Mouches floaters

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Classification according to ICD-10
H43.2 Crystalline deposits in the vitreous
H43.3 Other vitreous opacities
ICD-10 online (WHO version 2019)
Eye floaters in the initial stage ( impression of a person affected)

Mouches volantes (French literally flying flies , German flying mosquitoes , Latin : muscae volitantes ,oftencalled floaters in English-speaking countries, synonym : 'vitreous flakes ') are small, dark or transparent points, spots or thread-like structures in the field of vision that are characteristic of scurrying In a way that moves them together with the line of sight, performing slowly swinging movements around a basic position. It is a vitreous destruction. In the initial phase, they are particularly noticeable when backgrounds with relatively few dark structures are viewed, such as lightly painted walls, blue sky or white paper . There is no categorization of vitreous opacities. Depending on the type and severity, they differ in the type of impairment. With advanced vitreous destruction, the opacities can be seen against any background, even with closed eyes in a bright environment.

The term floaters is sometimes used in ophthalmology as a synonym for any type of vitreous opacity. However, this is misleading. The generic term floater , on the other hand, includes every type of vitreous destruction such as floaters , vitreous opacities and the white ring floater . It can now be found frequently in German-language specialist literature.

Mouches floaters represent a subdivision of the positive scotoma .

Emergence

Condensate in the vitreous humor, manifesting as floaters in the field of vision

Mouches floaters are based on small irregularities in the vitreous fluid and can be found in almost every eye. They arise through the physiological condensation of collagen fibrils , which are dissolved in the basic substance, into microscopic threads and lumps. Mouches floaters can be explained by shadow and diffraction effects on these condensates, which are stronger the more light falls into the eye and the closer the irregularities are in front of the retina, the more clearly they are seen. They often occur in connection with more severe myopia .

Mouches floaters as a disease

Almost everyone perceives eye floaters in certain light conditions in the course of their life. The diagnosis refers to a harmless, but very annoying change in the visual field. The visual acuity , which is used to assess the impairment, is not a reliable parameter for measuring the degree of impairment because it is carried out while sitting, without moving the eyes or head. As a result, the opacities of the vitreous body, which otherwise constantly swim back and forth in the eye, come to a standstill. The disease value is determined to a large extent by the degree of severity, the typology, the localization in the central field of vision, the proximity to the retina, the mobility of the opacities and, above all, the subjective impairment.

treatment

One possible treatment would be the surgical removal of the vitreous body ( vitrectomy ), which, however, is only a possible therapy in severe cases and when there are pronounced complaints due to the disproportionately great effort and possible complications . In a retrospective study with 116 patients, retinal detachment occurred in 2.5% of the cases. Alternatively, minimally invasive techniques are being researched that remove only a very limited part of the vitreous, either all of the affected areas or the parts in the visual axis (so-called core vitrectomy or floaterectomy ). Laser treatments are also carried out to a limited extent, but their benefits and success are controversial. Influencing the collagen metabolism in the vitreous humor is another approach to improve light permeability again. A combination of L-lysine , vitamin C, procyanidins and citrus flavonoids has now been clinically investigated.

Moving the eyes often helps for a short time. Looking up and down, back and forth, moves the vitreous fluid and thus mostly the floaters out of the field of vision.

Demarcation

Mouches floaters are to be distinguished from the perception of other types of vitreous opacities. Sudden, pronounced changes such as an increase in number, size, change in the type of movement or the color of the perceived spots are particularly suspicious. The massive appearance of coarse, deep black spots that move evenly up or down, comparable to a "soot shower", can be caused by bleeding in the vitreous humor. A sudden increase in floaters, combined with the perception of lightning , is a common symptom of the physiological "posterior vitreous detachment ". In rare cases, it can lead to retinal detachment via a retinal tear . The changes mentioned should always give rise to an immediate ophthalmological examination.

