Flashes and Floaters

Imagine sitting quietly and noticing small specks or strings floating in your vision, or sudden flashes of light that seem to appear and disappear in an instant. These visual phenomena, known as “floaters” and “flashes,” may become more common with time. Understanding the nature of these symptoms, why they occur, and recognizing when they might indicate a more serious problem is crucial. 

What are Flashes and Floaters?

Floaters are small, dark shapes that can appear as spots, threads, or cobweb-like images in your vision. They are actually tiny clumps of cells or gel inside the vitreous, the clear, jelly-like substance that fills the middle of your eye. Floaters are more noticeable when looking at a plain, bright background like a blue sky or a white wall.

Flashes appear as flickers or streaks of light, usually in the peripheral vision. These occur when the vitreous gel tugs on the retina, the light-sensitive layer of tissue at the back of the eye.

Posterior Vitreous Detachment and Floaters

As we age, the vitreous in our eyes—the clear, gel-like substance between the lens and the retina—begins to thicken or shrink. When this vitreous pulls away from the retina in the back of the eye, it results in a condition known as posterior vitreous detachment. This process can also lead to the formation of clumps or strands. These clumps can cast shadows onto our retina and may be perceived as “floaters.” While floaters from a posterior vitreous detachment are often benign, sometimes they may signal more serious conditions, such as retinal tears or retinal holes, which necessitate treatment from your retinal specialist. Sometimes floaters diminish and become less noticeable over time. Severe floaters affecting quality of life can be surgically removed, but the risks and benefits of this procedure should be carefully considered with your retinal specialist.

Flashes and Migraines

Occasionally, people experience flashes of light that resemble colorful jagged lines or heat waves. These visual disturbances can occur in one or both eyes and may last up to 20 minutes. Such flashes are often associated with migraines and are described as “flickering or twinkling lights” seen in the peripheral vision. Migraines are thought to involve a spasm of blood vessels in the brain.

If a headache follows these flashes, it is referred to as a “migraine headache.” However, it is possible to see these flashes without developing a headache, a condition known as an “ophthalmic migraine” or “migraine without headache.”

How Do Retinal Tears and Holes Occur?

The retina is crucial for capturing what you see and sending the information to the brain. As we age, the vitreous slowly shrinks and can pull on the retina, sometimes causing a tear or hole (see the section on posterior vitreous detachment above). This condition is more likely if you are nearsighted, have undergone eye surgery, or have had a severe eye injury. When the retina tears, your eye fluid can invade the space behind the retina, leading to a retinal detachment—a serious condition that can cause permanent vision loss if not treated promptly.

Symptoms Indicating Retinal Tears or Holes:

• Sudden Increase in Floaters: While having a few floaters is normal, a sudden increase in the number of floaters can be a warning sign. This can appear as a shower of black spots or specks.
• Flashes of Light: Flashes of light can occur when the vitreous gel pulls on the retina. These flashes often appear in the peripheral vision and are more noticeable in dark environments.
• Shadow or Curtain Over Vision: If a retinal tear progresses to a retinal detachment, you might notice a shadow or curtain effect coming over part of your visual field. This can indicate that the retina is lifting away from the back of the eye.

Prevention and Monitoring:

Regular eye exams are crucial, especially if you are at higher risk due to factors such as high myopia or a history of eye conditions. These check-ups can catch early signs of potential problems before they develop into serious issues.

Diagnosis and Treatment:

Diagnosing retinal tears or holes involves a comprehensive eye examination with dilation. Imaging tests like ocular ultrasound or specialized retinal photography might be used to get a detailed view of the eye’s interior. Treatment options include laser surgery or cryopexy, both of which help seal the retina to the back of the eye, preventing further damage and potential retinal detachment. If there is an associated retinal detachment, then surgery is indicated. 

When to See a Doctor:

You should consider seeing a retinal specialist for flashers and floaters if you experience a sudden increase in the number or size of floaters, sudden flashes of light, or accompanying visual changes such as loss of peripheral vision or a shadow over part of your visual field. Immediate attention is also necessary if these symptoms are persistent, associated with eye pain, redness, or other signs of inflammation or infection. If you have a history of eye problems, high myopia, eye surgery, or conditions like diabetes, you should be particularly vigilant. 

If you are experiencing any unusual eye symptoms like flashes or floaters, don’t wait. Contact California Oculoplastics and Retina today at 626-653-9395 to schedule an appointment with one of our specialists. Your vision is our priority, and we are here to help ensure that your eyes remain in excellent health.