Posterior Vitreous Detachment (Eye Floaters)
If you experience symptoms of a large new floater or many new floaters (often described as a spider web) or flashes of light you must come in for a retina exam right away.
What is Posterior Vitreous Detachment (Eye Floaters)?
Posterior Vitreous Detachment (PVD) occurs when the portion of the vitreous gel that is lining the retina (the inside back of the eye) peels away from the retina and suddenly appears floating in the center of the vitreous cavity.
When this happens, you may experience a sudden large floater, bigger than the normal floaters that you may have occasionally seen throughout your life. This is commonly described as a large spider web that is suddenly in the middle of your vision. It may also be accompanied by flashes of light. The flashes occur as the separating gel pulls on the retina.
This pulling of the retina by the gel during a PVD is what puts you at risk for a retinal tear and/or retinal detachment. That is why, when you have the symptoms of a large new floater or seeing flashes of light, you must come in for a retina exam right away.
The risk of a retinal tear from a PVD is highest during the first four to six weeks after the initial symptoms occur. Therefore, you must be followed closely with retina exams during this time. If you experience any worsening floaters or flashes of light in between your appointments, you must call us 24/7 and leave an urgent message for the on-call doctor.
PVDs and retinal tears/retinal detachments, cannot be prevented, but if diagnosed and treated early, they can save your vision. An untreated retinal detachment may cause blindness.
Most people with a PVD do not get a retinal tear or retinal detachment, but if you are going to get a retinal tear or retinal detachment, it is most common to occur within the first six weeks. After 6 weeks, the risk of a retinal tear goes down, and your symptoms of the new floaters and of flashing lights should slowly improve over time.
What are the causes of PVD?
Causes of Eye Floaters from a PVD include:
- Age, usually 60 years or older, but they can occur younger
- Traumatic injury to eye
Patients who experience PVD in one eye will often experience PVD in the other eye within 1 year. PVDs occur to almost everyone at some point in their life whether they are symptomatic of it or not.
What are the Signs and Symptoms of Eye Floaters?
Signs and symptoms of “normal” eye floaters include small floating specs in the field of vision that are more prominent with a lot of light or looking at a white background. You may also see occasional flashes of light. Unlike floaters, flashes are more prominent in low light situations.
As opposed to normal floaters, flashes and floaters from a PVD are much more prominent. The floaters are much bigger and can be seen easily even when not in a lot of light. They usually occur suddenly. The flashes are also very prominent and seen easily even if not in a dim setting. If either of these symptoms occurs, dramatic new large floaters or much worse flashes of light than you have ever experienced, you should call us and leave an urgent message 24/7.
Additionally, If you are seeing a shadow or curtain over your vision, this may already be a sign of retinal detachment and you should call us and leave an urgent message right away 24/7.
What are the Risk Factors?
Risk factors of posterior vitreous detachment include:
- Eye trauma
- Previous cataract surgery
What are the Possible Treatments for Posterior Vitreous Detachment?
An accompanying retinal tear or retinal detachment needs to be treated right away.
A retinal tear can be treated with a quick laser procedure that can be done during your office visit. It is usually a quick and painless procedure but may be mildly uncomfortable. This laser can prevent you from developing a retinal detachment and can save your vision.
A retinal detachment needs treatment to save the eye from going blind. Retinal detachments are usually treated with either a surgery called a vitrectomy, a scleral buckle or a pneumatic retinopexy. These procedures are described at length in other sections.
As long as you do not develop a retinal tear or retinal detachment, a PVD itself does not pose a threat to sight loss and the floaters and flashes slowly subside for a majority of patients within 3-6 months. In these cases, no specific treatment is needed. The vitreous gel that has peeled away from the retina, will remain floating in your vitreous cavity. Your brain will slowly learn to ignore the big floater.
If the floaters continue to be a nuisance after 6-12 months, we may consider a surgery (vitrectomy) to remove them. Other treatment options include a laser (laser vitreolysis) which does not remove the floaters but breaks them up into smaller pieces and makes them less noticeable.
Are there preventative steps or measures to avoid Posterior Vitreous Detachment?
Yearly retina exams may detect a PVD that you may have had in the past without any symptoms.
If you have had a PVD in one eye, a PVD in the other eye may often occur within the next year.
If you have had a traumatic injury to your eye and have eye floaters, you may have had an acute PVD caused by the trauma and need a retina exam right away as you are also at risk of retinal tear and retinal detachment.
Otherwise, PVDs usually occur suddenly and without warning. Therefore, PVDs not related to trauma cannot be prevented and must be acted upon once they occur.
What are the risks if Posterior Vitreous Detachment is left untreated?
If left untreated, a retinal tear or detached retina can lead to permanent vision loss, even total blindness, in the affected eye. Those who experience a sudden increase in size or number of eye floaters or an increase in flashes of light should have a retina exam right away.
Are there other related conditions to Posterior Vitreous Detachment?
Besides a retinal tear or retinal detachment, conditions that may occur after a PVD are:
- Bleeding in your vitreous, or Vitreous Hemorrhage. May occur at the same time as your PVD
- Macular Pucker, or Epiretinal Membrane. May occur months after your PVD
If you have any questions about floaters or flashes or you are having vision issues, please contact us for a retina evaluation.
Select Relevant Publications
Shulman Julia, de la Cruz EL, Latkany P, Milman T, Iacob C, Sanjana V. Cryptococcal Chorioretinitis with Immune Reconstitution Inflammatory Syndrome. Ocular Immunology and Inflammation. 2009;17:5, 314-316. Link to Article.
Shulman Julia, Kropinak M, Ritterband DC, Perry HD, Seedor JA, McCormick SA, Milman T. Failed Descemet-Stripping Automated Endothelial Keratoplasty Grafts: A Clinicopathologic Analysis. American Journal of Ophthalmology. 2009 Nov; Volume 148, Issue 5, Pages 752–759.e2. Link to Article.
Patel NN, Shulman Julia, Chin KJ, Finger PT. Optical Coherence Tomography/Scanning Laser Ophthalmoscopy (OCT/SLO) Imaging of Optic Nerve Head Drusen. Investigative Ophthalmology & Visual Science. May 2007, Vol.48, 2476. Link to Article.