Why Am I Seeing Black Spots in My Vision?

Black spots in vision (or floaters) are the specks, squiggly lines, or cobwebs you may notice in your line of sight. Floaters are clumps of the gel-like substance (vitreous humor) that fill your eye. They are common and usually do not need treatment unless there is an underlying problem with the eye that's causing them. 

This article covers what it means if you’re seeing black spots in your vision. You'll also learn about what causes floaters in your vision, when to worry about them, and how floaters can be treated.

Symptoms

Floaters can look slightly different depending on how the vitreous gel in the eye clumps together. You might describe them as:

• Spots
• Squiggly lines
• Cobwebs
• Dark blobs
• Ring-shaped
• Strands of thread

Floaters are sometimes more noticeable when you’re looking at a light or bright background and less noticeable in the dark.

Usually, floaters move with your vision as your eyes move rather than staying in one spot. A black, fixed spot in your vision could be another condition, like a macular hole.

Causes

Floaters can be a normal part of aging. Even though anybody can get floaters, they’re more common in people over the age of 50 as well as in people who have vision problems like nearsightedness.

Floaters also happen if the vitreous in the eye begins to shrink, clump together, and form particles. These particles float through the eye into your line of sight and cast shadows on the retina as they do. Many times, these particles will eventually settle, and you will no longer notice them as “floaters” in your vision.

Sometimes, people will see flashes of light before they start seeing floaters. Floaters can occur after what is known as a posterior vitreous detachment (PVD). By age 80, more than half of the population has had a posterior vitreous detachment.

This eye problem happens when the central part of the vitreous gel starts to liquefy and can no longer support the gel on the edges. When this part gets weak, it detaches from the sides and collapses into the liquified center. This tugs the light-sensing layer at the back of the eye (retina) and can cause you to see flashes of light. 

In many cases, the posterior vitreous tugs on the vitreous without any problem and detaches from it. However, it can lead to more serious issues such as retinal tears or retinal detachment.

You may see flashes if you hit your head. The motion shakes the vitreous fluid and can make you “see stars” for a moment. Seeing flashes of light that look like a jagged lightning bolt can happen if you get a blood vessel spasm in your brain. This usually happens just in one eye and is called an ocular migraine. It may or may not come with a headache. Migraine with aura is a type of ocular migraine.

Eye floaters can also be a side effect of medications used to treat eye conditions (like injections for ARMD) or those given after eye surgery. In these cases, leftover bubbles from medication or oils used during surgery can look like floaters.

In other cases, floaters can be related to having blood in the eye from leaking blood vessels—a problem that can be related to conditions like diabetic retinopathy (which is why people with diabetes should regularly have their eyes checked). 

People with conditions that cause inflammation and swelling of the middle layer of the eye (uveitis) can also get floaters.

When to See a Provider

If you notice a sudden increase in the number of specks or floaters in your line of sight, you need to see a provider to have your eyes checked. 

While posterior vitreous detachments can happen without causing lasting problems and may even go unnoticed, they can also happen suddenly and be very serious. 

Having a lot of new floaters can be a sign of a tear in the retina. If diagnosed quickly, the condition can usually be successfully repaired. However, if not treated, it can lead to retinal detachment, which can cause vision loss if it’s not fixed with surgery.

Treatment

You may not need treatment for black spots in your vision. If you do, there are a few options depending on what the cause of the floaters is. 

Vitrectomy

A vitrectomy used to be the only treatment for black spots in vision. It is a procedure to take out all of the jelly in the eye and replace it with a clear sterile fluid. This treatment has risks that your surgeon will go over with you, including:

• Potential for retinal detachment
• Serious eye infections
• Appearance of new floaters
• Retinal tear
• Clouding of the lens of the eye (cataracts)

Because of these risks, some of which can threaten your sight, your surgeon will have to weigh the potential for these issues with the need to remove the floaters.

Laser

Another treatment with less risk is laser vitreolysis. With this outpatient procedure, floaters are broken up with the aid of a laser, which is aimed through the dilated pupil at the floater. The floaters are either vaporized or broken up into smaller, less noticeable pieces.

Keep in mind that not all floaters can be treated with this approach. If the floaters are too close to the retina (which often happens in younger people), the laser technique cannot be used.

In deciding whether to treat your floaters with a laser, your surgeon will likely consider whether:

• Your floater has soft borders that make laser treatment possible.
• The floater is located in an area where the laser can be safely used.
• The floater came on recently and was related to posterior vitreous detachment.

Summary

Black spots in your vision are often just annoying and will go away without treatment. When medical care for floaters is needed, your provider might recommend the removal of the gel-like fluid in the eye and the replacement of the fluid. They can also use a laser to vaporize the floaters or break them into smaller pieces. 

If you have black spots in your vision and do not know why, it’s important to see a provider. They can figure out what is causing them and recommend treatment that will help keep your eyes and vision healthy.