I See a Fruit Fly in My Eye!

Is that normal??

That’s a very common complaint when patients call the office. They are usually puzzled, often scared, and always eager to find out why they are seeing weird dots, floaters or webs inside their eye.

The only way to really assess this problem is with a complete, dilated eye exam. Even though the eyedrops are a hassle, they allow the ophthalmologist to look at the entire retina, including the optic nerve, blood vessels (veins and arteries), the macula and fovea, as well as the peripheral retina. The vitreous gel is usually optically clear, but sometimes floaters or strands can be seen within it.

When a patient calls the office with these complaints, it is important that their complaint be treated in an urgent or emergent fashion. This means that an examination must be carried out within twenty four to forty eight hours of the call to the office. This is the safest way to examine and treat promptly to prevent further complications.

First the visual acuity is checked in each eye with glasses. The pressure check is not essential for this type of emergency visit. Dilation with eyedrops is carried out, usually just to the eye that is affected. A very careful examination of the retina is performed, usually using special tools such as 4-mirror contact lens apparatus, or indirect ophthalmoscope with depression for a good view of the peripheral retina. This is the area where most tears or detachments are found.

If a tear is found, immediate treatment with an Argon laser can be carried out in the office setting. The goal with this type of laser is to ‘wall off’ the tear, so that it cannot extend. It is usual to perform a few hundred spots, and to completely surround the tear. Commonly, 3 rows of laser are performed around the tear, and then the treatment is extended to the edge of the retina, an area known as the Ora Serrata.

If the hole or tear does extend, fluid can get under the retina and cause a full detachment. If a detachment occurs, sugical treatment is usually necessary. Obviously, it is better to get to this problem BEFORE the retina begins to detach. Sometimes detachments can be treated with more extensive laser. Other times, cryotherapy is needed. Sometimes a gas bubble (such as perflourate), or silicone oil is needed. In addition, some patients will need an encircling band placed around their eye. This is known as a scleral buckle, and is very successful in re-attaching the retina. Unfortunately, it requires a trip to an operating room, and can result in high degrees of near-sightedness. This is, of course, better than having a complete detachment!!

In a very few cases, the detachment progresses, and a surgery on the inside of the eye (known as vitrectomy) needs to be performed. If none of these treatments work, the patient may go blind from this problem.

If you, or anyone you know, has floating dots, webs, or flashing lights in their vision, tell them not to wait!! Get it checked out, even if the symptoms seem to be getting better.