Posterior vitreous detachment (PVD)
Inside your eye is a clear, gel-like substance called the vitreous. Over time, the vitreous changes in texture and may start to pull away from the retina, the light-sensitive layer at the back of the eye. This is known as posterior vitreous detachment (PVD).
PVD is a common change, especially in people over 50, and more likely if you are short-sighted or have had eye surgery. In most cases, it’s simply part of the ageing process. The important thing is recognising when it needs urgent attention.
Causes of PVD in the eye
PVD occurs when the vitreous becomes more liquid and begins to shrink, gradually separating from the retina. Some factors make it more likely to happen earlier or more suddenly, including:
- Natural ageing changes (most common over age 50)
- Short-sightedness (myopia)
- Previous eye surgery (such as cataract removal)
- Eye injury or trauma
- Certain inflammatory eye conditions
Is PVD urgent?
For many people, PVD is uneventful and doesn’t cause lasting problems. However, if part of the vitreous is firmly attached, the pulling can place enough stress on the retina to cause a retinal tear.
A retinal tear can allow fluid to pass underneath the retina, leading to a retinal detachment, a sight-threatening emergency. Around 1 in 10 people with acute PVD develop a retinal tear. The good news is that tears can often be repaired with a quick laser procedure if caught early.
This is why any sudden onset of new floaters, bright flashes, or a shadow across your vision should be checked immediately.
Symptoms of PVD in the eye
The most common symptoms include:
- Floaters: Dark specks, threads, cobweb shapes, or rings drifting across vision, more noticeable against bright backgrounds.
- Flashes of light: Brief flickers or lightning-like streaks, often at the edge of vision, especially in dim light.
A sudden increase in floaters or flashes should be treated as urgent, as it may indicate a retinal tear.
PVD – how long does it last?
The detachment process usually completes within a few weeks to several months. Flashes often stop once the vitreous has fully separated from the retina. Floaters may persist but generally become less noticeable over time as the brain adapts to them.
Can PVD in the eye be reversed?
No. Once the vitreous has detached, it does not reattach. PVD is a permanent structural change inside the eye. However, it does not usually require treatment once complete, provided there is no associated retinal tear or detachment.
What is the treatment for PVD?
There’s no way to reverse PVD; the focus is on protecting the retina and acting quickly if complications develop. Our approach at the clinic includes:
- Comprehensive retinal examination – using dilated fundoscopy and imaging to check for tears.
- Same-day laser treatment – if a retinal tear is found, we use laser retinopexy to seal it and prevent retinal detachment. This is a quick outpatient procedure with a high success rate.
- Follow-up monitoring – to ensure healing is complete and no new areas of concern develop.
With early detection and prompt laser repair, most retinal tears can be treated before they cause lasting damage.
How do retinal holes occur?
A retinal hole occurs when a small, round gap forms in the delicate tissue lining the back of the eye. It often develops as part of the natural ageing process, when the vitreous, the clear gel inside the eye, becomes more liquid and pulls on the retina. If the retina is thin or fragile in certain areas, this traction can create a hole.
Causes of retinal holes
Other factors can increase the likelihood of a hole in the eye forming:
- High myopia (short-sightedness): The eye is longer and the retina more stretched, making it thinner and more prone to breaks.
- Previous eye surgery: Procedures such as cataract removal can increase risk.
- Eye injury: A direct blow to the eye can create a hole, particularly in younger adults.
- Naturally thin retina: Some people are born with areas of thinner retinal tissue, which are more vulnerable.
- Not caused by daily activity: Everyday tasks or normal visual use do not create retinal holes - they result from structural changes or injury.
Symptoms to be aware of
Most retinal holes are symptom-free. When symptoms are present, they can include:
- New or increased floaters (dark spots, threads, or cobweb-like shapes)
- Brief flashes of light in peripheral vision
- A small patch of blurred or shaded vision
If the hole progresses and fluid begins to pass underneath the retina, symptoms will become more pronounced:
- A curtain or veil moving across your vision
- Sudden loss of side vision
- A rapid increase in floaters or flashes
Any sudden change in symptoms should be reported immediately, as it may indicate the start of a retinal detachment.
Diagnosis
Diagnosis is made during a dilated retinal examination, allowing the specialist to see the far edges of the retina. If the hole is near the centre of vision, an optical coherence tomography (OCT) scan may be performed to produce a cross-section image of the retina.
The examination will determine:
- The size and position of the hole
- Whether there is any fluid under the retina
- If there is traction pulling at its edges
- Other risk factors, such as short-sightedness or a history of retinal problems
Monitoring and prognosis
With careful monitoring, most retinal holes remain stable and never cause vision loss. The aim is to detect any early signs of change so that treatment can be carried out before detachment occurs.
When treatment is needed, laser retinopexy is one of the most effective approaches. This seals the retina around the hole to reduce the risk of fluid passing underneath. For low-risk holes, observation with regular follow-up appointments is usually the safest option.
The outlook for a retinal hole is generally very good when appropriate management is in place.
Frequently asked questions
Have any questions?
Our team is happy to guide you through the next steps.
