Posterior Vitreous Detachment
When the gel inside the eye separates from the retina
Quick Facts
- Type: Age-related eye change
- Core change: Vitreous gel separates from the retina
- Common symptoms: New floaters and flashes of light
- Usually: Harmless, but can rarely signal a retinal tear
Overview
The inside of the eye is filled with a clear, jelly-like substance called the vitreous, which helps the eye keep its shape. The vitreous is attached to the retina, the light-sensing layer at the back of the eye. With age, the vitreous gel naturally shrinks and becomes more liquid, and it can separate from the retina. This separation is called a posterior vitreous detachment (PVD).
PVD is very common as people get older and is usually a normal, harmless part of aging. As the gel pulls away, many people notice new floaters (small shapes drifting across the vision) and brief flashes of light. In most cases no treatment is needed and the symptoms settle over time. However, occasionally the pulling vitreous can tear the retina, which can lead to a retinal detachment, a sight-threatening emergency. For this reason, the sudden onset of new floaters or flashes should be checked by an eye specialist.
Symptoms
PVD often begins suddenly and usually affects one eye. Typical symptoms include:
- New floaters, which may look like specks, threads, cobwebs, or a ring drifting across the vision
- Brief flashes of light, often seen at the side of vision, especially in dim light
- A sense of haziness or a cobweb in the field of view
These symptoms are often most noticeable at first and gradually become less bothersome. Warning signs that may indicate a retinal tear or detachment, and which need urgent care, include a sudden shower of many new floaters, persistent or worsening flashes, or a dark shadow or curtain spreading across part of the vision.
Causes
PVD is mainly caused by normal age-related changes in the vitreous gel:
- Aging: Over time the vitreous shrinks and liquefies, loosening its attachment to the retina.
- Nearsightedness (myopia): People who are very nearsighted tend to develop PVD earlier.
- Eye surgery or injury: Previous cataract surgery or eye trauma can make PVD more likely.
- Inflammation: Certain eye conditions can also contribute.
Risk Factors
- Older age
- Nearsightedness (myopia)
- Previous cataract or other eye surgery
- Eye injury
- A PVD in the other eye
Diagnosis
An eye specialist diagnoses PVD and, importantly, checks that the retina is not torn:
- Dilated eye exam: Drops widen the pupil so the vitreous and the entire retina can be examined carefully for tears or detachment.
- Retinal imaging: Photographs or scans may be used to document findings.
- Ultrasound: Occasionally used if bleeding or cloudiness blocks the view of the retina.
Because a tear can sometimes appear shortly after a PVD, a follow-up exam may be advised even when the first exam is normal.
Treatment
Most posterior vitreous detachments need no treatment.
- Observation: When the retina is intact, the usual approach is reassurance and monitoring, as floaters and flashes typically settle over weeks to months.
- Treating a retinal tear: If the exam finds a tear, it can often be sealed with laser treatment or a freezing procedure to prevent a retinal detachment.
- Treating a retinal detachment: If detachment has occurred, surgery is needed promptly to reattach the retina.
- Bothersome floaters: Rarely, persistent floaters that significantly affect vision are treated, but this is considered carefully because of the risks of intervention.
The key point is that PVD itself is usually benign, but it must be checked to rule out a tear.
Prevention
PVD is a natural part of aging and cannot usually be prevented, but you can protect your vision by acting on warning signs:
- Have new floaters or flashes evaluated promptly by an eye specialist
- Attend any recommended follow-up exam after a PVD
- Protect your eyes from injury, especially if you are nearsighted
- Keep regular eye exams, particularly if you are at higher risk
When to See a Doctor
See an eye specialist promptly if you develop new floaters or flashes of light. Seek urgent eye care right away if you notice:
- A sudden shower or large increase in floaters
- Persistent or worsening flashes of light
- A dark shadow or curtain moving across part of your vision
- A sudden loss of part or all of your vision
These can be signs of a retinal tear or detachment, which need prompt treatment to protect sight.
Frequently Asked Questions
What is posterior vitreous detachment?
It is a common, usually harmless age-related change in which the gel inside the eye (the vitreous) shrinks and separates from the retina. As it pulls away, many people notice new floaters and brief flashes of light.
Is PVD dangerous?
Usually not. Most PVDs are benign and the symptoms settle over time. However, the pulling vitreous can occasionally tear the retina, which can lead to a sight-threatening retinal detachment, so a prompt eye exam is important.
What symptoms should make me seek urgent care?
Seek urgent eye care for a sudden shower of new floaters, persistent or worsening flashes of light, or a dark shadow or curtain spreading across your vision. These can signal a retinal tear or detachment.
Will the floaters go away?
Floaters from a PVD often become less noticeable over weeks to months as the brain adapts and they drift out of the line of sight. They may not disappear completely, but most people find them much less bothersome over time.
Who is more likely to get a PVD?
PVD is more common with older age, in people who are very nearsighted, and after cataract surgery or an eye injury. Having had a PVD in one eye also raises the chance of one in the other eye.
References
- American Academy of Ophthalmology. Posterior vitreous detachment.
- National Eye Institute (NEI). Floaters and flashes.
- MedlinePlus, U.S. National Library of Medicine. Vitreous detachment.
- Mayo Clinic. Eye floaters — Symptoms and causes.