Vitreous Detachment - Symptoms of posterior vitreous detachment, such as flashes of light, and complications associated with retinal detachment or vitreous opacities

Vitreous opacities, flashes of light, or blurred vision are usually not cause for alarm. In a vitreous detachment, the vitreous humor separates from the retina. If this causes tears in the retina, the retina may detach. From an ophthalmological perspective, this is a medical emergency.

A vitreous detachment is usually age-related and often occurs after the age of 65 @ Syda Productions / AdobeStock

Increased occurrence of vitreous opacities

These appear as small, semi-transparent specks or cobweb-like formations (floaters). Larger “clumps” in the visual field are also possible.

Since they follow every movement of the eye, they are mobile. If you try to focus on them, they seem to flit away. If you look at something else, they come back into view.

Floaters located directly on the optical axis are particularly bothersome because they appear in the center of the visual field. Depending on their size, they can affect vision to a greater or lesser extent.

Flashes of light

In most cases, the detached vitreous body is still partially attached to the retina. In such cases, eye movements, changes in head position, or the acceleration or deceleration of the head can trigger flashes of light.

Floaters caused by bleeding

If the connection between the vitreous and the retina breaks, small blood vessels may burst. These small hemorrhages cloud vision because they create tiny dark spots (“soot-like specks”).

Larger hemorrhages lead to larger blind spots in the visual field. These opacities usually disappear after a few days. Therefore, they are usually not serious.

Nevertheless, if you experience such symptoms, you should see a doctor promptly to rule out retinal tears, retinal holes, or retinal detachments.

The most common cause of vitreous detachment is age-related shrinkage of the vitreous humor. Another cause is pathological myopia (a rare and severe form of nearsightedness).

The vitreous body (corpus vitreum) is a gel-like substance that fills most of the eyeball. It consists of 98 percent water. Hyaluronic acid is responsible for its gel-like consistency; this substance, much like gelatin, can bind an extremely large amount of water. The vitreous body also contains finely distributed connective tissue fibers.

Cross-section of the human eye @ Henrie / AdobeStock

The outer boundary of the vitreous body is formed by a thin layer of connective tissue, the vitreous limiting membrane. Connected to the eyeball at several points, it adheres more or less firmly to certain areas of the retina.

The vitreous body shrinks over time due to the partial liquefaction of the hyaluronic acid-water gel. A similar shrinkage can be observed, for example, in foods containing gelatin. As the fluid drains away, the volume of the vitreous body decreases. As a result, clumped connective tissue fibers can cast shadows on the retina in bright light (floaters).

In cases of nearsightedness, the eyeball is usually too long. An eyeball that is too long exacerbates the effect of vitreous shrinkage. Starting at approximately -6 diopters and with progressive nearsightedness, vitreous detachment can occur even at a young age. Worldwide, nearsightedness is increasing at an alarming rate.

If vitreous detachment is suspected, an examination of the back of the eye must first be performed to rule out retinal damage. During this procedure, you will be given special eye drops to dilate the pupil. The ophthalmologist then examines the vitreous and the retina using a slit-lamp microscope. During this examination, the specialist looks for opacities, hemorrhages, and retinal tears.

Vitreous detachment usually does not require immediate treatment. However, it should definitely be monitored. We recommend that you schedule a follow-up appointment with your ophthalmologist in about 6 weeks.

If you have a retinal detachment or retinal tears, you should act quickly:

Laser treatment

The laser repairs the tear by selectively sealing the retina to the underlying choroid. These days, this is not a complicated procedure.

Laser eye surgery @ comicsans/AdobeStock

Surgical Procedure

You’ll need surgery if you have a retinal detachment. During the procedure, specialists reattach the detached retina using sutured silicone patches or bands.

Vitreous removal

In more severe cases, removal of the vitreous body (vitrectomy) is necessary. During this procedure, specialists press the retina back into place. Later, the eyeball fills with aqueous humor produced by the eye itself, which then replaces the vitreous body.

In most cases, patients simply have to learn to live with vitreous opacities because the risks of treatment outweigh the benefits. Larger opacities sometimes sink to the bottom of the vitreous and become less bothersome.

For severe, extremely bothersome opacities, there are two treatment options:

Laser treatment

Laser treatment removes vitreous opacities and dissolves floaters. However, the treatment is only suitable for opacities located at a safe distance from the retina. Only a few specialists perform laser treatments for floaters.

Vitrectomy

In cases of severe opacities, bleeding, or large “clumps,” vitrectomy is an option. However, this surgery is risky. It can lead to cataracts, infections, and retinal problems.

Ophthalmologists are responsible for the diagnosis and treatment of vitreous opacities, flashes of light, or vitreous detachments. 

The conclusion is that vitreous detachment is a natural part of the aging process in which the vitreous body detaches from the retina. The vitreous is a gel-like substance that changes as it liquefies over the course of the aging process and eventually becomes completely liquid. These changes can cause the vitreous to detach from the retina. Typical symptoms include “floaters” or “mouches volantes,” which are often perceived as small opacities or snake-like lines in the visual field. These visually perceptible phenomena occur because shadows fall on the retina.

In most cases, vitreous detachment is harmless; however, those affected should be aware of the symptoms and take them seriously. In rare cases, retinal tears may occur, which can lead to retinal detachment. If left untreated, such changes can lead to blindness, which is why an immediate eye exam by an ophthalmologist is crucial. Early diagnosis and treatment help prevent complications and protect vision.

A vitreous detachment is diagnosed through a thorough eye examination, during which the vitreous cavity and the attachment of the vitreous to the retina are assessed. The vitreous and the retina are normally closely attached to each other, but they can become separated with age. This can also cause tears in the retina if tensile forces are applied.

In most cases, no treatment is necessary, as the symptoms become less bothersome over time. Removal of the vitreous may be necessary only if vitreous opacities cause significant impairment or if complications arise. Overall, vitreous detachment is considered a common, mostly harmless change in an important part of the eye, but one that should be closely monitored.