When Should You See a Doctor for Eye Floaters?

The floating spots appearing in our vision are most often a symptom of eye floaters. The interior of the eye is filled with a gel-like, transparent substance called the vitreous, which in youth presses against the wall of the eyeball and its constituent fibers are less visible. However, the vitreous gel gradually changes over the course of life, and liquefaction and clumping appear within it; moreover, in older age it also separates from the posterior wall of the eyeball (posterior vitreous detachment), resulting in the appearance of eye floaters.

“These looser or clumped-together, cloudier particles in the vitreouscast shadows on the retina, which we perceive as moving shapes in our field of vision. Thus, when we perceive the floating spots in front of our eyes , we are not perceiving the vitreous opacity itself, but rather the projection of its shadow,” explains Dr. Róbert Gergely, an ophthalmologist and vitreous specialist.

These black or translucent floating spots in front of the eye are characterized by “swimming” along with eye movement, then continuing to drift slowly in front of the eye. There are essentially two types of positional changes: one case is when we do not see them when looking straight ahead, but then when we look in a certain direction, they swim into our field of vision; the other is when we see the spot continuously in our visual field, but as soon as we look away, it immediately moves, disappears, then slowly swims back to its starting position.

Why Do These Spots Appear?

Eye floaters most commonly develop due to the appearance of vitreous opacities. As we age, the gel-like consistency of the vitreous begins to liquefy, and collagen fibers may clump together, creating opacities. However, age-related vitreous opacities are not the only cause of this phenomenon. Below we list the most common causes that lead to eye floaters:

🔸Age-related changes: Due to the natural aging of the vitreous, vitreous opacities become increasingly common after age 40, as do changes in the lens.

🔸Posterior vitreous detachment: Over time, usually after age 60, changes in the vitreous become so pronounced that the gel-like substance collapses. The gel that had been pressing against the posterior wall of the eyeball shrinks and retracts to the anterior portion of the eye’s central region, while the posterior area is filled with liquefied material. Between the two regions lies the vitreous boundary membrane, whose shadow thus also becomes visible as a smoke-like, veil-like opacity, and on which a more disturbing, larger, often ring-shaped opacity also forms (the Weiss ring). This is one of the most common types of eye floaters.

🔸Vitreous changes in youth: In recent decades, we have increasingly observed vitreous changes characteristic of older age in healthy young individuals. There is currently no proven cause, but altered dietary habits may play a role in the process.

🔸Myopia: It is well known that especially in cases of high myopia, the vitreous cannot follow the elongation of the eyeball, which may lead to earlier clumping or boundary membrane detachment.

🔸Injury, surgery, or inflammation: These cases can directly cause abnormalities in the vitreous or indirectly, through the appearance of inflammatory cells. In such cases, medical or surgical treatment may be considered, depending on the underlying cause.

🔸Vitreous hemorrhage: Especially in cases of diabetes, bleeding inside the eye may develop, which typically causes a dense fog-like opacity or the appearance of many tiny, black eye floaters. Treating the underlying cause is important; the hemorrhage usually resolves over time, but sometimes surgery is necessary.

🔸Retinal tear: A condition requiring urgent care, which may occur in up to 14% of cases of posterior vitreous detachment. In the case of a retinal tear, pigment-containing particles are also released from the retinal pigment epithelium layer, which appear as many tiny dot-like floating spots in addition to existing vitreous opacities. It is not uncommon for some bleeding to develop as well, which also causes similar complaints.

When Should You See a Doctor if You Experience Eye Floaters?

Eye floaters caused by vitreous opacities are in themselves harmless to the eye. Nevertheless, it is important to distinguish between simple floaters and more dangerous conditions. It is especially important to consult an ophthalmologist as soon as possible if:

⚡Eye floaters appear suddenly or in large numbers,
⚡You also notice flashes of light in the peripheral parts of your visual field,
⚡Part of your visual field “darkens” or drops out in a “curtain-like” manner,
⚡Blurred vision or vision loss develops or
⚡A new, particularly disturbing ring-shaped opacity appears (Weiss ring).

These may be symptoms of a retinal tear or even retinal detachment , which require immediate treatment. It is important to understand that diagnosis is not possible based solely on symptoms; however, regardless of the cause, visual field loss or vision impairment always requires urgent ophthalmological examination.

“Arecent vitreomacular detachment must always be thoroughly examined, because it is associated with a retinal tear in one out of every ten patients. Early detection of this condition is also important because severe vision loss can be prevented through laser treatment of the retinal tear. However, there is no cause for concern even if a visual field defect has already appeared—which may indicate retinal detachment—since, thanks to modern surgical techniques, vision can be restored to the patient with early surgery. Time is of the essence in such cases; upon noticing symptoms—or no later than the next day—it is advisable to visit the local hospital to schedule surgery as soon as possible.” – adds Dr. Róbert Gergely, vitreous and retina specialist.

Do Eye Floaters Resolve on Their Own?

Vitreous opacities that have developed typically do not disappear, but in certain cases they can transform somewhat. Larger opacities can shrink together over a few weeks, and some very small opacities may even be completely reabsorbed. It may also happen that the opacity moves to the area in front of the optic nerve head, the so-called blind spot, and therefore the patient may not notice the opacity at all.

One of the best examples is the Weiss ring that appears during posterior vitreous detachment, which usually becomes somewhat smaller after approximately one month. The cellular elements that enter the vitreous from the retinal surface during boundary membrane detachment also lead to the appearance of eye floaters; however, their number significantly decreases over a few weeks, and these smaller ones may disappear entirely. However, smaller and larger opacities originating from collagen fibers, as well as the Weiss ring, will never disappear, and it is also rare for larger opacities to undergo significant improvement more than two months after the onset of symptoms.

