Stains before the eyes

There are those who see them as flies, others as black dots or filaments, others as shadows: everyone has their own way of describing those “unidentified flying objects” that seem to float in our eyes, especially when we raise them to look at a blue sky or point them towards a white wall.

“The dark spots in front of the eyes, of various sizes and that move following the movements of the eyes and eyelids, but do not cause any pain, are called in scientific terms myodesopsias (from the Greek miodes, similar to flies, in fact)”, explains Francesco Carones, ophthalmologist specialized in refractive surgery and cataract surgery. “Usually they are not a sign of diseases, but they are symptoms caused by the degeneration or alteration of the vitreous, the transparent gelatinous substance (formed by sugars, proteins, collagen, hyaluronic acid, fibers) that fills the entire eye between the retina and the crystalline lens which, with the aging process, tends to dehydrate, forming small impurities that float in the vitreous and are identified in the visual field”.

Dehydration can also have another consequence: “Causing a reduction in the volume of gelatin that is no longer completely adherent to the retina like a ball, but recedes towards the center of the eyeball. These areas of detachment give the feeling of seeing “midges” passing in front of us». In the vast majority of cases, therefore, the “flies” are nothing serious, they are the consequence of physiological or paraphysiological events, that is, connected to advancing age, and are therefore extremely common, even if they affect more the “long” eyes than the “short” eyes: that is, more the myopic than the hypertmetrops or those who do not have vision defects, because the myopic eyes contain more vitreous and it is easier for this to become impure or to detach.

The risks associated with myodesopsias

“There is only one potential danger,” continues the ophthalmologist. “Almost always the retina is strong enough to remain attached to the choroid (membrane that surrounds the retina from the outside): but in some cases, fortunately rare, when the vitreous retreats microlacerations can form which, in turn, can predispose to the real detachment of the retina. There are conditions that increase the risk of this degenerative process: first of all the strong myopia. Those who have this visual defect, in fact, have a thinner and more delicate retina and therefore more subject to “tearing” in the case of vitreous detachment». Therefore, even if myodesopsias should not generally alarm, it is advisable – especially if they arise suddenly and are accompanied by blurred vision – to report them to the ophthalmologist. “Because it is not possible to discriminate upstream if the phenomenon has been benign, without problems for the retina; If there has been damage to the retina, a diagnosis is needed, based on the symptoms.”

The detachment of the vitreous is characterized, in addition to the “flying flies”, especially by the “lightning”. Francesco Carones explains: “If the person goes to sleep and once all the lights in the field of vision of one eye have turned off he has bright flashes or the impression of having a light that turns on and off continuously, it is good that he consults the ophthalmologist as soon as possible: the effect of vitreous retraction on the retina stimulates the nerve fibers and gives the sensation of light even in the dark and it is the moment that can precede a vitreous detachment. Even this is not a phenomenon in itself risky or worrying, but if upon awakening there are myodesopsias, especially in those who have a strong myopia and in the elderly, it is good not to underestimate it».

Usually, however, the myopic are alerted: “The specialist visit is also important to be informed about the prevention of possible events that the patient may face, based on his visual defect”, underlines the expert. “Opticians are very well trained today and make high-quality glasses. But periodically a medical check is necessary, as well as for some checks that only a doctor can do (for example intraocular pressure, to avoid the risk of glaucoma, silent pathology) also to improve one’s awareness of any risks, to recognize the alarm bells of various eye diseases ». Sometimes the spots can be the indicator of a neurological disorder connected to the optic nerve, for example.

Stains before the eyes: the most common causes

Impurities that form in the vitreous due to the normal dehydration process can occur at all ages, even in children, adolescents, young adults. “The first time can be scary,” continues Francesco Carones. “But in young people vitreous dehydration is almost always temporary, and often resolves. To then maybe reappear years later, but always without danger, because vitreous detachment practically never happens before the age of 45-50 ». The months of the year when it is easier to “see flies” are from June to September: “It is the period in which we dehydrate the most, due to the heat and sweat: the body recovers liquids where it can, and the vitreous is a nice reserve. Much of the problem manifests itself in summer and in September, punctually, there is an increase in demand for eye examination from people who have seen the “flying flies” appear and want to be reassured. Spending many hours at the computer or in very dry environments can also worsen the disorder.”

The summer season also favors the “discovery” of myodesopsias: “Impurities are seen above all in situations of high contrast: turning their gaze towards the sea, the sky, clouds (or even snow) or light surfaces because they are very sensitive to the diameter of the pupil: the narrower it is due to the passage of brightness, the more visible the phenomenon is.

