Floaters And Flashes In The Eyes

Overview

Floaters are tiny specks, dots, squiggles or cobweb shapes that seem to drift across your vision. They are not really in front of your eyes — they are tiny clumps or strands inside the clear jelly (called the vitreous) that fills the middle of your eyeball. As light passes through, these clumps cast small shadows on the back of your eye, and you see them as floaters. Flashes are brief streaks or sparks of light, like a camera flash or lightning, that happen when something tugs or rubs on the retina — the light-sensitive layer at the back of the eye. Most of the time both are harmless, but a sudden burst of new floaters or flashes needs to be checked quickly, because in a small number of people it can be a sign of a retinal tear.

Yes, floaters are extremely common. Most adults notice at least a few at some point in their lives. Flashes are less common but still a frequent reason people visit an eye doctor or their family doctor.

Anyone can get floaters, but they become more common as the jelly inside the eye shrinks and changes with age, usually from around 50 to 60 onwards. They are also more common in people who are short-sighted (need glasses to see things far away), people who have had eye surgery such as cataract surgery, people who have had an eye injury, and people with diabetes or inflammation inside the eye. Children can get them too, but this is less common.

Symptoms

Common symptoms

• Small dots, specks, rings, lines or cobweb shapes that float and drift in your vision
• Shapes that move away when you try to look straight at them, and drift back when your eye rests
• Floaters that are easiest to notice against a plain light background, like a white wall or a bright sky
• Brief flashes or sparks of light, often off to one side, lasting a fraction of a second
• A feeling of something in your vision that you cannot rub away, because it is inside the eye
• Occasional jagged, shimmering zigzag lines that slowly spread and fade — these are usually a different problem called an eye migraine (migraine aura), not floaters

Symptoms in children

• Children often do not describe floaters clearly — they may rub their eyes a lot, squint, or say something is 'in the way'
• A child may simply seem less interested in looking at things, or hold objects closer than before
• Any sudden change in a child's vision, or a child who says they keep seeing lights, should be checked by a doctor

Symptoms in older adults

• Floaters become more noticeable with age as the jelly inside the eye shrinks and pulls slightly away from the back wall of the eye — this is called posterior vitreous detachment and is usually harmless
• A sudden shower of new floaters, often shaped like a ring or a cobweb, plus flashes, is a typical pattern at this age and should be checked within a day
• Older adults may also have other eye conditions, so changes in vision are worth mentioning at every routine eye test

Causes

Main causes

• Age-related changes in the vitreous (the clear jelly inside the eye) — small clumps form and cast shadows, which you see as floaters
• Posterior vitreous detachment — the jelly shrinks and separates from the back of the eye, which often causes a sudden burst of floaters and flashes; this is very common and usually harmless
• Short-sightedness (myopia) — longer eyes are more likely to have these changes
• Cataract surgery or other eye surgery
• Eye injury or inflammation inside the eye
• Bleeding inside the eye, sometimes linked to diabetes or high blood pressure
• Retinal tear or retinal detachment — rare, but the most serious cause of new floaters and flashes
• Migraine aura — jagged shimmering lines, usually affecting both eyes in a similar pattern and fading within about 20 to 30 minutes

Risk factors

• Being over about 50 years old
• Being short-sighted
• Having had cataract surgery or other eye surgery
• A previous eye injury
• Diabetes or high blood pressure
• Inflammation inside the eye (uveitis)
• A family history of retinal problems

When to see a doctor

See a doctor urgently if:

• A sudden shower of new floaters, or a big change in how many you see
• New flashes of light, especially if they keep coming
• A shadow, curtain or dark area appearing in your side vision
• Blurred vision that comes on suddenly
• Symptoms starting after an eye injury or eye surgery
• Pain, redness or sensitivity to light along with floaters

Book a routine appointment if:

• Floaters you have had for a long time that are not changing
• Floaters that annoy you but do not affect your ability to read, drive or work
• Occasional shimmering zigzag lines that fade within half an hour (mention these to your doctor or optometrist at your next visit)
• A routine eye test if you have not had one in the last two years

Diagnosis

A doctor or optometrist (an eye care specialist) will ask what you are seeing, when it started, and whether it came on suddenly. They will then look inside your eye using special lights and lenses. This is quick and painless, and it is the best way to check that your retina is healthy.

Tests that may be done

• A vision test (reading letters from a chart) to check how well each eye sees
• Dilated eye examination — eye drops are used to widen your pupil so the doctor can see the back of your eye clearly
• Slit lamp examination — a special microscope with a bright light that lets the doctor look at the front and inside of your eye
• A scan or photograph of the retina, such as an optical coherence tomography (OCT) scan, in some cases
• An eye ultrasound, occasionally, if the view inside the eye is blocked

What to expect at your appointment

The eye drops used to widen your pupils can make your vision blurry and your eyes sensitive to light for a few hours. It is a good idea to bring sunglasses and to arrange for someone to drive you home, or to wait until your vision clears before driving. The examination itself usually takes 15 to 30 minutes and does not hurt. You may be told that everything looks normal, that you have a harmless posterior vitreous detachment, or — less often — that you need to be seen by a specialist eye doctor.

