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Mouches volantes - Eye Floaters Explained

Mouches volantes are perceived opacities in the field of vision that appear as floating threads, dots, or cobwebs. They are most commonly caused by changes in the vitreous humor of the eye.

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Things worth knowing about "Mouches volantes"

Mouches volantes are perceived opacities in the field of vision that appear as floating threads, dots, or cobwebs. They are most commonly caused by changes in the vitreous humor of the eye.

What are Mouches volantes?

Mouches volantes (French for flying flies, medically also known as floaters or vitreous opacities) are visual phenomena in which individuals perceive floating dots, threads, rings, or shadows in their field of vision. These opacities move along with eye movements and are especially visible against bright backgrounds such as a blue sky or a white wall.

Causes

The most common cause of mouches volantes is an age-related change in the vitreous humor (corpus vitreum), the gel-like substance that fills the interior of the eye. As we age, this gel undergoes changes:

Vitreous liquefaction: The gel gradually becomes more liquid, and solid components clump together to form opacities.
Posterior vitreous detachment (PVD): The vitreous humor detaches from the retina, which can cause a sudden onset of floaters.

Other possible causes include:

Short-sightedness (myopia)
Eye injuries or eye inflammation (e.g., uveitis)
Diabetic changes in the eye (diabetic retinopathy)
Retinal tear or retinal detachment
Bleeding into the vitreous humor (vitreous hemorrhage)

Symptoms

Typical symptoms of mouches volantes include:

Floating dots, threads, rings, or shadows in the visual field
Movement of the opacities when the eyes move
Increased visibility against bright backgrounds

In most cases, mouches volantes are harmless. Over time, most people notice them less as the brain learns to filter them out.

When to See a Doctor

Certain warning signs require immediate ophthalmological examination:

Sudden onset of many new floaters
Flashes of light (photopsia) accompanying the floaters
A gray shadow or curtain in the visual field
Rapid deterioration of visual acuity

These symptoms may indicate a retinal detachment, which is a medical emergency and must be treated without delay.

Diagnosis

Diagnosis is made through a comprehensive ophthalmological examination, which typically includes:

Slit-lamp examination: Assessment of the anterior segment of the eye and the vitreous body
Fundoscopy (ophthalmoscopy): Examination of the retina and vitreous after pupil dilation
Optical coherence tomography (OCT): Detailed imaging of retinal layers when needed
Ocular ultrasound: Assessment of the vitreous when the optical media are opaque

Treatment

In most cases, no treatment is needed, as mouches volantes are usually harmless and symptoms often improve over time. For particularly bothersome floaters, the following treatment options are available:

Watchful waiting: The most commonly recommended approach for benign, age-related floaters
YAG laser vitreolysis: A laser procedure in which floaters in the vitreous are fragmented or dissolved using an Nd:YAG laser. Suitable for selected cases.
Vitrectomy: A surgical procedure in which the vitreous humor is partially or completely removed and replaced with a saline solution or other medium. Only indicated in severe cases, as complications are possible.

References

American Academy of Ophthalmology (AAO): Floaters and Flashes in the Eyes. www.aao.org (2023)
Spraul CW, Grossniklaus HE. Vitreous Hemorrhage. Surv Ophthalmol. 1997;42(1):3-39.
Sebag J. Floaters and the Quality of Life. Am J Ophthalmol. 2011;152(1):3-4.

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