Eye Flashes and Floaters: Causes, Risks, and Treatment Options - Dr Rashmi Shirwant

Eye flashes and floaters are frequent visual occurrences that a lot of individuals see in their lifetime. While often benign, these symptoms can sometimes signal underlying issues that require medical attention. This article delves into the causes, symptoms, and available treatment options for eye flashes and floaters, providing essential information for those who experience these visual disturbances.

What Are Eye Flashes and Floaters?

Flashes of light are described as brief, sudden streaks or spots of light that appear in the field of vision. These flashes can be alarming, especially when they occur suddenly or increase in frequency. The sensation of seeing flashes is often due to the vitreous humour

pulling on the retina, the light-sensitive layer at the back of the eye.

Floaters, on the other hand, are small, shadowy shapes that appear to drift across your field of vision. These shapes can vary in form, appearing as spots, specks, clumps, or thread-like strands. Floaters are typically more noticeable against bright or plain backgrounds, such as a clear blue sky or a blank wall.

The medical term for floaters is "muscae volitantes," derived from the Latin phrase meaning "flying flies," aptly describing their erratic movement across the visual field.

The Anatomy Behind Flashes and Floaters

The eye is filled with a gel-like substance known as the vitreous humour, which helps maintain its shape and supports the retina. The vitreous is composed of water, collagen fibres, and proteins. As we age, the vitreous humour undergoes changes—most notably, it starts to liquefy and shrink, causing the collagen fibres to clump together. On the retina, these clusters produce shadows that are seen as floaters.

Flashes occur when the vitreous humour tugs on the retina as it shifts and shrinks. This tugging can stimulate the retina, creating the sensation of light even when there is no actual light source. This is why flashes are sometimes described as "lightning streaks" or "sparks."

Common Causes of Eye Flashes and Floaters

Flashes and floaters are most commonly associated with age-related changes in the vitreous humour. However, they can also be linked to other conditions:

• Posterior Vitreous Detachment (PVD): This occurs when the vitreous humour separates from the retina. While PVD is a normal part of ageing, it can cause both flashes and floaters.
• Myopia (Near-sightedness): People with myopia are more likely to experience floaters due to the shape of their eyes and the associated changes in the vitreous humour.
• Migraine with Aura: Some individuals with migraines experience visual auras, which can include flashes of light, before or during a headache.
• Anxiety: High levels of stress and anxiety can exacerbate the perception of floaters, making them more noticeable.

More serious causes include:

• Vitreous Haemorrhage: This condition involves bleeding into the vitreous humour, often due to trauma, retinal tears, or diabetic retinopathy. The blood cells can appear as floaters, and if left untreated, this can lead to vision loss.
• Retinal Tears or Detachment: Retinal tears or detachment are emergencies that require immediate medical attention. Retinal detachment occurs when the retina separates from its underlying tissue, which can lead to permanent vision loss if not promptly treated.
• Infection or Ocular Trauma: Infections, particularly those involving the retina or vitreous, can cause floaters and flashes. Trauma to the eye can also result in similar symptoms.

When to Seek Medical Attention

While most floaters are harmless and simply a part of the natural ageing process, certain symptoms warrant urgent medical evaluation:

• Sudden Onset of Flashes or Floaters: If you suddenly notice flashes or a significant increase in floaters, it could indicate a retinal tear or detachment.
• Accompanying Visual Disturbances: If you experience a shadow or curtain-like loss of vision along with flashes or floaters, this may be a sign of retinal detachment.
• Changes in Frequency or Intensity: An increase in the frequency or intensity of flashes could signal a worsening condition that needs prompt assessment.

Treatment Options

In most cases, floaters do not require treatment, as they tend to become less noticeable over time. The brain can adapt to their presence, learning to ignore them. However, if floaters are particularly bothersome or are associated with retinal issues, several treatment options are available:

• Laser Treatment: This is used to break up the floaters, making them less noticeable. However, this procedure is not always recommended and is typically reserved for severe cases.
• Vitrectomy: In cases of significant vitreous haemorrhage, retinal tears, or detachment, a vitrectomy may be necessary. Following surgery, the vitreous humour is removed and replaced with a saline solution. While effective, vitrectomy carries risks, including infection and cataract formation.

Eye flashes and floaters are common visual disturbances that can be unsettling but are usually benign. Understanding the causes and knowing when to seek medical help is crucial for maintaining eye health. If you experience any sudden changes in your vision, it’s essential to consult with an ophthalmologist to rule out serious conditions and receive appropriate care.