How to Manage Posterior Vitreous Detachment

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Your eye is filled with a gel-like fluid called vitreous. The vitreous is attached to the retina, located in the back of the eye. Posterior vitreous detachment (PVD) is when the vitreous becomes detached from the retina.

Posterior vitreous detachment usually isn't dangerous to your vision, but it can cause stress and complications that need to be managed and followed by your eye doctor. Here is more information about posterior vitreous detachment (also called vitreous detachment), including symptoms, complications, and treatments.

Closeup, side view of a brown eye.

Carmelo Geraci / EyeEm / Getty Images

What Is Posterior Vitreous Detachment?

The vitreous in your eye is attached to a light-sensitive area called the retina through millions of small fibers. In fact, the vitreous composes 80% of your eye's volume.

With age, the vitreous becomes smaller, pulling those fibers on the surface of the retina. Sometimes, those fibers break, causing the vitreous to become even smaller and to separate.

Risk Factors for Posterior Vitreous Detachment

There are some people who are more likely to have a posterior vitreous detachment, including those who:

  • Are age 50 or older. By age 80, vitreous detachment is very common.
  • Are nearsighted. This means you can see things close up but need glasses or contact lenses to see things at a distance. If you are nearsighted, you have a risk for vitreous detachment at an earlier age.
  • Have had previous cataract surgery.
  • Have previous eye trauma, such as an injury.
  • Have had a vitreous detachment before. However, it may not happen until years later.

Symptoms

Posterior vitreous detachment does not always have symptoms. When there are symptoms, they can include:

  • Floaters, which can look like small dots, spider webs, or lines in your field of vision. These occur because the strands of fiber that are becoming smaller can cast shadows on the retina. If you already have floaters, a posterior vitreous detachment may cause more floaters to occur.
  • Flashes of light in your side (peripheral) vision, particularly in the dark
  • Seeing a dark curtain or shadow moving across your field of vision: This is not common in PVD and more likely occurs with a retinal detachment. Seek immediate medical care.

When you have a posterior vitreous detachment, the flashes and floaters can go away in a couple of months.

Seek Medical Help Quickly

Although a vitreous detachment is usually harmless, you could go on to develop a sight-threatening complication such as a retinal detachment. The symptoms of a PVD often mirror the symptoms of complications such as retinal detachment or a retinal tear.

For this reason, it's important to see an eye doctor quickly if you are having floaters for the first time or if you have more floaters than usual or you have flashes of light, and especially if you have a dark curtain or shadow moving across your field of vision. If an eye doctor is not available, go to the emergency room.

The doctor will perform a dilated eye exam, which will widen your pupil and allow the doctor to examine the vitreous and retina.

Quick assessment through a dilated eye exam can lead to faster treatment if there is a more serious problem. That prompt treatment can lead to better vision-preserving results.

Complications

Eighty-five percent of people with posterior vitreous detachment have no other problems caused by the detachment. However, there are vision-threatening complications that occur in some people with vitreous detachment:

Retinal Detachment

With most posterior vitreous detachments, a break occurs between the vitreous and the retina, with no further problems. In a small percentage of patients, however, the vitreous fibers pull hard enough to tear or detach the retina, causing what is called a retinal detachment. A retinal detachment is a serious condition that can cause loss of vision.

The hallmark symptom for a retina detachment is an increase in floaters, which also can occur with a posterior vitreous detachment. Another sign is a curtain coming down over your vision.

Surgery is needed for retinal detachment. For this reason, you should see an eye doctor if you have a sudden increase in floaters to help determine the cause and seek treatment as needed.

Retinal Tear

When pulling away from the retina, the fibers of the vitreous occasionally tear a hole in the retina. Symptoms of a retinal tear include floaters and flashes of light. Without prompt treatment, a retinal tear can lead to a retinal detachment.

There is a 10% that you will have a retinal tear after a vitreous detachment. Half of those retinal tears lead to retina detachment.

Macular Hole

The macula is the part of your retina responsible for central vision. It is possible for vitreous detachment to cause a hole in the macula. Symptoms of a macular hole include blurry vision and loss of central vision.

Macular Pucker

In the months or years after posterior vitreous detachment, a layer of scar tissue may grow on top of the macula. This is called a macular pucker. Macular pucker causes blurry or distorted vision and a gray or blind spot in the central vision.

Follow-Up Is Needed

Your eye doctor will need to follow up with you as retinal tears or detachment can occur weeks to months later after initially having a PVD. Do not ignore your follow-up visits and care. You may not have any symptoms and still have developed a retinal tear, hole, or (uncommonly) a retinal detachment.

Treatments

Most of the time, a posterior vitreous detachment does not require any treatment. When treatment becomes necessary, it is usually to treat one of the more serious conditions mentioned above. A retina specialist (an ophthalmologist who specializes in the back of the eye) may perform surgery or cryopexy.

Surgery

If posterior vitreous detachment progresses to a retinal detachment, it may require surgery. With one type of surgery used, the retina specialist may need to remove the vitreous and then inject gas in the eye to fill the vitreous space.

This helps to hold the retina in position, giving the eye time to produce more fluid to replace the vitreous. The success rate of this surgery is closer to 90%. A macular hole that occurs after vitreous detachment also may require surgery.

Unless the vision change is severe, macular pucker does not usually require further treatment. In a severe case, surgery also may be needed.

Cryopexy

Cryopexy is a freezing treatment used to help close a retinal tear. It involves the use of intense cold to freeze the damaged retina tissue and promote scar formation. That can help heal a retinal tear.

Coping

It may be stressful to know that you have had posterior vitreous detachment. You may wonder if a more serious eye problem will occur, such as a retinal detachment. You may find yourself monitoring your eye floaters to see if they have become worse.

A 2017 study in the Journal of Ophthalmology found that those with more symptoms (such as floaters) related to a posterior vitreous detachment felt more psychological distress. The distress seemed to worsen as their symptoms became more severe.

Ask your eye doctor for help in managing your worry about symptoms and possible complications from posterior vitreous detachment. Remember that quick action when you have vision changes or a change in the frequency of floaters can help to preserve your vision and eye health.

A Word From Verywell

Posterior vitreous detachment commonly occurs with age. Most people do not require treatment. However, it still is important to see an eye doctor if you have the related symptoms, such as floaters or flashes of light. Wear safety goggles for sports or construction work to lower your chance of an eye injury that can put you at risk.

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Article Sources
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