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Vitreous floaters Glaskörpertrübungen Mouches volantes
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Intro:
–Vitreous floaters are very common, require no treatment, but are uncomfortable and accompanied by light flashes or peripheral vision loss, they may indicate a retinal detachment.
–Glaskörper-Trübungen (Mouches volantes) sind häufig, erfordern meist keine Behandlung, sind aber unangenehm, von Lichtblitzen-Begleitung oder peripherem Sehverlust begleitet sind sie ein Warnzeichen für eine Netzhautablösung.
What is the vitreous?
The vitreous body (humor) is a more or less clear gelatinous mass and occupies the entire space of the cavity of the eyeball between the posterior surface of the lens and the retina. The vitreous is important in the first months of life in formation of the eye, but has no special function exept for maintenance of its transparency which is important for vision, intraocular pressure and providing a passage for metabolites. The vitreous occupies four fifths of the volume of the eye and weights about 4.0 g. It contains no vessels and no nerves. The vitreous body is composed of many small “bags” and communicating channels, convex posteriorly and to the sides, anteriorly there is a slight depression in which the lens is located. A central canal (Cloquet’s canal) with a diameter about 2 millimetres becomes wider as it approaches the optic nerve. Peripherally it is very close with the inner retina, and is fixed to the anterior part of the eye, described as “vitreous base”. The strength of fixation depends on the location: optic disc> macula> retinal vessels> retinal tissue. The vitreous is 99% water and 1% is formed bei special collagen fibers and hyaluronic acid.
Vitreous body. Schematic representation with an eye-model: the vitreous body is composed of many small "bags" and communicating channels, convex posteriorly and to the sides, anteriorly there is a slight depression in which the lens is located. Copyright © 2013 GETOCT™ Ltd. All rights reserved.
Is the vitreous important?
Yes! These fibers form a wondrous network. Over the years, or in special situations (myopia, inflammation, accidents) these delicate nets decompose, fibers clump together and liquid filled spaces arise. The fluid in theses spaces has no “shock absorbing vitreous network” around it, and moves without restriction leading to a stronger force development on the attached retina. The possibility of a retinal tear and a possible retinal detachment increases, particularly at the vitreous base.
Are changes of the vitreous important?
Sometimes. In every person, the vitreous body changes over the years. This is a normal process. Typically, the transparency is reduced and these fibrillar aggregates are seen as “dancing midges”. These opacities are seen only with sufficient light, for example, looking on a white wall, the snow or at the blue sky 90 degrees from the sun. However, one must never look at the sun. In the dark, these opacities are invisible. It is very disturbing when one moves from light into the fog, whene the eye is then illuminated diffusely and ” hundreds of flies” suddenly appear. This is not dangerous, but can interfere, especially in people who are very dependent on their eyes as photographers and illustrators.
Therapy against vitreous floaters?
In this situation “patience” helps as the cloudiness moves along the force of gravity and thus out the optical axis. This can unfortunately take months. In appropriate cases, a direct laser treatment of the floaters may be considered.
Uncomfortable it can be when suddenly extraordinarily many new floaters occur, associated with flashes or a “lightning”. These flashes can be a sign of a more powerful traction of the vitreous to the retina. The retina is relatively tough and usually nothing happens. Nevertheless, a check carried out at an eye doctor is important. With excessive traction a tear in the retina may occur, opening an entry to the subretinal space. Sometimes these holes heal on their own. In critical situations, a hole is sealed off with a laser beam, so that the tear can not go further, but it takes up to two weeks untill the laser spots are strong enough. If the lesion is progressing only surgery can help: from the outside of the eye (scleral buckling) or inside (vitrectomy). These surgeries show very good results, so that today the onset of blindness due to retinal detachment is extremely rare.
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