Myodesopsias can be the cause of photophobia, i.e. discomfort and sensitivity to natural light, even with tearing, in any season of the year: “The vitreous with impurities is comparable to the windshield of the dirty car: if you drive against light, the view is blurred and the focus is very tiring”.

Paradoxically, even the correction of a visual defect by means of glasses, contact lenses or refractive surgery can cause the patient to suddenly notice the “flying flies”: “Improving vision, even with cataract surgery, makes people “see better” even the moving bodies of the vitreous. Eye drops or artificial tears, on the other hand, do not bring improvements or worsening, because their water component does not penetrate the vitreous (unlike the pharmacological one) and therefore does not serve to increase hydration».

“Among the classic diseases that can give these visual disorders is diabetes, which can compromise both the retina and the state of the vitreous. Even from a trauma (not so violent as to cause a retinal detachment) fluctuating impurities can be generated: a ball in the face playing football can upset the vitreous and maybe suddenly make visible an impurity that was already there but, for example, in a more lateral position and therefore not perceived » explains the specialist.

The presence of blood due to microbleeding of blood vessels and inflammation due to retinal ruptures – caused by traumatic reasons, capillary fragility, important pressure changes – can instead result in blurred vision, but generally the patient does not have the perception of “flying flies”. Only the specialist can help avoid confusion between different symptoms.

Finally, sometimes even headaches, or headaches, can cause flashes and flashes that then spread throughout the visual field, but do not appear as “single” moving bodies (migraine aura) and there may be other symptoms such as nausea and vomiting.

Stains in front of the eyes and stress

Stress can also be a risk factor for the appearance of spots in front of the eyes: “In itself it does not increase the probability of vitreous detachment or that vitreous impurities are generated, but it makes those that are already there more visible, because even when you are under a lot of pressure the pupil tends to remain narrower,” explains Francesco Carones.

In addition to being a cause, stress can also be a consequence of the presence of impurities that compromise the visual field. “Although it depends on the extent of the problem, there are actually conditions in which the vitreous becomes opaque and creates so much discomfort that medical intervention is necessary, because visual ability can be reduced, going from 10 tenths to 7 or even 5, also significantly impacting the quality of life and well-being of people. The disorder can worsen or improve over time, but it can also become a cause of stress and anxiety – because the patient continues to visualize them, almost to “look for them” – creating a vicious circle. What for almost everyone is just a discomfort, in case of hypersensitivity of the person who suffers from it, can affect the quality of sleep, giving difficulty falling asleep and, in some cases, turn into a real obsession.

How to prevent spots in front of the eyes

The best method to prevent the appearance of myodesopsias is to hydrate a lot, always: “Drink at least a liter and a half of water a day, even in the form of herbal teas or teas, and eat many foods rich in water, namely fruit and vegetables, in all ways: soups, soups, centrifuged, extracts, fruit salads, for snacks and hunger breakers, at breakfast, lunch and dinner. It is also possible to take specific supplements to make the vitreous more fluid and consistent, so as to prevent the phenomena of dehydration: a cycle of a month and a half of products based on vitamin E, collagen, hyaluronic acid, coenzyme Q10, zinc, lead, and in general antioxidant substances that serve to counteract the aging processes and promote circulation can be useful.

Remedies for spots in front of the eyes

Fortunately, therapies also exist for this aspect of eye health. “There are three possible paths,” explains the ophthalmologist. The least invasive also coincides with prevention. If the diet is not sufficient to improve myodesopsias when they have already occurred, a laser intervention is possible: “The treatment is called Vitreolysis Yag Laser: in practice, the ophthalmologist focuses the corpuscles by applying a contact lens and vaporizes them with low-energy laser pulses, so that they disappear or reduce in size, Stop bothering. It is an outpatient treatment, without the need for hospitalization, preceded by a local anesthetic and mydria eye drops to dilate the pupil ». The session lasts about half an hour, and it may take more than one. The treatment is not always possible, there may be contraindications and therefore it is preceded by a series of tests to verify its absence and ensure its safe performance.

There is also an extreme solution: “Only in the most serious cases, when the vitreous is very dense, irreparably opaque and the visual capacity is very reduced, or the problem still heavily affects the serenity and quality of life of the patient, it is possible a real ocular microsurgery, vitrectomy, with which the ophthalmologist aspirates the vitreous and replaces it with physiological fluid. The surgery is done in a sterile environment, anesthesia is by local infiltration, and recovery takes place in two-three days.