease pupil diameter may allow a person to obtain a better view of his or her own floaters. The head may be tilted in such a way that one of the floaters drifts towards the central axis of the eye. In the sharpened image the fibrous elements are more conspicuous.

The presence of retinal tears with new onset of floaters was surprisingly high (14%; 95% confidence interval, 12%-16%) as reported in a meta-analysis published as part of the Rational Clinical Examination Series in the Journal of the American Medical Association. Patients with new onset flashes and/or floaters, especially when associated with visual loss or restriction in the visual field, should seek more urgent ophthalmologic evaluation.

When to seek urgent medical care
A small number of floaters are a typical part of aging that are not considered a medical emergency.

However, a sudden increase in floaters, possibly accompanied by light flashes or peripheral (side) vision loss, could indicate a retinal detachment. A retinal detachment occurs when any part of the retina, the eye's light-sensitive tissue, is lifted or pulled from its normal position at the back wall of the eye. A retinal detachment is a serious condition and should always be considered an emergency. If left untreated, it can lead to permanent visual impairment within two or three days or even blindness in the eye.

Those who experience a sudden increase in floaters, flashes of light in peripheral vision, or a loss of peripheral vision should have an eye care professional examine their eyes as soon as possible.

Treatment options
For people who have floaters that are simply annoying, no treatment is recommended.

On rare occasions, floaters can be so dense and numerous that they significantly affect vision. In these cases, a vitrectomy, a surgical procedure that removes floaters from the vitreous, may be needed.

A vitrectomy removes the vitreous gel, along with its floating debris, from the eye. The vitreous is replaced with a salt solution. Because the vitreous is mostly water, you will not notice any change between the salt solution and the original vitreous.

This operation carries significant risks to sight because of possible complications, which include retinal detachment, retinal tears, and cataract. Most eye surgeons are reluctant to recommend this surgery unless the floaters seriously interfere with vision.

Where to find medical care for a floater?
Directions to Hospitals Treating a floater

Prevention of a floater
You cannot prevent floaters, but by seeking medical attention when exhibiting symptoms of a retinal tear and retinal detachment, you can prevent vision loss.

What to expect (Outlook/Prognosis)?
In most cases, floaters are part of the natural aging process and simply an annoyance. They can be distracting at first, but eventually tend to "settle" at the bottom of the eye, becoming less bothersome. They usually settle below the line of sight but do not go away completely.

Sometimes a section of the vitreous pulls the fine fibers away from the retina all at once, rather than gradually, causing many new floaters to appear suddenly. This is called a vitreous detachment, which in most cases is not sight-threatening and requires no treatment.

However, a sudden increase in floaters, possibly accompanied by light flashes or peripheral (side) vision loss, could indicate a retinal detachment. If left untreated, a retinal detachment can lead to permanent visual impairment within two or three days or even blindness in the eye.

Additional links
http://www.nei.nih.gov/health/floaters/floaters.asp http://www.nlm.nih.gov/medlineplus/ency/article/002085.htm