Floaters (muscae volitantes) refer to the perception of small, moving dark spots in front of the eyes, which appear more pronounced when viewing a bright white background. This condition may be accompanied by flashes of light. Vitreous liquefaction, condensation, and detachment can result from age-related changes or pathological alterations caused by other factors, such as ocular trauma, surgical procedures involving electrocautery or cryotherapy, high myopia, or uveitis. These factors may lead to the depolymerization and liquefaction of hyaluronic acid within the vitreous. Simultaneously, the dehydration and contraction of the fibrous framework of the vitreous can result in condensation. As a result, vitreous liquefaction and condensation often coexist. Increased mobility and traction of the vitreous due to these changes make vitreous detachment more likely. Most cases of vitreous detachment involve posterior detachment, while anterior detachment—especially in the basal region—is rare and is typically associated with ocular trauma.
Retinochoroidal inflammation may lead to vitreoretinal adhesion, and posterior vitreous detachment under such circumstances may cause traction-related complications, including retinal folds, cystoid degeneration, optic disc pits, retinal tears, retinal detachment, and hemorrhage. Vitreous liquefaction and posterior detachment are the primary causes of floaters, accounting for approximately 70% of cases. However, about 1/4 of affected individuals may harbor vision-threatening lesions, the most significant of which is the formation of retinal tears. Clinically, some individuals report symptoms of floaters without detectable vitreous abnormalities upon careful examination.
Patients presenting with complaints of floaters require a thorough dilated fundus examination, including slit-lamp biomicroscopy with a three-mirror lens. Patients with isolated posterior vitreous detachment do not require specific treatment. For those with vision-threatening conditions, such as retinal tears, appropriate management strategies should be implemented.