Vitreous detachment

The posterior vitreous detachment is the detachment of the vitreous body from the back of the retina.

The vitreous body occupies about 80% of the eye volume.
It consists mainly of:

  • water (99%),
  • Hyaluronic acid
  • Kollagenfasern.Es are millions of fine collagen fibers that cross inside the vitreous and are attached to the surface of the retina, the tissues in the eye that react sensitively to light.

With age, the vitreous slowly shrinks due to a physiological dehydration phenomenon.

There are two possibilities:

  1. When the vitreous body is lifted, flashes of light (photopsies) appear on the retina as a result of the pull.
  2. There is no pull on the retina, in this case the patient sees black dots in the field of vision.

If the detachment injures a retinal vessel, vitreous hemorrhage may occur.

The vitreous detachment can only affect one eye, but usually occurs on both sides.

Risk factors of posterior vitreous detachment

  • Age
  • Myopia
  • Inflammation of the middle skin of the eye uvea (uveitis)
  • Laser treatment in the eye
  • Surgery in the eye (for example, due to cataract)
  • Trauma to the eye (often caused by sports)


Symptoms of posterior vitreous detachment

The main symptom is the phenomenon of so-called myodesopasia, in which the patient sees mobile bodies (also called flying mosquitoes or mouches volantes).
Depending on the degree of detachment, these vitreous flakes are described as:

  • Spider webs
  • Shadow
  • Circle
  • Oval
  • fixed line.

A shower of soot (sinking black dots) most likely indicates vitreous hemorrhage (which can occur together with retinal detachment).

Eye flashes (photopsies) occur when the vitreous detachment triggers tension on the retina.
The detachment of the vitreous body is a non-painful disease without visual disturbances (there is only discomfort due to the mobile body).

Vision lossVision loss usually does not occur, although vision may be clouded as a result of internal eye bleeding or retinal detachment.

Is the rear vitreous detachment dangerous?

Most people who develop posterior vitreous detachment are not at risk of further eye complications.
The only remaining symptom may be the flying mosquitoes in the field of vision.

7-15% of those who experience posterior vitreous detachment with mobile bodies, flashes of light (photopsies) and vision loss also have retinal rupture.
Retinal rupture can also lead to retinal detachment.
Unfortunately, the symptoms of vitreous detachment without retinal rupture are the same as those with injury.
The injury can only be detected by an ophthalmologist during an examination with pupil dilation.

The flying bodies can be uncomfortable, but they are harmless. They remain present, but become less disturbing over time because they sink inside the eye due to gravity and move away from the retina.
The flashes usually resolve within 4 to 12 weeks, but in some patients this process may take longer.

Complications of vitreous detachment

In rare cases, vitreous detachment can tear the retina.
This can lead to detachment of the retina or to bleeding inside the eye.
This complication is most likely in people with visual impairment.
The ophthalmologist performing the examination must make sure that there is no retinal injury or detachment of the retina at this moment.

Retinal detachment and vitreous hemorrhage (bleeding in the vitreous) are diseases that can lead to blindness.
Rapid treatment and surgery are successful in over 95% of cases.

Diagnosis and assessment of vitreous detachment

The ophthalmologist must carry out the following examinations:

  1. Collection of the patient’s medical history and family history
  2. Eye examination
  • examination of the vitreous body to exclude bleeding and detachment;
  • study of the peripheral background and scleral depression;
  • a thorough examination on the slit lamp is required to confirm the diagnosis and rule out retinal rupture or retinal injury.
  1. Ultrasound of the eye
    If bleeding is detected, an echography must be performed.
    This examination is easy to perform by positioning a small probe over the patient’s closed eyelids.
    If there is a lesion or detachment, the visual field can be determined to determine the extent of possible vision loss.

What to do? Therapy for vitreous detachment

Currently, there is no definitive treatment for vitreous lifting.
There is no evidence to show that eye exercisesdietary changes, vitamins or other natural remedies can help with vitreous detachment.
Supplementsare not recommended because they are not nutritious and cannot reach the inside of the eye.

Since in most cases the flying mosquitoes pass on their own, the risks outweigh the possible advantages of surgery.

A small number of ophthalmologists carry out therapy with laser (vitreolysis) for myodesopsia.
However, this cannot be considered standard therapy for mobile bodies in vitreous and is not often performed.
Some studies have shown that this therapy contributes to the partial reduction of myodesopsies in only one-third of cases.
It is possible to reduce the size of mobile bodies, but vision is not improved in the long term.

Laser vitreolysis during vitreous detachment
The YAG laser can be used to evaporate the vitreous flakes in selected cases.
Patients with significant turbidity in the anterior depression of the vitreous (behind the lens) may gain benefits from this therapy.
However, the moving points are often located in the rear area and thus often become a controversial matter.
It can be difficult to detect myodesopsia that the patient complains of.
The overall risk seems low enough and you could try it before performing a vitrectomy.
It is believed that the potential risks of laser surgery outweigh the benefits that can be achieved.

Vitreous detachment surgery

There is a surgical procedure called vitrectomy, in which the vitreous body is completely or partially removed and the flying mosquitoes are reduced.
It is a complex operation that is usually not recommended to patients due to the risks involved.

Vitrectomy is an operation performed under general anesthesia. The surgeon removes the entire vitreous body and replaces it with air or with a liquid compatible with the eye.
Over time, the fluid is absorbed and replaced by eye fluid. The absence of the vitreous body does not affect the patient’s vision.

Dealing with vitreous detachment

If flashes of light appear in the field of vision, you should visit an emergency room immediately (the same day).
The doctor must carefully examine the central and peripheral retina and rule out possible retinal injuries or tears that can lead to detachment of the retina.
In these cases, the doctor may advise immediate surgery to avoid aggravation of the withdrawal.
If the patient postpones the procedure, there will be difficulties in recovery.
Retinal rupture is present in 10% of patients who have vitreous detachment (half of whom have further lesions).

Precautions for vitreous detachment

Most people with a vitreous detachment do not need to spare themselves. There is no evidence that failure to perform certain activities prevents vitreous detachment from leading to rupture of the retina.

There is no evidence that the following activities can cause problems with vitreous detachment:

  • lifting heavy weights or heavy physical activity;
  • contact sports such as rugby, martial arts or boxing;
  • extreme sports such as bungee jumping;
  • difficult postures during activities such as yoga or Pilates.

It’s possible that some of these activities make mosquito flying more obvious.
This phenomenon is caused by movement during physical activity, but not by an anatomical change inside the eye. Therefore, one should wait until the scurrying spots and lightning return to their previous state.
One can continue daily activities, such as:

  • Walk
  • light gymnastics,
  • swimming (but no competitive swimming),
  • Read
  • Television
  • Use of the computer.

There is no evidence that flying on the plane can damage the vitreous body or make the situation worse.

How long are the healing times? Prognosis for patients with vitreous detachment

Most patients experience a full recovery and the symptoms pass.
The detachment is not repaired, but the accompanying symptoms pass and there are no complications.
Most patients gradually get used to myodesopsies and notice them only when they see a bright background and try to concentrate.
To fix the malfunction, it takes a few months.
The flashes or photopsies gradually pass when the vitreous detaches completely and no longer pulls on the retina.

Rarely, the flashes are so unpleasant that surgical intervention (vitrectomy) is required.
However, this is not without risk.

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