Eye Floaters – Black Dots in the Eyes

Image of sky seen from an eye with floaters

Floaters or spots in front of the eyes are indistinct or clear spots that float in front of the eyes without impairing vision. Floaters are typically described as small spots or “mosquito-like particles” that tend to drift in front of your eyes. These generally are seen more clearly when looking at something that is illuminated well, like a white sheet of paper, or the bright blue sky. They tend to move in your field of vision as you move your gaze. They also run around erratically and dart away when you try to focus on them.

They can be of various shapes and sizes like dots, squiggles or strands. Some people also describe cobwebs and hollow rings, which are typically seen in case of posterior vitreous detachment. Some people even define them as O or C shaped. The spot or floater that you see is the image formed on the retina by the condensed protein fibrils floating in the vitreous.

These floaters, usually do not interfere with vision, but can often cast irritating shadows, and therefore, cause significant distress and worry to the patient. The blur that is commonly reported by the patient is because the debris in the vitreous casts a shadow on the retina, making the image blurred.

Eye floaters cannot be seen in the darkness or when the eyes are closed. They do not disappear on blinking and move with movements of the head and eyes. It is essential to distinguish flashes from floaters, as will be explained later in this article. Flashes typically can be seen in the dark and with the eyes closed.

What are the causes of floaters?

The back of the eye is filled with jelly or gel-like structure called the vitreous humor. This vitreous humor, popularly called vitreous, is loosely adherent to the retina, the light-sensitive portion of the eye, in the periphery. This gel is composed of protein fibers which are embedded in gel-like matrix.

With age, these protein fibers clump and condense, and get separated from the gel-like matrix which liquefies. This collapse of the vitreous gel is called Posterior Vitreous Detachment, or PVD. These clumped fibers cast a shadow on the retina, which is perceived as “floaters” or “something floating inside the eye.

Sometimes, the protein fibers that are attached to the retina get pulled, resulting in the sensation of bright flashes of light dancing in the eye. It is because the pull exerted on the retina stimulates the retina cells, and the eyes “see” brilliant lights, even when none exist. This is often seen during a posterior vitreous detachment.

Sometimes, during PVD, a small blood vessel on the retina may rupture, leading to slight bleeding inside the eye. It results in a shower of little, new floaters in addition to the preexisting ones.

A posterior vitreous detachment must not be confused with a retinal detachment. The latter is a severe vision disorder which requires urgent medical and surgical attention for preserving vision, while PVD is a relatively innocuous finding.

Floaters can also result from the following reasons:

  • Eye injury or trauma causing bleeding inside the eye.
  • Diabetic retinopathy or new vessels being formed on the retina due to diabetic eye disease, since these new vessels are fragile and tend to “leak” blood.
  • Inflammation or swelling of the inner coats of the eye including the choroid (the brown inner layer of the eye) and vitreous, for example, pars planitis, vitritis, and This inflammation may be due to an autoimmune condition or due to infections. For instance, systemic diseases like sarcoidosis, tuberculosis, etc.
  • Crystalline deposits in the vitreous as seen in diseases of the vitreous like synchisis scintillans and asteroid hyalosis.
  • Rarely, eye tumors may also result in floaters.

Other disorders which may be associated with floaters include:

  • Dry eye: These floaters are due to the protein particles suspended in the tear film, and typically disappear on blinking. These floaters are not of a consistent shape or size, and therefore can be easily distinguished from the floaters due to retinal or vitreous diseases.
  • Migraine: An ophthalmoplegic migraine and migraine with aura may be associated with visual symptoms like colored haloes, flashes, and These usually last transient and may involve both eyes simultaneously. What sets these apart from floaters due to vitreous or retinal disorders is the fact that these are followed by a severe headache, and resolve entirely between episodes.

Are floaters dangerous or vision-threatening?

Floaters may be due to the natural process of ageing and are commonly seen in individuals more than fifty years of age. They are common in patients with high myopia (high “minus” power of glasses) and after cataract surgery. These tend to disappear if ignored, over six months to a year. They can, however, cause considerable anxiety and visual disturbances.

All floaters are not innocuous and self-limiting and maybe the symptoms of serious eye diseases.

As a rule of the thumb, if you have noted a few floaters over time which have not increased in size or number, you can decide to wait for a while before seeking medical attention.

What are the symptoms that mean I must see the doctor immediately?

You must schedule an appointment with an eye specialist as soon as possible in case of the following symptoms:

  • A sudden increase in the number of floaters
  • Floaters accompanied by flashes of light
  • A loss of side vision, or a curtain like phenomenon in one part of the field of vision
  • Decrease in central vision.
  • Accompanied by redness or pain in the eyes, along with poor tolerance of light.
  • Floaters after any trauma or intraocular surgery, including cataract surgery or LASIK.

How common are floaters?

Floaters are the most common reason as to why patients seek an ophthalmologist’s opinion. About half of the people over sixty have a PVD in at least one eye and will have experienced floaters. A person who has had a PVD in one eye is likely to develop a PVD in the other eye within the following 18 months.

The risk factors for developing floaters include:

  • Increasing age: Almost everyone above the age of 70 has some degree of floaters
  • High myopia (especially higher than -5D)
  • Diabetes
  • Vitreous hemorrhage: due to PVD, Diabetes, trauma or following surgery
  • Patients of lymphoma, leukemia, etc.
  • Certain systemic diseases like sarcoidosis, syphilis, tuberculosis. Collagen vascular diseases etc.

How are floaters treated?

Most eye floaters are caused by age-related changes and do not require any treatment. Your doctor will dilate your eyes for a comprehensive eye examination to make sure there are no associated complications like a hole in the retina, and ask you to ignore the floaters. However, a thorough eye examination is essential before you decide to ignore your floaters.

In case they interfere with your reading or cast a shadow on your near work, you can remove the floaters from your line of sight by moving your head up and down, which is more effective than moving the head from side to side.

Very rarely, the doctor may advise a surgery called vitrectomy or even Nd YAG laser disruption to deal with persistent floaters that interfere with your vision.

In case the floaters are caused by an underlying disease process and not just natural ageing, your doctor will advise a disease-specific treatment plan. These may involve diagnostic tests which could be blood tests, imaging, ultrasounds, etc.

The treatment could range from the use of steroids, non-steroidal anti-inflammatory drugs, laser or surgical treatment of new vessels, injections into the vitreous (steroids, anti- VEGF agents, etc), and surgery like vitrectomy, vitreoretinal surgery for retinal detachment, etc.

Who should I seek an appointment?

All ophthalmologists are trained in comprehensive examination techniques and can usually detect the reason for floaters. Your eye doctor will be able to direct you to a retina specialist who has been specially trained to take care of disorders of the vitreous and retina, in case he or she sees any reason to seek a specialist’s opinion.

Alternatively, you can choose to seek an appointment with a retina specialist to save time and multiple eye examinations.

Eye7 Chaudhary Eye Centre in the National Capital Region of Delhi are well equipped to deal with all your eye care needs. The highly trained and experienced retina specialists will be happy to help you in taking care of your eye issues.

The retina specialists who are available for consultation with the Eye7 Chaudhary Eye Centre include the best in the country. Eminent retina specialists who are associated with the group include Dr. Ajay Aurora, Dr. Neeraj Sanduja, Dr. Pawan Gupta, Dr. S. P. Chaudhary, Dr. Tinu Gupta, Dr. Charu Malik, Dr. Ankur Agarwal and Dr. Smita Dikshit. They are available for consultation across all the centres and will help you find a solution for your continued eye health and all visual needs.