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Vitreous Detachment

A vitreous detachment is a common condition that usually affects older people and especially those who suffer from nearsightedness. Rarely does it have any serious consequences.

Most of the eyeball is filled with vitreous gel (also called vitreous), a jelly-like substance that helps maintain its round shape. The vitreous contains millions of fine fibers that are attached to the retinal surface. The retina is the light sensing layer at the back of the eye. As people approach middle age, the vitreous slowly shrinks away from the retina, and if the fibers pull free, it becomes detached. If you have a vitreous detachment in one eye, the other eye is also likely to have one, though it may not happen until years later.

Symptoms

As the vitreous shrinks, it becomes somewhat stringy and the strands can cast tiny shadows on the retina that you may notice a gradual increase in floaters. Floaters are little “cobwebs” or specks that seem to float about in your field of vision; they become most apparent when you look at the sky or brightly lit reading material. Even though you may never have been aware of them, you have had some floaters since birth.

When the vitreous detaches, the number of floaters suddenly increases. It may resemble a swarm of flies, dust or spider webs. You may also experience bright flashes of light (lightening streaks) off to the side whenever you move your eye. These are especially noticeable when you go into a darkened room. Light flashes occur when the detached vitreous, which now moves about more freely as the eye moves, bumps lightly against the retina.

Almost always the floaters and light flashes decrease during the weeks or months after the vitreous detaches, though they may never disappear completely.

Is a Vitreous Detachment Ever Dangerous?

Most of the time a vitreous detachment is only annoying because of its symptoms. Once in while, some of the vitreous fibers pull so hard on the retina that one or more retinal tears or holes are created. These can lead to a retinal detachment—a much rarer problem that threatens vision. If a retinal tear happens to a blood vessel, blood will spill into the vitreous and partially obstruct your vision. Extensive bleeding can obscure the retina and prevent the tear or even a retinal detachment from being found during an eye exam.

If you have the sudden symptoms of a vitreous detachment, your eye should be examined for retinal tears.

Examinations

You will have a complete eye exam where eye drops will be used to dilate (enlarge) the pupils to permit a careful look at your retina and vitreous with an ophthalmoscope and a slit lamp (clinical microscope). A gonioscope (special type of contact lens with built-in mirrors) may be placed on the eye to permit a better look of the retinal surface. The primary purpose of this examination is to determine whether or not a retinal tear has occurred, and if so, its exact location.

Though a vitreous detachment can begin suddenly, the full detachment process can take up to several weeks. The danger of retinal tear formation continues throughout this entire time. This is why it is so important to have your retina examined again in about 4 to 6 weeks after the initial appearance of floaters.  Vitreous detachment will require no treatment if there are no retinal tears.

Retinal Detachment: A Serious Complication

Though the floaters and light flashes decrease with time, it does not necessarily mean that all is well. If a retinal tear is present, the most watery part of the vitreous might leak through the tear, causing the retina to peel (detach) like wallpaper, from the underlying layer. This is a retinal detachment.

The first symptoms may only be floaters and light flashes identical to those caused by the vitreous detachment. Its classic symptom appears late: a “curtain” of darkness that moves in from one direction and gradually—over a period of days—blocks out some peripheral vision. If left untreated, the detachment will progress. When it reaches the central zone of the retina, (the macula) it will cause sudden blurring of vision. The curtain will continue to darken and more and more vision until only bright light can be seen. If, in addition, a large retinal blood vessel has been torn, blood may fill the vitreous and cause almost total loss of eyesight.

A retinal detachment is an emergency! If you have any symptoms of a retinal tear or a retinal detachment, call at once for an immediate appointment. If this is not possible, go to an emergency service or hospital. It is important that your eye be examined by an eye surgeon as soon as possible. Early treatment can often prevent permanent loss of vision.