Vitreous detachment or floaters

Vitreous detachment can cause bothersome "floaters". If the floaters or dark spots are disconcerting they can be removed by means of vitrectomy.

Posterior vitreous detachment

Initially, the vitreous is attached to the retina and fills the entire posterior chamber of the eye. As we get older the composition of the vitreous body changes. It shrinks somewhat and the jelly-like substance (= vitreum) becomes more liquid. As a result, the vitreous membrane may come away from the retina, creating a space between the retina and the vitreous body (= posterior vitreous detachment). This space will fill up with water. While this is happening, impurities will form in the vitreous, which the patient will experience as tiny objects moving up and down, known as floaters. These floaters can be quite disconcerting. Patients will mainly notice them in strong light, while looking at a blue sky or a white wall. For the treatment of floaters please refer to the next page.

Sometimes vitreous detachment may cause bleeding or a retinal tear

The overall majority of patients with a vitreous detachment will remain in this stage and will never go on to develop a retinal tear or retinal detachment. To exclude the latter two scenarios an in-depth examination of the retina will be required however.

Vitreous detachment: symptoms

The following complaints could indicate vitreous detachment:

  • “Floaters”: these are opacities in the vitreous patients describe as tiny spiders, spots, strings, specks or flecks. A synonym for floaters is ‘mouches volantes (flying flies)’
  • Flashing lights as if a fluorescent light is on the blink
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‘At long last, those annoying floaters are gone’

Treatment of vitreous detachment or floaters

If floaters don’t really bother the patient no treatment is required.

If the floaters or dark spots are disconcerting they can be removed by means of vitrectomy. The first step in a vitrectomy is to create 3 microscopic incisions in the eye’s sclera (= white outer layer of the eyeball). These incisions are required for the surgeon’s instruments. Via the first incision, the eye is infused with water to ensure that it retains its shape during surgery. Next, the endolight is inserted via the second incision so that the surgeon can see everything clearly. The vitrectomy probe is inserted via the third incision. This probe is a tiny tube that cuts away and suctions microscopic particles of the vitreous. To rid the patient of floaters, the entire vitreous is replaced with clear water.

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