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Posterior Vitreous Detachment (Floaters and Flashes)

Related conditions: Retinal tear, retinal detachment, vitreous hemorrhage

Background

The back portion of the eye is filled with a substance called vitreous gel. It is made of collagen fibers and water and has multiple attachment points on the retina. As people age, the fibers contract and gradually separate from their attachments on the retina. This happens to everyone over time, however, only 10–20% of the population will experience symptoms.

The attachments of the vitreous gel are separating from the retina and optic nerve. Note the firm adhesion point that can lead to a retinal tear (arrow).

The attachments of the vitreous gel are separating from the retina and optic nerve. Note the firm adhesion point that can lead to a retinal tear (arrow).

Often, the first sign of a posterior vitreous detachment is the appearance of flashing lights in the peripheral vision. This is caused by the gel pulling on the retina. As the vitreous gel continues to contract, it pulls away from its firm adhesions on the macula and optic nerve. This may cause a large floater, which patients often describe as looking like a cobweb. If the gel pulls hard enough, it may sever a blood vessel and form a vitreous hemorrhage, or it may create a break in the retina called a retinal tear. Bleeding inside the eye often resolves on its own; however, a retinal tear places the person at risk for developing a retinal detachment and losing vision unless retinal detachment surgery is performed.

Most common symptoms

  • Flashing lights in the peripheral vision
  • Floaters
  • Shadows or curtains that originate in the peripheral vision and do not resolve

Potential complications

  • Retinal tear
  • Vitreous hemorrhage
  • Retinal detachment
  • Vision loss

What to do if you develop these symptoms

Call your retinal specialist or eye doctor immediately. Most complications arise with the new onset of symptoms and should be addressed promptly.