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Flashes and Floaters

Flashes and floaters are one of the most common urgent visits that I see in the office. Nationwide this is one of the most common reasons that someone will visit an ophthalmologist or eye doctor. Although similar symptoms may be caused by migraine, this tends to be caused by a posterior vitreous detachment. The flashes are usually on the outside (near the temple) of the effected eyes. The floaters are spiderwebs, gnats, or circular areas of the vision that appear to be floating and will often move in the opposite direction of eye movement. The center of the eye is filled with a jelly called the vitreous. With age or trauma, this jelly can turn into a liquid. The vitreous is also stuck on the surface of the retina by a membrane called the hyaloid. The hyaloid will separate from the retina and pull or tug on the retina. This pulling causes the flashing lights. The floating membrane can cause the floaters or the floaters can be within the vitreous that has turned into liquid. I think anyone with these symptoms (especially flashes) should be seen by an ophthalmologist or eye doctor because sometimes the vitreous will pull hard enough on the retina that it causes a retinal tear. It is impossible to know whether or not the flashes are just caused by the detachment of the vitreous jelly, or by the presence of a retinal tear. A retinal tear can usually be treated with laser or cryotherapy, but if untreated, it may lead to a retinal detachment. Signs of a retinal detachment include a hazy area or curtain over part of the vision. This will usually need more significant surgery and can lead to permanent vision loss or even blindness in some cases. There are some treatments for floaters alone, but I rarely recommend them, and most people will experience "neural adaptation" where the floaters no longer bother them after several months. Below is a video from the American Academy of Ophthalmology that speaks about a posterior vitreous detachment.

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