Vitreous floaters

These are usually small particles or protein strands in the jelly inside your eye. They are harmless and usually only an irritation.
As they move around inside your eye, the strands cast shadows on the retina at the back of the eye. These shadows are perceived as small particles, strands, or wispy threads. They always move and often appear to jump away when you try to look at them.

They are more noticeable when looking at a light surface, such as a blue sky or white paper. As we get older (around 50–70 years), the jelly inside the eye becomes more fluid, and floater activity gradually increases.
Eye floaters can be clumpy or stringy, light or dark. They are caused by clumps or specks of undissolved vitreous gel floating inside the eye.
They may be annoying, but they usually do not affect vision. Most people learn to ignore them over time. Only rarely do floaters become severe enough to require treatment.

Signs and Symptoms

Floaters earn their name by moving around in your eye. They tend to dart away when you try to focus on them.

They come in many different shapes:

• - Black or gray dots
• - Squiggly lines
• - Threadlike strands, which can be knobby and almost see-through
• - Cobwebs
• - Rings

The shrinking vitreous can tug on the retina and pull away from it. This event, called a posterior vitreous detachment (PVD), is common and usually doesn’t threaten vision. In about one in six people, a PVD can cause the retina to tear.
Fluid from inside the eye can then seep through the tear and separate the retina from the tissues that nourish it. This separation, called retinal detachment, is an ocular emergency and can lead to permanent vision loss.
Light flashes, known as photopsias, can occur when the retina receives non-visual (mechanical) stimulation. This can happen when it is being tugged, torn, or detached. These flashes may appear as lightning, random sparks.

Key warning signs include:

• - Sudden onset of new floaters and flashes of light, usually in one eye
• - A shower of floaters and spots, especially if accompanied by flashes of light
• - Gradual shading of vision from one side, like a curtain being drawn
• - Rapid decline in sharp, central vision

The sudden appearance of these symptoms may mean the vitreous is pulling away from the retina, or that the retina itself is becoming dislodged from the inner lining at the back of the eye, which supplies blood, nutrients, and oxygen essential for healthy function.

Causes and Risks:

Floaters occur when the vitreous, a gel-like substance that fills about 80% 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.
In most cases, floaters are part of the natural aging process and are 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 and do not go away completely.

You are more likely to get floaters if you:

• - Are nearsighted (need glasses to see far away)
• - Have diabetes
• - Have had cataract surgery
• - Have had inflammation (swelling) inside the eye

Treatment

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. This procedure 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 procedure does, however, carry significant risks to sight due to possible complications.

Complications can include:

• - Retinal detachment
• - Bleeding
• - Retinal tears
• - Cataracts

Most eye surgeons are reluctant to recommend this surgery unless the floaters seriously interfere with vision.
If a tear is detected early, treatment can prevent the retina from detaching. Tears can be treated in several ways. Pinpoints of laser light can be used to fuse the retina to the back wall of the eye. Extreme cold, a procedure called cryopexy, does much the same thing.
Cold and laser light can also be paired with the injection of a gas bubble into the eye (pneumatic retinopexy) to repair a detached retina. Two operations, scleral buckling and vitrectomy, can also be used to reattach the retina.

Clinical References

1. Eye Floaters: Causes, Symptoms, and Treatment - WebMD

2. Eye Floaters | Cleveland Clinic

3. Eye Floaters Treatment & Floaters in the Eye | CooperVision

4. Eye floaters Treatments and drugs - Mayo Clinic

5. Web MD

6. Eye Floaters, Flashes and Spots By Marilyn Haddrill; reviewed by Charles Slonim, MD

7. What are Floaters Written By: Kierstan Boyd Reviewed By: Robert H Janigian Jr MD

8. Harvard Health Patrick J. Skerrett, Former Executive Editor, Harvard Health