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What are flashes and floaters?



I just saw a patient who noticed flashes in his left eye for the past two days and he came in concerned. This patient happens to have glaucoma that is under control as well as Diabetes Mellitus, which is under control. He also has had cataract surgery with implants in both eyes and sees well.

The floaters and flashes are very common complaints in all populations of patients at any age and even those with out eye disease. High myopes meaning people who are near sighted have more complaints than those who are not.

The person who notes an onset of flashes or floaters should have a dilated exam

The infant eye is filled with a clear jelly like substance called vitreous. The vitreous is supported by a framework of many fibers that run from one the retina or inner lining of the eye extending from one wall and attached across to the other wall. Imagine a tennis ball that is hollow inside and has millions of crisscrossing fibers from one wall of the tennis ball across to the other wall and all of these criss-crossing fibers are encased in a clear jelly like substance.

As an infant the jelly is basically solid and when the eye moves the fibers and jelly move as one unit. From the day we are born, the jelly or vitreous becomes more and more liquid and the fibers begin to move with in the jelly when the eye moves just like seaweed in a slow current.

The retina tissue is an extension of your brain tissue and therefore does not have pain fibers. If I pull your hair you fell pain because of the nerves in the skin of your scalp. If the fibers pull on your retina you see a flash of light and so flashes are common in many people. Most of the time the fibers break loose cleanly from the retina and then curl on themselves producing this floating shadow that people call floaters. Also, there may be some pigment or even a tiny few blood cells released into the jelly when the fiber breaks loose.

After a time the flashes and floaters usually go away although some people can always see them.

The real reason to have your eyes examined is that in 2% to 5% of people the retina tears because the fibers do not break away cleanly. The resultant hole allows fluid to get beneath the retina and pushes it away from the wall of the eye, hence the term retinal detachment. The retina needs to be attached to receive nutrients and blood supply and when it detaches it dies and the vision is lost.

Detached retinas need immediate surgery that may include in-office laser treatment or it may be sever enough to require more extensive surgery in the operating room.

Everyone having the onset of flashes or floaters should immediately do what my patient did and come in for a dilated eye exam.

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Disclaimer: This information is not a recommendation to fail to seek proper eye examinations from your eye doctor. I am a Board Certified Ophthalmologist.

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