Doc, I get these weird clear swirls in my vision that look like gnats. What are they? 

Well, I can’t know for sure without taking a look inside your eye, but there is a decent chance that it is a vitreous floater. Vitreous floaters or opacities come in all shapes and sizes and affect most people at some point in their lives. A lot of times there will be a few of them at a time, and they definitely show up more when looking at a plain background. A bright blue sky without any clouds, or a stark white wall without any color generally bring my floaters out more frequently. 

Okay they have a name, how do they get there? 

Everybody has a gel-like structure on the inside of their eye called the vitreous. It helps keep the eye protected and inflated, similar to water in a water balloon. The vitreous is plastered up against the back part of the eye at various different locations. As time goes by, the gel structure starts to break down and liquify. As it does that, it comes forward from the very back of the eye and floats around closer to the center of the eye. This is what you are seeing as floaters.

Ah, easy enough. Are they dangerous or not? 

Typically no, but if you notice a distinct change in their pattern or presentation, you should have your local optometrist or ophthalmologist take a look at them as a precaution. As an FYI, you will likely have to be dilated for that exam. Floaters themselves do not do any actual damage; however, when the gel shrinks and comes forward it can pull on the spot where it was attached to the retina. Rarely, this pull can cause a hole or tear in the retina. A retinal hole or tear is more of an annoying problem if it is detected early. You likely will need to go see a retinal specialist to see if getting some laser treatment is needed. However, an untreated retinal tear can lead to a retinal detachment, which is a significantly larger problem requiring surgery. 

Will I be able to tell if I have a retinal hole/tear? 

Unfortunately, probably not. Sometimes people will experience some flashes of light associated with the floaters. Those tend to be a little more dangerous, but do not actually tell you with any confidence if a hole or tear is forming. That flash of light is a sign that the vitreous is pulling on the retina in an attempt to detach and float near the center of the eye. If you should see floaters that are brown or red in color, there is definitely a higher chance that you have suffered a retinal break of some sort. 

Is there anything I can do to get rid of them? 

Technically yes, but they are not overly common. If you have enough birthdays, you will likely suffer a total posterior vitreous detachment. This age is different for everyone. Total vitreous detachments are more common in people in their fifties and sixties, but they can happen earlier based on numerous factors. This just means the entire gel vitreous has broken free of all of its attachments from the retina. At that point, a lot of people develop a very large floater called a “weiss ring” from the adhesion around the optic nerve. This presents as a large annoying floater that hangs around a little longer near the center of your vision. 

Normally, your brain will adjust and stop seeing the floater as relevant information. I can still see it during your annual eye exam, but it does not affect your daily life nearly as much as it did originally. If it has been three to six months and it is still very distracting for you, the company Macuhealth has a supplement that you can use. This supplement is branded as a way to decrease the appearance of your obvious floaters. Another option is what is known as vitreolysis. This is an off-label procedure done by a retinal specialist that essentially uses a laser to vaporize the persistent floater. Retinal specialists that I have worked with traditionally want their patients to wait at least a year for their symptoms to resolve before employing this treatment. The last is what they call a post posterior vitrectomy (PPV). This is a surgery done by a specialist in an operating room. In my ten years of practice, I have had one patient that has gotten the surgery done for persistent and debilitating floaters, and one other that I thought could benefit from the procedure. Other than that, it is a significantly more invasive option than I would generally recommend. 

Floaters can be annoying, but they are usually not a problem. Let your local eye doctor know if you start experiencing some. We only get one set of eyes as Amazon does not sell replacements at this point. Making sure they stay healthy is and should be a top priority.