Vitreous detachment and floaters

Floating spots and sometimes flashes of light. Often harmless, but have it checked once.

In short

With age the vitreous gel becomes thinner and eventually detaches from the retina. This is normal.
You then see floating threads or spots (floaters) and sometimes flashes of light.
It is usually harmless and you get used to the spots within a few months.
Very occasionally a small tear in the retina develops. That is why the retina is checked once when symptoms are new.

Drawing of floaters in the vitreous casting a shadow on the retina — Left: the opacities float in the vitreous and cast a shadow on the retina. Right: how they look against a light background. Own drawing.

Symptoms

Threads, flecks or cobwebs that move with your gaze
More visible against a light background, such as a white wall or the sky
Sometimes brief flashes at the side, especially in the dark
Vision itself stays good

How it develops

With age the vitreous becomes more liquid and its protein clumps together; these clumps cast shadows on the retina. Eventually the vitreous detaches from the retina. This happens earlier in short-sighted people, after cataract surgery and after a blow to the eye.

Treatment

Examination of the retina with dilated pupils to rule out a tear.
Without a tear no treatment is needed: the brain learns to ignore the spots, usually within weeks to months.
A retinal tear can be sealed with laser to prevent detachment.
If symptoms change within a few weeks, have it checked again, even if the first check was fine.

When to get help the same day

Contact your GP or the out-of-hours GP service (huisartsenpost) straight away if you have:

Suddenly many more spots than usual, like a swarm or shower of soot
Flashes of light that persist or increase
A curtain or shadow rising from the edge of your vision
Vision that quickly gets worse

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This page is a short summary and does not replace a consultation. Want to know how the eye works? See The eye.