Treatment

In most cases, no treatment is needed. Floaters usually become less bothersome over time as your brain adjusts and stops paying attention to them. The important thing is to have your eyes checked so that any serious cause, such as a retinal tear, can be ruled out or treated early. If floaters are caused by an underlying condition like diabetes or inflammation, treating that condition is the priority.

Self-care at home

• Try moving your eyes up and down or side to side — this helps shift floaters away from the centre of your vision
• Look towards a plain, darker background when floaters bother you; they are hardest to see against dark surfaces
• Keep a simple note of when you first noticed them and whether anything has changed, so you can tell your doctor clearly
• Keep up with routine eye tests, usually every two years, or more often if your optometrist advises
• Wear protective glasses or goggles for DIY, sport and any activity where something could hit your eye
• If you have diabetes, keep your blood sugar within the range your healthcare team recommends

Medical treatments

There is no medicine, drop or supplement that removes floaters. Most people do not need any treatment at all. If floaters are very dense and seriously affect daily life, an eye specialist may discuss options such as a procedure to break up floaters with a laser, or surgery to replace the jelly inside the eye. These are only considered in specialist care, have risks, and are not suitable for most people. Flashes and floaters caused by migraine are managed by treating the migraine pattern with your doctor's help. If a retinal tear is found, it can usually be sealed with a quick laser or freezing treatment, which works best when done early.

When is surgery considered?

Surgery is not needed for ordinary floaters. It may be needed if you have a retinal detachment, which is repaired with an operation to put the retina back in place. Some people with extremely troublesome floaters may be offered surgery called a vitrectomy, where the cloudy jelly is removed and replaced with a clear fluid. This is a specialist decision and carries risks, so your eye doctor will talk it through with you carefully.

Living with this condition

Most people find that floaters are annoying at first but become much less noticeable within a few weeks or months. Your brain is very good at filtering out things it sees all the time. In the meantime, try not to 'chase' them with your eyes, as this tends to make you notice them more. If you drive, check with your optometrist if you feel unsure about your vision, and follow the rules for vision and driving where you live.

Lifestyle tips

• Wear sunglasses on bright days to reduce glare and make floaters less obvious
• Use good lighting for reading and close work
• Take regular breaks from screens — look into the distance every 20 minutes or so
• Do not smoke, or get help to stop; smoking is linked to several eye problems
• Keep up regular eye tests, especially if you are over 50, short-sighted, or have diabetes
• Eat a balanced diet with plenty of fruit and vegetables, which supports general eye health

Diet and exercise

No food, vitamin or exercise has been shown to remove floaters, and it is important to be cautious about products sold online that claim to 'clear floaters'. A healthy, balanced diet and regular activity are still good for your eyes because they help control blood pressure and blood sugar, which affect eye health. If you have diabetes, keeping your blood sugar steady is one of the most valuable things you can do for your eyes. Ask your healthcare team for advice that fits you.

Mental health and emotional wellbeing

It is very normal to feel anxious when your vision suddenly changes, or to find floaters distracting and worrying. Many people feel a rush of fear that something is seriously wrong. Usually the eye check is reassuring, and the worry fades along with the symptoms. If you find yourself checking your vision constantly, feeling low, or struggling to sleep because of worry about your eyes, tell your doctor. Support is available and you do not have to cope alone. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support line in your country straight away.

Prevention

Most floaters cannot be prevented, because they come from natural changes in the jelly inside the eye as we get older. What you can do is reduce the risk of the more serious causes and protect your sight overall: wear eye protection during DIY, sport and hazardous work; keep blood pressure and blood sugar in a healthy range; do not smoke; and have regular eye tests so problems are spotted early.

Screening programmes

Regular eye tests are the best 'screening' for eye problems, including retinal changes. Many optometrists recommend a test every two years, or more often if you are over 60, short-sighted, have diabetes, or have a family history of eye disease. Eye tests are often free or reduced in cost depending on where you live — ask your local optometrist or health service.

Complications

If left untreated

• In a small number of people, new floaters and flashes are the first sign of a retinal tear. If a tear is not treated, it can lead to retinal detachment, which can cause permanent vision loss if not repaired promptly.
• Bleeding inside the eye or inflammation can worsen if the underlying cause is not checked.
• Very dense floaters can, in rare cases, make reading, driving or recognising faces difficult.
• Long-standing worry about vision changes can affect sleep, mood and confidence.

Long-term outlook

The outlook is very good for most people. In the great majority of cases, floaters and flashes are harmless, settle down, and become far less noticeable over time. Even when a retinal tear is found, treatment is usually quick and works well when done early — which is exactly why getting a sudden change checked promptly matters so much. Keeping up with routine eye tests and knowing the warning signs puts you in the best possible position.

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