At M&M Eye Institute in Prescott, Arizona, we understand that new floaters or flashes can be concerning. Floaters and flashes are common, particularly as the vitreous naturally changes with age, and many cases are not dangerous. However, a sudden onset or significant increase in floaters or flashes can be a warning sign of a retinal tear or retinal detachment and should be evaluated promptly by an eye-care professional.
If you notice sudden new floaters, flashes, a curtain or shadow in your vision, or sudden vision loss, call M&M Eye Institute right away to schedule an urgent eye exam. If immediate eye care is unavailable, go to an emergency department.
What Are Floaters?
Floaters are spots, lines, rings, strands, or cobweb-like shapes that appear to move through your field of vision, especially when looking at a bright, uniform background such as a blue sky or white wall. They are usually caused by opacities or condensations within the vitreous, the clear, gel-like substance that fills the inside of the eye. These opacities cast shadows onto the retina, which are perceived as floaters.
What Causes Eye Floaters?
- Posterior vitreous detachment (PVD): With aging, the vitreous becomes more liquefied and can separate from the retina. A symptomatic PVD is a common cause of new floaters and flashes. Although most PVDs are uncomplicated, vitreoretinal traction during the separation can sometimes produce a retinal tear.
- Retinal tear or retinal detachment: A retinal tear may cause new floaters, flashes, or both. If fluid passes through a retinal tear, it can lead to a rhegmatogenous retinal detachment, which may cause a shadow or curtain in the peripheral or central vision.
- Vitreous hemorrhage: Blood in the vitreous, which can occur with conditions such as diabetic retinopathy, retinal tears, or trauma, may cause a sudden increase in floaters, spots, cobwebs, or hazy vision.
- Inflammation inside the eye: Uveitis and other inflammatory conditions can produce inflammatory cells and debris in the vitreous, which may be perceived as floaters.
- Eye trauma or recent eye surgery: Trauma and some ocular procedures can cause vitreous changes, retinal traction, bleeding, or retinal tears, all of which can produce new visual symptoms.
- Migraine with visual aura: Migraine aura can cause flashing, shimmering, zigzag, or scintillating visual phenomena. A typical visual aura is usually a binocular neurologic phenomenon and may occur with or without a headache. The term “ocular migraine” is often used loosely and can be confusing; new or unexplained visual symptoms should not automatically be attributed to migraine without an appropriate evaluation.
What Are Flashes?
Flashes of light, also called photopsias, are brief streaks, arcs, or bursts of light that may be noticed particularly in peripheral vision. They commonly occur when the vitreous exerts traction on the retina, especially during a posterior vitreous detachment. New flashes can also occur with a retinal tear or other retinal pathology.
A retinal detachment itself is not simply “caused by flashes.” Rather, flashes are often a symptom of vitreoretinal traction or a retinal tear that can precede or accompany a retinal detachment. Because symptoms alone cannot reliably distinguish an uncomplicated PVD from a PVD associated with a retinal tear, a new onset of flashes and/or floaters warrants a dilated retinal examination.
Treatment Options for Floaters and Flashes
Treatment depends on the underlying cause. Many uncomplicated floaters become less noticeable over time and do not require treatment. A posterior vitreous detachment without a retinal tear is generally observed, with follow-up based on symptoms and individual risk factors.
- Observation and follow-up: Most uncomplicated PVDs and stable floaters are managed with observation and appropriate follow-up. Patients should be instructed to return promptly if symptoms worsen or new symptoms develop.
- Retinal tear treatment: When an acute retinal tear is identified, laser photocoagulation and/or cryotherapy may be used to create a protective scar around the tear and reduce the risk of progression to retinal detachment.
- Retinal detachment repair: A retinal detachment generally requires prompt surgical treatment. Depending on the type, location, and extent of the detachment, treatment may include pneumatic retinopexy, scleral buckle, pars plana vitrectomy, or a combination of procedures.
- Treatment of underlying disease: Vitreous hemorrhage, uveitis, diabetic retinopathy, and other underlying conditions are treated according to their specific cause.
- Treatment of bothersome floaters: In selected patients with persistent, visually significant floaters, pars plana vitrectomy may be considered after a discussion of the potential benefits and risks. Surgery is not routinely necessary for typical age-related floaters.
When to Seek Medical Attention
You should seek prompt ophthalmic evaluation, ideally the same day, if you experience any of the following:
- A sudden onset or marked increase in floaters
- New or sudden flashes of light
- A shadow, a curtain, or a missing area of peripheral vision
- Sudden or unexplained decrease in vision
- New floaters accompanied by hazy or smoky vision, particularly if you have diabetes, significant nearsightedness, recent eye surgery, or recent eye trauma
These symptoms can be associated with a retinal tear or retinal detachment. Retinal detachment is a sight-threatening condition that requires prompt evaluation and, when present, timely treatment.
Our Approach to Floaters and Flashes at M&M Eye Institute
At M&M Eye Institute, we take new floaters and flashes seriously. Evaluation typically includes a detailed history and a comprehensive dilated eye examination with careful assessment of the peripheral retina. Additional testing or imaging may be used when appropriate, but a thorough retinal examination is essential when evaluating new flashes or floaters.
Our goal is to determine whether your symptoms are related to a normal vitreous change, posterior vitreous detachment, retinal tear, retinal detachment, vitreous hemorrhage, inflammation, or another condition and to recommend the appropriate follow-up or treatment. If you develop sudden new floaters, flashes, a curtain or shadow in your vision, or sudden vision loss, call M&M Eye Institute right away to schedule an urgent eye exam with one of our eye doctors.