However, the good news is that also within a few weeks, due to our brain’s adaptive capacity (neuroadaptation), in certain cases it becomes able to “filter out” the opacities, and we then only rarely become aware of them. If this has not occurred within a few weeks, then unfortunately the opacity is of such a size or in such a location that the process cannot take place, or our brain is simply unable to ignore the disturbing floater.

How Does the Ophthalmologist Determine What Is Behind the Eye Floaters?

In the process of establishing a diagnosis, the physician takes the following steps:

🩺 Taking a medical history: The ophthalmologist asks questions about the symptoms, their time of onset, duration, changes in symptoms, and other health conditions.

🩺 Slit-lamp examination: After pupil dilation, the ophthalmologist examines the anterior part of the eye, then performs a vitreous examination and fundus examination to assess the cause of the eye floaters and to rule out any abnormalities that definitely require treatment. Pupil dilation is particularly important in these cases, as without it the peripheral part of the retina, where tears develop, cannot be assessed.

🩺 Imaging studies: In certain cases, supplementary imaging studies must be performed to obtain a detailed picture of the condition of the vitreous and retina. Ophthalmic ultrasound examination and retinal OCT examination are both painless, quick, and harmless procedures that provide the physician with additional useful information about the condition of the eye.

What Treatment Options Exist for Eye Floaters?

For Eye Floaters Originating from Vitreous Opacities

🔹Laser treatment (vitreolysis): Vitreous opacities can be removed effectively and safely with a quick and painless laser treatment. For treating vitreous opacities, this is currently the lowest-risk intervention, which is why the vast majority of cases undergoing treatment choose this option. One of the most common causes of eye floaters is the Weiss ring that appears during posterior vitreous detachment.

In the case of a Weiss ring vitreous opacity, an experienced vitreous specialist can usually eliminate the opacity in a single session. For other opacities, depending on their size, number, and density, multiple treatments may be necessary to achieve the appropriate result.

Well-defined opacities in good locations and not too numerous can usually be completely eliminated, in contrast to many smaller and larger opacities affecting the entire vitreous, for which laser treatment in multiple sessions can achieve only partial improvement.

The quick and painless vitreous laser treatment can be performed as early as the day of the examination. However, it is important that after the appearance of floaters—following the ophthalmologist’s diagnosis—it is advisable to wait approximately six weeks before the procedure. During this time, the opacities may transform somewhat, allowing the eye to naturally adapt to the phenomenon. If the floaters remain disturbing, laser intervention can then be performed with greater effectiveness.

After the procedure, you can immediately return to your usual lifestyle; you should not expect any significant restrictions. You should only avoid rubbing your eye for a few hours, and you should take into account that due to pupil dilation, your vision may remain blurred for a few hours and driving is not recommended.

🔹Vitreous surgery (vitrectomy): In cases of numerous opacities affecting peripheral areas or large opacities, the solution is removal of the gel. The surgery places greater stress on the eye and carries more risks; however, it provides a solution in cases where opacities severely impair the patient’s life and laser treatment would not be feasible or would prove insufficient. However, it is necessary to discuss very thoroughly and consider multiple times what we are undertaking with such a surgery.

For Eye Floaters of Other Origins

🔹Floating black spots caused by hemorrhage: If the hemorrhage is minor or reabsorption is likely and no other action is required, waiting is recommended. In cases of larger or long-standing (more than three months) hemorrhage or other complications, surgery (vitrectomy) is necessary. Minor old hemorrhage can also be removed with vitreolysis.

🔹Floating black spots caused by inflammation: In cases of uveitis, the condition can usually be managed with eye drop treatment, but in some cases we must also use tablet or intravenous treatment to eliminate the underlying cause.

🔹Opacities caused by injury or surgical complications: Various injuries can lead to changes in the vitreous or foreign material may enter it, which usually requires surgical treatment. After certain surgical procedures, various materials may enter or remain in the vitreous (silicone oil after retinal surgery, capsule fragments after capsulotomy, retinal fragments after retinal tear). In such cases, there is usually nothing to be done about them, but if they are disturbing, they can be removed with laser or surgery.

🔹In special cases, if during cataract surgery a capsular tear causes a small portion of the vitreous to retract to the anterior part of the eye or into the corneal incision, it may cause edema in the fundus (macular edema). In such cases, the vitreous in the inappropriate location can be removed with surgery or vitreolysis, thereby eliminating the cause of vision loss.

Summary

The appearance of eye floaters can understandably cause concern. The symptoms should not be ignored, and a comprehensive ophthalmological examination should be performed as soon as possible. The good news is that, on the one hand, these opacities can become familiar, and on the other hand, several treatment options now exist, and one does not have to resign oneself to their presence, in contrast to what we recommended to patients a decade ago.

Modern laser ophthalmological procedures offer safe and effective treatment solutions for vitreous opacities as well.

If you are experiencing the sudden vision loss, flashes of light, or numerous floaters described above, do not delay: a thorough ophthalmological examination is essential to rule out more serious complications.

ℹ️ Expert treatment: Dr. Róbert Gergely is one of the most experienced vitreous and retina specialists internationally, who has been performing an outstanding number of laser vitreolysis treatments since 2018 and has been performing laser treatments for retinal tears for more than 15 years.

Based on patient feedback, he eliminates disturbing “floaters” with exceptionally high effectiveness, restoring the experience of clear vision.
As an experienced retina specialist, during the examination he pays particular attention to screening for possible retinal tears associated with posterior vitreous detachment, and if necessary, provides immediate laser treatment for them.

Frequently Asked Questions (FAQ) About Eye Floaters