I see fluid coming up in my eye

Another case by Juan Ding, OD PhD

A young gentleman in his 20s came in complaining of poor vision in his left eye which worsened for the past 2 weeks, particularly that it bothered him to see ‘fluid seeping up’ in his left eye vision happening a few times in the past two weeks. No it is not seeing fluid in his left eye in a mirror, it is seeing that with his left eye.

He grew up in a middle east country, had congenital cataract and cataract surgery both eyes. When he was a young kid, he unfortunately had an injury to his left eye that made him completely blind in that eye. He wears a prosthetic shell in the right eye. After removing the shell, it is obvious that this eye has gone – it is withered (phthisis bulbi), with a white membrane (pannus) over the entire cornea. Importantly, there is no sign of infection in this eye, and it does not hurt.

The left eye had only hand motion vision, meaning he can see hand moving in front of his eye but no details. This eye also shows back and forth shaking (nystagmus), which sometimes happens with poor vision from a very early age. Eye pressure is 10, which is normal. There are a lot of cells (4+) in the anterior chamber, which means very severe inflammation. The pupil is irregular and completely stuck to the artificial lens behind (posterior synechiae). The dilation drops could not dilate the pupil at all, so I was not able to see anything behind. Additionally, there appears to be a white membrane on the artificial lens, further blocking any view to the back. Unfortunately in my small eye clinic we do not have B scan to check if there is any retinal detachment.

Further questioning did not yield much more useful information. The patient was aware that he did not see well out of the left eye, but he did not know why, and could not produce any previous medical record.

Given the finding, I prescribed steroid drops for inflammation, and atropine, a strong dilating drop to break the sticky pupil. I made an appointment for him to see our uveitis specialist in 2 weeks, hopefully the pupil will be dilated then for her to see.

The patient walked in to see another eye doctor of our department 6 days later, complaining that his sx did not improve with the drops. In this visit, his eye pressure went up to 29, which was attributed to steroid response. He was given timolol to lower eye pressure

One day later he walked in again, complaining seeing everything white with the dilating drops. His eye pressure in the left eye now became 5. This time the access doctor happened to be the uveitis specialist. She found still the same amount of inflammation that I saw, and found funnel retinal detachment (this is retina detached almost entirely except for the optic nerve head position, causing a funnel shape on ultrasound, as shown below) on B scan. She increased steroid dosage and referred him to our retinal surgeon.

funnel RD from web

image: Ultrasound scan showing a funnel retinal detachment (source: https://imagebank.asrs.org/file/1431/open-funnel-retinal-detachment). This is not my patient.


Weeks later, as I checked back the medical record to see how he’s doing. I found out that he went to Mass Eye and Ear (MEEI) in Boston. From their notes, it appears that he used to see eye doctors there, diagnosed with chronic funnel retinal detachment in 2015, but lost to follow up subsequently.

So the mystery is solved. His chronic retinal detachment is most likely the cause of his uveitis (eye inflammation), and bleeding in the vitreous (found on B scan at MEEI) would be the cause of worsening vision recently, and seeing ‘fluid going up’ in his vision.

Retinal surgeons at MEEI plan to do surgery for him, though the prognosis for vision is poor due to chronic macula off retinal detachment.

It is sad to see a young person who already is blind in one eye to lose vision in the other eye. Infants need to be screened for conditions such as congenital cataract. It is already late if you notice nystagmus. Fortunately this is done routinely in newborns and well visits by pediatricians. Eye injuries should be prevented, especially for boys. And if you already have a serious eye condition, like retinal detachment, please follow up with your eye doctor.

Annoying floaters, where do they come from? And what should you do about them?

By Juan Ding, OD, PhD


I discussed previously floaters in a young woman, in her case (link here) the floaters came from inflammation of her eyes, which is not a common condition. Today I want to talk about the “common” or “regular” floaters that almost everyone has or will have.

I will start with two patients I saw yesterday. A 68 year old gentleman was on the airplane to Arizona to buy a house when he noticed a big floater following him everywhere in the right eye. It had been 5 days now and wouldn’t go away. His vision was the same, but he was very concerned and came to my walk-in clinic. One of my old patients, a 75 year old woman, who saw me 6 months ago for her annual eye exam, made an urgent appointment due to a similar complaint, big floater that suddenly showed up 3 days ago. As she’s an avid reader and knitter, this floater was quite annoying with her near work.