Vitreous Destructions

Large-scale liquefaction of the glass body, which is perceived as clouds and streaks, must also be distinguished from this. A vitreous detachment creates the so-called white ring floater , which, depending on the type of detachment, can be perceived by the person affected as a single, multiple, torn or lumpy ring. Depending on the stage of progressive detachment, it can be perceived primarily centrally or peripherally. If the liquefaction of the vitreous body has progressed far, it is swirled continuously and with great speed through the entire field of vision due to the movements of the head and eyes. This type of cloudiness leads to hazy smeared vision and annoying entoptic phenomena . The blurred vision, the entoptic phenomena and the mobility of the opacities can be perceived by those affected - depending on the severity - as very impairing and irritating.

literature

General

Vitrectomy and Floaters

  • William M. Schiff, Stanley Chang, Naresh Mandava, Gaetano R. Barile: Pars plana vitrectomy for persistent, visually significant vitreous opacities. In: Retina. Vol. 20, No. 6, June 2000, ISSN  0275-004X , pp. 591-596.
  • Pauline H. Hong, Dennis P. Han, Janice M. Burke, William J. Wirostko: Vitrectomy for large vitreous opacity in retinitis pigmentosa. In: American Journal of Ophthalmology. Vol. 131, No. 1, January 2001, ISSN  0002-9394 , pp. 133-134, doi : 10.1016 / S0002-9394 (00) 00713-3 .
  • H. Hoerauf, M. Müller, H. Laqua: Mouches volantes and vitrectomy with full vision? In: The ophthalmologist. Vol. 100, No. 8, August 2003, ISSN  0941-293X , pp. 639-643, doi : 10.1007 / s00347-002-0766-y .
  • M. Roth, P. Trittibach, F. Koerner, G. Sarra: Pars plana vitrectomy for idiopathic vitreous opacities. In: Clinical monthly sheets for ophthalmology. Vol. 222, No. 9, September 2005, ISSN  0023-2165 , pp. 728-732, doi : 10.1055 / s-2005-858497 .
  • H. Hoerauf: Vitrectomy Against Floaters. In: Bernd Kirchhof, David Wong (Eds.): Vitreo-retinal Surgery. Springer, Berlin et al. 2007, ISBN 978-3-540-33669-3 , pp. 115-124.

YAG laser treatment and floaters

  • Daniele Aron-Rosa, David A. Greenspan: Neodymium: YAG laser vitreolysis. In: International Ophthalmology Clinics. Vol. 25, No. 3, 1985, ISSN  0020-8167 , pp. 125-134.
  • Carmen A. Puliafito, Paul J. Wasson, Roger F. Steinert, Evangelos S. Gragoudas: Neodymium-YAG laser surgery on experimental vitreous membrane. In: Archives of Ophthalmology. Vol. 102, No. 6, June 1984, ISSN  0003-9950 , pp. 843-847, doi : 10.1001 / archopht.1984.01040030663013 .
  • W. F. Tsai, Y. C. Chen, C. Y. Su: Treatment of vitreous floaters with neodymium: YAG laser. In: British Journal Ophthalmol. Vol. 77, No. 8, 1993, ISSN  0007-1161 , pp. 485-488, PMC 504581 (free full text).

Individual evidence

  1. ↑ Vitreous opacity and dry eye. Retrieved September 21, 2019 .
  2. ^ Pschyrembel clinical dictionary. With clinical syndromes and nouns anatomica. = Clinical Dictionary. Edited by the publisher's dictionary editor under the direction of Christoph Zink. 256th, revised edition. de Gruyter, Berlin et al. 1990, ISBN 3-11-010881-X .
  3. ↑ H. Hoerauf, M. Müller, H. Laqua: floaters and vitrectomy with full visual acuity? In: The ophthalmologist. Vol. 100, No. 8, August 2003, ISSN  0941-293X , pp. 639-643, doi : 10.1007 / s00347-002-0766-y .
  4. ↑ HS Tan, M. Mura, SY Lesnik Oberstein et al .: Safety of vitrectomy for floaters. Am J Ophthalmol, ISSN  0002-9394 , 2011, Vol. 151, pp. 995-998, doi : 10.1016 / j.ajo.2011.01.005 .
  5. ↑ Craig Goldsmith, Tristan McMullan, Ted Burton: Floaterectomy Versus Conventional Pars Plana Vitrectomy For Vitreous Floaters. In: Digital Journal of Ophthalmology 2007 , Volume 13, Number 2, 13 July 2007.
  6. ↑ Frank HJ Koch: Floaterectomy: Effects on Patients Quality of Life. In: Retina Society in Washington DC , Sept. 6th 2012
  7. ↑ U. Welge-Lüßen, TH Kaercher, LN Marchenko et al .: The role of micronutrients in the treatment of vitreous floaters. Eur J Ophthalmol, ISSN  1120-6721 , 2015, vol. 25, p. E67.
  8. ↑ Flashes and Floaters. ( Memento of July 28, 2013 in the Internet Archive ). At: US National Library of Medicine. (PDF; 257 kB).

Web links

Commons : Floaters  - collection of images, videos and audio files