Floaters in the Eye

Q: For years I've had what my doctors refer to as "floaters" in my eyes. They are very bothersome. Sometimes I think I see something, but what I'm seeing are just little objects floating in my field of vision. I'm 56 and they're more prevalent than they used to be. Are they serious and can anything be done?

A: Floaters are tiny specks of clumped material that move throughout the gel-like fluid inside the eye. They often appear and disappear throughout the day, are most noticeable when looking at a bright sky or light colored paper. They can be quite annoying and can interfere with vision. While usually harmless, they do have the potential to signal a more concerning or serious eye condition. Given you've had a change in your usual pattern of floaters, you should visit an eye care specialist such an optometrist or ophthalmologist.

Speak with your doctor

It's great that you are concerned about the health of your eyes. Being proactive in your own eye care is important. You should use sunglasses that provide at least 98 percent UVA and UVB sunray protection and also have regular eye check-ups, in which you inform your physician of any changes that have occurred to your vision. Be prepared to provide this key information:

• How long you have been affected by floaters?
• When do they occur (only when reading, looking at bright objects, all day long, etc.)
• Do you have eye allergies?
• Do you have any medical conditions or illnesses?
• Have you had a change or loss of vision?
• Are your floaters accompanied by flashes of light?
• Do you have a history of migraines with headaches or without headaches (ophthalmic migraines), as they may be associated with flashes of light or "rainbows" of color suddenly appearing in your vision?
• Have you had any injuries to your eyes?
• Do you wear glasses for distance vision?

After reviewing the answers, the eye specialist will check your vision with a slit lamp and ophthalmoscope. This will include the use of eye drops to dilate the pupils in order to fully examine the vitreous and retina. At that point, your doctor will have more information to better diagnose the cause of your floaters.

What's a floater, and why do I get them?

Our eyes contain a gel-like mixture known as the vitreous. This substance is largely responsible for each eye's size and shape. It's filled with a mixture of fibers that are woven together into a matrix. This matrix is then connected to the light-sensitive tissue in the back of the eye known as the retina. As we get older, the gel-like consistency inside the matrix begins to liquify, causing some areas to shrink and release fibers that may freely move inside the vitreous. These floaters end up passing in front the retina, resulting in shadow-like dots, strands, strings or clumps that drift in and out of the line of sight. They seem to float away, even when the eyes have stopped moving.

While anyone can get floaters, they're more common in individuals with the following risk factors:

• Age 40 or older
• Diabetic retinopathy
• Previous trauma to the eye
• Nearsightedness
• Family history of retinal detachment
• Previous cataract operation or YAG laser surgery
• Inflammation (uveitis)
• Diseases such as tuberculosis and toxoplasmosis

Cause for concern?

Even though most floaters are related to the normal process of getting older, there are other conditions that may contribute to the symptoms.

• Debris inside the layer of tears that lubricate the eyes. This may be due to the remnants of cosmetic makeup, blepharitis, or eye allergies. The difference is these floaters tend to move and disappear when blinking and are not true floaters.
• Vitreous detachment may cause a sudden increase in the amount or size of the floaters. It occurs when the fibers in the vitreous shrink, break and separate away from the retina. Symptoms may or may not be accompanied by flashes of light along the sides of vision. While those age 50 and above have a higher risk, this is more likely to occur in individuals over the age of 70. Although usually harmless, it may signal the possibility of a potentially eyesight-threatening condition related to a retinal tear or retinal detachment.
• Retinal detachment requires emergency attention by an ophthalmologist and is needed if flashing lights, loss of side vision or a curtain-like, vision-impairing cloud accompanies a sudden increase or change in the pattern of floaters.

Is there a treatment for the common floater?

In general, the harmless types of floaters are not treated because of two reasons: Most tend to shrink in size as they are gradually absorbed within the eye. Plus, the brain tends to tune them out and ignore them over time. There are no medications or supplements proven to treat or remove floaters.

If floaters are present to such a degree as to impair or obstruct vision, a surgical procedure to remove vitreous fluid and replace it with a saltwater solution may be suggested. However, this has potential for serious complications, including a retinal detachment. The use of laser treatments might be suggested, but the risks may outweigh the benefits in an otherwise healthy eye.

For further information, visit your eye specialist and check out resources at the National Eye Institute, Eye Care America or The Eye Digest.

Find More on Eye Care:

• Floaters, Flashes, and Retinal Tears
• Search: Find More Articles on Vision
• 10 Tips to Protect Your Eyes
• Eye Exams for Your Elder Parent

Find all articles by Dr. Rob.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)