Vitreous Detachment – A Complete Medical Guide

Overview

Posterior vitreous detachment (PVD) occurs when the gel‑like vitreous body that fills the back of the eye separates from the retina, the light‑sensing layer at the back of the eye. The vitreous is composed mostly of water, collagen, and hyaluronic acid; with age it liquefies and shrinks, causing it to pull away from the retina.

• Who it affects: Most commonly adults over 50, but it can occur earlier in people with high myopia, previous eye surgery, or eye trauma.
• Prevalence: Approximately 20–30 % of people aged 65 years develop a vitreous detachment each year. By age 80, up to 80 % will have experienced it (source: Mayo Clinic).

Symptoms

Symptoms can be subtle at first and often mimic other eye conditions. Recognizing the full spectrum helps you decide when to seek care.

• Floaters – Small, dark specks, cobwebs or thread‑like shapes that drift across the visual field, especially when looking at a bright background.
• Flashing lights (photopsia) – Brief, lightning‑like streaks or sparks, usually in the peripheral vision.
• Reduced contrast sensitivity – Colors may appear “washed out,” and it becomes harder to see fine detail.
• Blurred or hazy vision – May be intermittent and often improves after blinking.
• Shadow or curtain‑like effect – Rare, but indicates that the retina may be tearing; requires urgent evaluation.
• Eye discomfort or mild pain – Typically due to associated ocular strain, not the detachment itself.

Causes and Risk Factors

Primary cause

The vitreous shrinks and liquefies (a process called syneresis). As it contracts, it pulls away from the retina. When the attachment weakens sufficiently, a separation occurs.

Risk factors

• Age – The risk rises sharply after age 50.
• High myopia (nearsightedness) – Elongated eyeballs stretch the vitreous‑retinal interface.
• Previous ocular surgery – Cataract extraction, laser procedures, or vitrectomy can accelerate vitreous changes.
• Eye trauma – Direct impact can cause vitreous to detach prematurely.
• Inflammatory eye disease – Conditions such as uveitis can weaken vitreoretinal bonds.
• Systemic diseases – Diabetes and hypertension are linked to earlier vitreous changes.

Diagnosis

Diagnosis is usually clinical, based on history and a thorough eye exam performed by an ophthalmologist or optometrist.

Key examination steps

• Visual acuity test – Checks clarity of central vision.
• Slit‑lamp examination – Uses a microscope with a bright light to view the front eye and