In both patients, I diagnosed them with posterior vitreous detachment (PVD). This is a common age-related eye condition, and happens in 60% of those in their 60s, and by age 90, 90% of people would have developed PVD. This may start in one eye and eventually the other eye would develop it also.

Vitreous is the big jelly occupying the bulk of our eyeball (Figure 1A. Please pardon my poor drawing techniques). On the backside of the vitreous is the critically important tissue- retina. Vitreous and retina are normally attached to each other. It provides structural support of the eyeball and nutrients to the retina. When we were born, the vitreous is typically a single solid piece. With age, the jelly gradually forms liquefied pockets here and there with protein strands floating around. This could happen at any age. So young people also may complain about seeing floaters, but typically small floaters that don’t interfere with vision. You may notice these in a bright uniform background such as the blue sky or a white computer screen. I personally have noticed my floaters since age 8.

As the vitreous becomes ‘weaker and weaker’, it will eventually lose its contact with the retina in multiple locations. The last location that this happens is usually close to the center of our vision, near the optic nerve. The moment that it pulls away from the optic nerve, it leaves a ring-shaped residue (Figure 1B), which floats around to annoy you. Since this is much larger, you will notice it more, and many people become very symptomatic and seek medical attention. Some people also experiences brief flashes of light lasting a second or two, and this is due to the vitreous pulling on the retina.


Figure 1. Normal vitreous and posterior vitreous detachment (PVD).  A. Normal vitreous is a jelly substance that attaches to the underlying retina. B. in PVD, the vitreous detaches from the optic nerve, forming a large floater.

The whole process is actually a normal age-related phenomenon, much like wrinkled skin or gray hair. However, one caveat- when the vitreous detaches, it sometimes pulls a piece of retina with it, causing a retinal tear and even retinal detachment. Fortunately this terrible incident happens in only 7% of those experiencing PVD 1, though some studies find this number to be 22% 2. Still, if you are experiencing a new floater, you should go to your eye doctor for a dilated eye exam immediately, because if you do have a retinal tear, it needs to be fixed within 24 hours.

Further, with a new PVD, the risk of retinal tear or detachment is still high within the next 4-6 weeks, so you should have a repeated dilated eye exam in about 4-6 weeks’ time even if no new symptoms come up. At any time, if you notice new floaters, flashes or light, or have a change in vision or losing a part of your visual field, you should seek immediate medical attention.

So what do you do with a PVD? If there is no retinal tear or detachment that come with it, you can rest assured. Your brain will eventually adapt to the floater and ignore it, though this may take quite a few months. Some very few people who are bothered by floaters and find it interfering with their normal life after even 6 months, a laser can be done to break up the big floater into smaller pieces so that you won’t notice them. Alternatively a vitrectomy surgery can be done to remove the vitreous; however, the surgery is invasive and carries the risk of having infection of the whole eye or developing new retinal detachment. You should talk to your retinal specialist if you are absolutely interested in removing the floaters.

If there is indeed a retinal tear discovered, a retinal specialist will treat this immediately with a laser to seal off the tear. Or if the tear is extensive, a surgery can be done to repair the detached retina.

Fortunately, both of my patients only had PVD and no retinal tear or detachment. I asked them to follow up with our retinal specialist in 4 weeks, and return to clinic immediately if new floaters, flashes or light, or change in vision happened to them.

Summary questions:

  • Can PVD cause retinal tear or retinal detachment?
    • Yes it may in a small subset of people. So always go to your eye doctor immediately if you notice new floaters or flashes of light.
  • How long will I see those annoying floaters?
    • Depends on individual, some may see them for up to 6 months.
  • Is there anything I can do if the floaters really bother me?
    • Please wait at least 6 months for your brain to ignore them. If they persist beyond that and bother you immensely, talk with a retinal specialist for laser or vitrectomy treatment. But be aware of risks of these treatments.



  1. Byer NE. Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment. Ophthalmology. Sep 1994;101(9):1503-1513; discussion 1513-1504.
  2. Uhr JH, Obeid A, Wibbelsman TD, et al. Delayed Retinal Breaks and Detachments after Acute Posterior Vitreous Detachment. Ophthalmology. Oct 23 2019.