When Should I Worry About...

Eye Floaters: When to Seek Help

Nov. 10, 2023 - Kim Rivera Huston-Weber

If you haven't experienced eye floaters yet in your life, it's likely just a matter of time before you will. Eye floaters can appear as specks, circles, threads or cobwebs of different shapes and sizes. What they mean — and how soon you need to see an ophthalmologist — can vary. Let's take a closer look at eye floaters to understand when you should worry if you notice them in your vision.

What are eye floaters?

Eye floaters are exactly what they sound like — spots that float and drift across your vision. Dr. Garvin H. Davis, a vitreoretinal surgeon with Houston Methodist, says there are usually three types of eye floaters someone may see during their lifetime.

"It's very normal to have an occasional translucent floater or one or two small dark floaters that you see every now and then — almost everyone sees those," Dr. Davis says. "Those types of floaters are very common and there are usually not any issues with those."

People most often notice that type of floater when looking at something bright or light-colored, such as the afternoon sky, white walls or reflective surfaces.

As we grow older, the vitreous humor, or gel-like fluid in the eye between the lens and the retina, changes from its gel-like consistency and starts to liquify. It is then that people can start to notice another type of floater in their vision — a posterior vitreous detachment.

"Usually in the fifth or sixth decade of life, the vitreous gel liquifies and separates from the back of the eye," says Dr. Davis. "We often see a different type of floater when that happens. Patients describe it very differently: sometimes like a cobweb, or cloudy vision, like a little cloud that moves around, and often it'll happen suddenly, usually associated with flashes of light."

Dr. Davis says the flashes of light occur because the retina does not have pain fibers. As the gel separates and pulls on the retina, seeing flashes is the retina's way of saying, "Hey, I'm in little bit of pain."

Finally, vitreous separation can lead to another, more serious type of eye floater. As the vitreous separates, it can break blood vessels and cause bleeding in the eye. And because the vitreous is firmly attached to the retina at points, its separation can cause a retinal tear that can then lead to retinal detachment.

"Usually, patients will describe two characteristics when they see these types of floaters," Dr. Davis says. "They say it looks like someone's sprinkled pepper or black spots in their vision, and it doesn't go away. It's not often subtle. As the retina tears, it releases pigment cells and that is what people are seeing. You should be seen by an ophthalmologist urgently. Because if there's a retinal tear or detachment, in general, we want to repair that quickly."

What causes eye floaters?

The most common cause of eye floaters is the normal wear and tear on the body that comes with aging. Living longer means you'll likely experience a posterior vitreous detachment that leads to the cobwebby, cloudy eye floaters — usually in the fifth or sixth decade of life. However, vitreous detachment can also happen at younger ages.

"Several things can lead to that happening either earlier in life or more urgently," Dr. Davis says. "If you're very nearsighted, the eyes are a little bit longer than normal eyes and can lead to early vitreous separations. Trauma or injury to the eyes can cause vitreous separation, so boxers may experience it younger in life. And eye surgery, such as cataract surgeries, can increase the risk of vitreous separation."

Treatment for eye floaters

No treatment is needed for those occasional floaters that people of all ages experience after looking at something bright. That's because in most cases, these types of floaters will move out of your vision on their own.

Vitreous separations or detachments will affect each person's vision differently. People with serious vitreous detachments may have no floaters or symptoms, whereas others can be very affected.

"In most cases, the body gets used to the floater and the brain says, 'Hey, I know what this floater is, I've noted it for a long time,' and the brain starts to ignore the floater," Dr. Davis says. "But for others, the floaters continue to get in their way and affect their work or daily living, and that's when I recommend treatment."

Surgeons can remove eye floaters by performing a vitrectomy. The procedure is used for other eye conditions, including retinal detachment and diabetes. The decision to move forward with eye floater surgery comes down to the severity of symptoms and findings from a clinical eye exam.

Retinal tears or detachments, which lead to those peppery eye floaters, need to be addressed soon after you notice them to help protect your vision. Retinal tears and detachments can vary, as do their treatments. Laser or freezing treatment (cryopexy) can seal tears or breaks in the retina, and gas therapy (pneumatic retinopexy) can gently push and reattach the retina. Surgery may be needed if a larger part of the retina is detached to move it back into place.

If you live long enough, it's almost certain that you'll experience eye floaters. Your brain can adapt to minimize the effect of floaters, or you might need treatment to save your vision and prevent impairment of your life. People of all ages can benefit from yearly eye exams to keep an eye on (pun intended) how their vision changes.

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Categories: When Should I Worry About...