Floaters After Cataract Surgery: Causes and Warning Signs

Floaters usually come from normal changes in the vitreous, the clear gel that fills the eye, and they often don't need treatment. Having had cataract surgery raises your risk of them and of retinal detachment. A sudden change is different: a lot of new floaters at once, flashes of light, or a dark shadow like a curtain over part of your vision can be signs of a retinal tear or detachment, and they need an eye exam right away (at an emergency room if we're closed), even if your next post-surgery checkup is days off.

Key takeaways

Having had cataract surgery makes floaters more likely, but most come from normal changes in the eye's clear gel and often need no treatment.
Cataract surgery also raises the risk of retinal detachment, a medical emergency in which the retina is pulled away from the back of the eye.
A sudden shower of floaters, flashes or a curtain over part of your vision needs an exam right away, or an emergency room if the office is closed.
Sudden loss of vision in the eye that had surgery, even if it comes back, means calling your surgeon right away, or 911 if you can't reach them.

Why do I see more floaters after cataract surgery?

Cataract surgery itself raises the risk. The National Eye Institute lists having had surgery to treat cataracts among the risk factors for floaters, along with being very nearsighted and having diabetes.

Floaters are small dark shapes that drift across your vision, like spots, threads, squiggly lines or little cobwebs. As the eye ages, tiny strands of the vitreous stick together and cast shadows on the retina, the light-sensitive tissue at the back of the eye, and those shadows are what you see. You may notice them more when you look at something bright, like white paper or a blue sky.

New floaters can also come from a change in the gel itself. A sudden increase in floaters is the most common symptom of a posterior vitreous detachment.

What is a posterior vitreous detachment?

A posterior vitreous detachment, or PVD, happens when the fibers of the vitreous pull away from the retina. It usually happens after age 50, the risk rises as you get older, and people who are nearsighted are at higher risk.

Along with new floaters, you may see flashes of light in your side vision. If the detachment doesn't cause a more serious problem, you'll probably stop noticing the symptoms as much after a few months.

Sometimes the fibers tear a hole in the retina as they pull away, and without quick treatment a retinal tear can lead to a retinal detachment. A dilated eye exam is the only way to tell whether a vitreous detachment has caused a serious problem, which is why the National Eye Institute advises going to your eye doctor right away when these symptoms start; when we're closed, go to an emergency room.

Can cataract surgery cause a retinal tear or detachment?

It raises the risk. The National Eye Institute lists eye surgery, like surgery to treat cataracts, among the things that put you at higher risk of retinal detachment, and the American Optometric Association lists it as a risk factor too. NEI includes retinal detachment among the known risks of cataract surgery, which it calls one of the most common, safe and effective types of surgery done in the United States.

A retinal detachment happens when the retina is pulled away from its normal position at the back of the eye. A small detachment may cause no symptoms. When more of the retina detaches, you may notice a lot of new floaters, flashes of light in one or both eyes, or a dark shadow or curtain on the sides or in the middle of your vision.

It is a medical emergency. If a detachment isn't treated right away, more of the retina can detach, which raises the risk of permanent vision loss or blindness. Getting treatment right away can help protect your vision.

Which floaters after cataract surgery need same-day care?

After cataract surgery, the National Eye Institute advises calling your eye doctor right away if you notice any of these; when we're closed, go to an emergency room:

Floaters: flashes of light, or a lot of small dark spots or squiggly lines floating across your vision
Vision loss (if it's sudden and in the eye that had surgery, call your surgeon first; see below)
Bad pain that won't go away even with pain medicine
Very red eyes

A dark shadow, like a curtain, over part of your vision belongs on that list too, because it can be a sign of a retinal tear or detachment.

If you suddenly lose vision in the eye that had surgery, even if it comes back, call your surgeon right away; if you can't reach the surgeon, call 911. Call 911 right away for sudden loss of vision in your other eye or both eyes, sudden double vision, or any change in vision with face drooping, arm weakness or trouble speaking. Sudden trouble seeing is one of the CDC's signs of stroke, along with sudden numbness or weakness in the face, arm or leg, sudden confusion or trouble speaking, and a sudden severe headache with no known cause. For any of those other signs, with or without a change in vision, call 911 right away, at any hour, as the CDC advises. Get help even if the symptoms go away.

