Eye Floaters

What Are Eye Floaters?

Eye floaters are small spots, specks, lines, or cobweb-like shapes that drift through your field of vision. They're particularly noticeable when looking at something bright and uniform, like a clear sky, white wall, or computer screen. When you try to look directly at them, they seem to dart away, moving as your eyes move.

These visual phenomena aren't optical illusions—they're real objects casting shadows on your retina. Floaters exist inside your eye, within the vitreous humor, the clear, gel-like substance that fills the space between your lens and retina.

What Causes Floaters?

Floaters form due to changes in the vitreous gel that fills your eye:

Age-Related Changes (Most Common)

As you age, the vitreous slowly shrinks and becomes more liquid, forming clumps or strands. These microscopic fibers cast tiny shadows on the retina, which you perceive as floaters. This process is called posterior vitreous detachment (PVD) and is a normal part of aging.

Other Causes

• Myopia (nearsightedness): Nearsighted people experience floaters at younger ages
• Eye inflammation (uveitis): Inflammatory debris in the vitreous creates floaters
• Eye trauma: Injury can cause bleeding or inflammatory cells in the vitreous
• Diabetic retinopathy: Bleeding from damaged blood vessels
• Eye surgery: Cataract surgery or other procedures may trigger PVD
• Retinal tear or detachment: Blood cells and pigment particles create sudden onset floaters
• Vitreous hemorrhage: Bleeding into the vitreous from various causes

Prevalence: How Common Are Floaters?

Eye floaters are extremely common, affecting millions of people:

• Approximately 7 in 10 people experience floaters at some point
• Become increasingly common with age
• Can appear as early as the 20s, but more typical after age 50
• Nearly universal in people over 70
• More common in people who are nearsighted
• Often appear after cataract surgery

What Do Floaters Look Like?

Floaters can take various forms:

Floaters may appear gray, black, or semi-transparent. They drift slowly when your eye is still and move quickly when you move your eyes, then settle slowly afterward. They're most visible against bright, plain backgrounds.

Normal Floaters vs. Warning Signs

Understanding the difference between benign floaters and those signaling a serious problem is crucial:

Diagnosis: What to Expect

If you experience new or concerning floaters, your eye doctor will perform a comprehensive evaluation:

• Medical history: Questions about symptom onset, description, and associated symptoms
• Visual acuity test: Checking how well you see
• Dilated eye examination: Eye drops enlarge pupils for detailed retina examination
• Slit lamp examination: Magnified view of eye structures
• Ophthalmoscopy: Direct visualization of the retina and vitreous
• Optical coherence tomography (OCT): Detailed imaging if retinal problems suspected
• Ultrasound: If the view of the retina is blocked by blood or severe floaters

Treatment: Options for Bothersome Floaters

Most floaters don't require treatment. They often become less noticeable over time as your brain learns to ignore them or as they settle out of your direct line of sight.

Conservative Management (Most Common)

• Observation: Monitor for changes but no active treatment
• Adaptation: Your brain gradually filters out the floaters
• Eye movements: Shifting your gaze can temporarily move floaters out of your central vision
• Time: Many floaters settle to the bottom of the eye or become less noticeable within months

Laser Vitreolysis

For significantly bothersome floaters:

• Uses a specialized YAG laser to break up or vaporize floaters
• Performed in office under topical anesthesia
• Non-invasive with minimal risks
• Success varies—works best for large, well-defined floaters away from retina
• May not eliminate all floaters
• Not suitable for all types of floaters
• Potential risks include damage to lens or retina if not performed carefully

Vitrectomy Surgery

Reserved for severe cases significantly impacting quality of life:

• Surgical removal of the vitreous gel containing floaters
• Replaced with saline solution or gas bubble
• Performed in operating room under local or general anesthesia
• Highly effective at eliminating floaters
• Carries surgical risks including infection, bleeding, retinal detachment, and cataract formation
• Generally reserved for cases where floaters severely impair vision or quality of life
• Risk-benefit assessment crucial given potential complications

Important: The risks of vitrectomy often outweigh benefits for typical floaters. This surgery is typically reserved for severe cases or when floaters result from bleeding or inflammation that threatens vision.

Treating Underlying Conditions

When floaters result from other eye conditions, treating the underlying cause is essential:

• Retinal tear: Laser photocoagulation or cryotherapy to seal the tear and prevent detachment
• Retinal detachment: Emergency surgery to reattach the retina
• Vitreous hemorrhage: Treating the underlying cause (diabetic retinopathy, trauma, etc.)
• Uveitis (eye inflammation): Anti-inflammatory medications or treatment of underlying infection

Living with Floaters

For most people, floaters become a minor annoyance that the brain learns to ignore. Strategies to cope:

• Understand they're normal: Knowing floaters are usually harmless reduces anxiety
• Shift your gaze: Moving your eyes can relocate floaters out of your central vision temporarily
• Adjust lighting: Floaters are less noticeable in dimmer light or when not looking at bright backgrounds
• Give it time: Most people find floaters become less bothersome within weeks to months
• Stay informed: Know warning signs that require immediate attention
• Regular eye exams: Especially if you have risk factors for retinal problems

Prevention

While you can't prevent age-related floaters, you can reduce risk of other types:

• Protect your eyes: Wear safety glasses during activities with eye injury risk
• Manage diabetes: Control blood sugar to reduce diabetic retinopathy risk
• Regular eye exams: Early detection of retinal problems
• Address eye infections promptly: Reduce inflammation risk
• UV protection: May help slow age-related eye changes

When to Schedule a Follow-Up

Even if your initial floaters were deemed benign, schedule another eye exam if:

• Floaters suddenly increase in number
• You notice new flashes of light
• Any changes in your peripheral vision
• Floaters persist and significantly impact daily activities
• Any shadow or curtain appears in your vision

Conclusion

Eye floaters are a common part of aging and usually nothing to worry about. Most people adapt to them over time, and they become barely noticeable. However, knowing the warning signs of serious conditions like retinal tears or detachment is critical. The sudden onset of many new floaters, especially accompanied by flashes of light or vision loss, demands immediate medical attention. When in doubt, get your eyes checked. A comprehensive dilated eye exam can provide peace of mind or catch problems early when they're most treatable. Don't let floaters float by without proper evaluation.