Vitreous Detachment

Synonyms posterior vitreous detachment, vitreous separation

The vitreous gel consists of hyaluronic acid and collagen fibrils. The concentration of hyaluronic acid decreases with age, and the vitreous liquefies and reduces in volume, causing it to fall away from the retina and cause a vitreous detachment. A retinal tear may result. As well as being associated with ageing, liquefaction of the vitreous occurs in myopia, and following ocular surgery or ocular trauma.

• Most common cause of flashes and floaters
• Very common in those over 55 years old

Risk Factors

• Increasing age
• Myopia
• Cataract surgery
• Eye trauma.

• Single (usually) or multiple floaters (dots, spots, or wispy "lace" objects floating across vision), vitreous haemorrhages.
• The floaters are often described as either a circle, ovoid or a bent line, depending on the completeness of the detachment.
• Most floaters in patients over 50 are due to benign vitreous syneresis (liquefaction).
• Occasionally photopsia (an ocular flash) may occur if the vitreous separation exerts traction on the retina.
• Ophthalmoscopy may reveal a Weiss' ring at the site of fibrocellular material.

• Visual acuity
• Slit-lamp retinal examination
• Visual fields
• Ultrasound.

• 15% of patients presenting with vitreous detachment have a retinal tear (half of these have multiple tears).
• Patients with no retinal breaks on presentation still have a 2-5% chance of developing them in the weeks that follow.
• A retinal hole can be sealed in the early stages by laser therapy, thus preventing liquid vitreous seeping through the hole and causing a retinal detachment.
• Depending on symptoms, risk factors, and amount of vitreous traction, patients should be followed-up in 1 to 6 weeks¹.

• Usually the posterior vitreous detachment remains as described, and results in no further harm to the retina. The patient gradually becomes accustomed to the floaters.
• A vitreous haemorrhage may occur if the detachment involves a retinal vessel.
• A retinal detachment occurs if the vitreous fluid passes through a retinal break resulting in separation of the retina from the underlying pigmented epithelium.