During office hours (Monday 10am to 5pm, Tuesday to Friday 8am to 5pm), call 310-828-2010 right away. We see flashes and new floaters the same day at urgent eye care, even between your scheduled post-surgery visits. For bad pain that medicine doesn't relieve or a very red eye when we're closed, call your surgeon right away or go to an emergency room.

When we're closed, including weekends, go to an emergency room for new flashes, a sudden shower of new floaters, or a curtain or shadow over part of your vision. The National Eye Institute advises going to your eye doctor or the emergency room right away for these symptoms.

Do floaters after cataract surgery go away?

Often they fade from notice. Most people have floaters that come and go, and floaters from aging that don't bother you usually need no treatment. After a vitreous detachment that causes no serious problem, you'll probably notice the symptoms less after a few months.

If floaters make it hard to see clearly and get in the way of daily life, your eye doctor might suggest a vitrectomy, a surgery to remove them. Ask about the risks and benefits first. Our floaters and flashes guide covers floaters at any age.

How we check floaters after cataract surgery at Cohenmehr Optometry

We co-manage cataract surgery. A cataract surgeon we refer you to does the operation, and your follow-up visits happen here on the surgeon's schedule, where we check healing, eye pressure and vision and manage your drops.

When floaters change, our optometrists in Los Angeles do a dilated retinal examination with retinal imaging and look for retinal tears, vitreous changes or bleeding. If we suspect a retinal problem, we arrange a prompt referral to a retina specialist, and your records go over the same day.

Our cataracts page explains how cataracts form and when surgery is worth it. For new flashes or new floaters during office hours, call 310-828-2010 first; calling ahead gets you triaged fastest. When we're closed, go to an emergency room.

Questions patients ask

What are the disadvantages of cataract surgery?

Like any surgery, it has risks. The National Eye Institute lists swelling, bleeding or infection; vision loss or double vision; unusual changes in eye pressure; retinal detachment; and secondary cataract, a clouding that can appear weeks, months or even years later and is fixed with a laser. Your eye doctor can treat these problems, and it helps to start treatment as soon as possible, so go to every checkup and call if anything seems wrong.

What are the side effects of steroid eye drops?

They can raise eye pressure, slow healing and make eye infections more likely. The FDA label for prednisolone acetate eye drops lists increased eye pressure with possible glaucoma, delayed wound healing and secondary eye infections, plus burning or stinging and blurry vision. It calls for routine pressure checks when the drops are used for 10 days or longer. Use them exactly as prescribed, and after cataract surgery, call your eye doctor right away for bad pain that medicine doesn't relieve, or go to an emergency room when the office is closed.

What is lens replacement surgery?

Lens replacement surgery takes out the eye's natural lens and puts in a clear artificial lens, called an intraocular lens or IOL. Cataract surgery is one form: the surgeon removes the cloudy lens and replaces it with an IOL, and the National Eye Institute says the surgery lasts about 1 hour. Our refractive lens exchange page explains how the same operation is used before a cataract forms, to reduce the need for glasses.

Can you prevent floaters after cataract surgery?

Floaters usually come from normal changes in the vitreous as the eye ages, so what matters most is catching a retinal problem early. Retinal detachment is often caused by aging, so there's often no way to prevent it, but safety goggles or other protective eyewear for risky activities like sports lower the risk of a detachment from an eye injury. A dilated eye exam can find a small retinal tear or detachment early, before it affects your vision.

Sources

Written by

Dr. Kevin Cohenmehr, OD

Medical eye care: glaucoma, diabetic eye exams, macular degeneration and eye infections, plus vision therapy for children. A graduate of UCLA and SUNY College of Optometry.

About Dr. Kevin →

Floaters After Cataract Surgery: What's Normal and When to Call