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Flashes and Floaters Should I Worry ?

Do you see floating black spots in front of your eyes ?

Do you see sparks of light in front of your eyes ?

If the answer to the first question is yes then you are suffering from floaters and if the answer to the second question is yes then you are having flashes of light.

Can these be dangerous ?

Yes and no

There are many causes of floaters in the eye of which some may be dangerous while others may not.

A retinal evaluation can help detect any sight threatening lesion.

A sudden shower of multiple floaters should always be investigated.

The floaters are generally due to particles (cells) in the gel like substance known as vitreous in front of the retina (the layer of the eye on which images are formed).

These particles can be produced due blood or inflammatory cells (swelling) inside the eye. Both the above conditions if left untreated can cause serious loss of vision.

Do not take these symptoms lightly, get an eye examination done by a retina specialist.
Other less serious cause can be due to degeneration of the gel like substance itself. This generally does not require treatment.

Flashes are due to pull on the retina (the layer of the eye on which images are formed) by the gel like substance (vitreous). This gel normally starts contracting with age and usually lifts off the retina without causing damage. In medical terminology this is called a posterior vitreous detachment (PVD). This generally occurs over the age of 60 years, but can start earlier also especially in myopes. During the process of separation this gel causes some pull on the retina which causes sensation of light or sparks for some time. This may resolve without causing damage if the vitreous separates smoothly. But, if this pull is strong enough to cause a break in the retina it is usually followed by floaters and can lead to severe loss of vision by resulting in detachment of the retina.

A combination of flashes followed by floaters is most dangerous and must be investigated.

Is there any treatment available ?

If after a retinal examination the doctor finds no defect in your retina then generally no treatment is required. The patient can relax and only a regular follow up is to be maintained till the symptoms persist.

However, if a retinal break is detected it must be treated immediately. Treatment consists of sealing of the break to prevent retinal detachment. This can be done either by cryopexy (cold application to produce a seal) or LASER (high energy light to seal the break). Once the break is sealed, the chances of detachment are significantly reduced.

If the floaters are found to be due to swelling in the eye then you are suffering from what is called uveitis. In this disease there is inflammation (swelling) of the inner layers of the eye. Appropriate investigations and timely treatment can prevent significant loss of vision in most cases.

Myopic (You are myopic if the power of your glasses is in minus) patients have a tendency to develop some sort of vitreous degeneration early. This can give rise to floaters. This degeneration may be harmless. Sometimes, however these patients may harbour lesions in the retina which can be considered to be weak areas (called lattice degeneration in medical terminology). There are more chances of holes and tears developing in these areas, which can cause a detachment.

Do we treat these weak areas ?

The incidence of detachment is not very high if you only have weak areas called as lattice degeneration and no other high risk factors. Other risk factors are high myopia, history of retinal detachment in one eye, family history of retinal detachment or if the patient has or is going to undergo ocular surgery such as cataract surgery or LASIK. (your retina specialist will be able to determine your risk factors).

Patients with only lattice degeneration and no other risk factor can still develop a retinal detachment and our advise is to maintain a regular follow up (once every 6months). It is important for such patients to understand the significance of flashes and floaters and be vigilant of any increase in flashes or floaters. In case of such an event you must get your eye examined immediately.

We prefer to treat (seal) any holes or breaks seen in these weak areas by cryopexy or LASER.

LASER can be done as an OPD procedure. Although anaesthetic drops are instilled prior to the procedure it may cause some pain. There is no other major side-effect of the procedure.

If certain lesions cannot be reached by LASER , cryotherapy is done. This is a more painful procedure and hence is done after giving local anaesthesia. Following cryo there might be some swelling and redness in the eye which usually subsides by 7-10 days. Otherwise there are no major complications of this procedure also.

How can I be helped at ARC Telediagnosis ?

If your doctor can provide you with a photograph of the retina showing these lesions, we can guide you regarding the treatment. Sometimes however it may be difficult to photograph these lesions as they might be in the far periphery of the retina. In such cases send us your brief history and your doctors comments and we can give you a second opinion. If you had a shower of floaters and your doctor has detected a retinal break, do not delay in getting prophylactic LASER or Cryopexy done as such lesions can cause a retinal detachment anytime.

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