The gel-like substance in the back of the eye is called the vitreous. As everyone gets older, the gel becomes more liquid-like and shrinks.
When you are born, the vitreous gel is stuck against the retina, which itself lines the back wall of the eye like wallpaper on a wall. As the gel shrinks, it pulls off the retina causing what is called a posterior vitreous detachment. When this happens, the gel often pulls a little tissue from the nerve in the eye and this tissue floats in the eye causing a "floater" or a spot that seems to shake around in the vision. After a period of time, the brain gets used to this "floater" and it becomes less noticeable although it is always present.
When the vitreous pulls away from the retina, it can cause a rip or a tear, otherwise known as a break, in the retina tissue. Then the liquid fluid in the eye can get through the tear and start to peel the retina off the back wall of the eye like water behind wallpaper causing it to come off the wall. If the retina pulls off the back wall of the eye, this situation is called a retina detachment.
A retinal detachment is a very serious situation and can lead to permanent blindness.
In general, if people notice flashing lights, a shower of floater, or a curtain over their vision they should seek eye care immediately as these symptoms could mean a problem with the retina. If a problem develops and it is caught early, sometime an office laser procedure is all that is needed to save the vision. Even if a surgery is needed to repair a retinal detachment, the earlier the surgery is performed, the higher the chance of a favorable visual outcome.
The examination of a posterior vitreous detachment involves either scleral depression, pushing on the eye, or a contact lens exam or both. Because the eye is shaped like a globe with a small window in the top, part of the retina closest to the window opening cannot be seen directly. Therefore, the wall of the eye needs to be pushed into an area where the doctor can see the tissue (scleral depression) or a special contact lens with mirrors is used to see this area.
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