October 1919

A very common phenomenon of imperfect sight is the one known to medical science as muscae volitantes, or flying flies. These floating specks are usually dark, or black; but sometimes appear like white bubbles, and in rare cases may assume all the colors of the rainbow. They move somewhat rapidly, usually in curving lines, before the eyes, and always appear to be just beyond the point of fixation. If one tries to look at them directly, they seem to move a little farther away. Hence their name of flying flies.

The literature of the subject is full of speculations as to the origin of these appearances. Some have attributed them to the presence of floating specks—dead cells or the debris of cells—in the vitreous humor, the transparent substance that fills four-fifths of the eyeball behind the crystalline lens. Similar specks on the surface of the cornea have also been held responsible for them. It has even been surmised that they might be caused by the passage of tears over the cornea. They are so common in myopia that they have been supposed to be one of the symptoms of this condition, although they occur also with other errors of refraction, as well as in eyes otherwise normal. They have been attributed to disturbances of the circulation, the digestion and the kidneys, and because so many insane people have them, have been thought to be an evidence of incipient insanity. The patent-medicine business has thrived upon them, and it would be difficult to estimate the amount of mental torture they have caused, as the following cases illustrate.

A clergyman who was much annoyed by the continual appearance of floating specks before his eyes was told by his eye specialist that they were a symptom of kidney disease, and that in many cases of kidney trouble, disease of the retina might be an early symptom. So at regular intervals he went to the specialist to have his eyes examined, and when at length the latter died, he looked around immediately for some one else to make the periodical examination. His family physician directed him to me. I was by no means so well known as his previous ophthalmological adviser, but it happened that I had taught the family physician how to use the ophthalmoscope after others had failed to do so. He thought, therefore, that I must know a lot about the use of the instrument, and what the clergyman particularly wanted was some one capable of making a thorough examination of the interior of his eyes, and detecting at once any signs of kidney disease that might make their appearance. So he came to me, and at least four times a year for ten years he continued to come.
Each time I made a very careful examination of his eyes, taking as much time over it as possible, so that he would believe that it was careful; and each time he went away happy because I could find nothing wrong. Once when I was out of town he got a cinder in his eye and went to another oculist to get it out. When I came back late at night I found him sitting on my doorstep, on the chance that I might return. His story was a pitiable one. The strange doctor had examined his eyes with the ophthalmoscope, and had suggested the possibility of glaucoma, describing the disease as a very treacherous one which might cause him to go suddenly blind and would be agonizingly painful. He emphasized what the patient had previously been told about the danger of kidney disease, suggested that the liver and heart might also be involved, and advised him to have all of these organs carefully examined. I made another examination of his eyes in general and their tension in particular; I had him feel his eyeballs and compare them with my own, so that he might see for himself that they were not becoming hard as a stone; and finally I succeeded in reassuring him. I have no doubt, however, that he went at once to his family physician for an examination of his internal organs.

A man returning from Europe was looking at some white clouds one day when floating specks appeared before his eyes.
He consulted the ship’s doctor, who told him that the symptom was very serious, and might be the forerunner of blindness. It might also indicate incipient insanity, as well as other nervous or organic diseases. He advised him to consult his family physician and an eye specialist as soon as he landed, which he did. This was twenty-five years ago, but I shall never forget the terrible state of nervousness and terror into which the patient had worked himself by the time he came to me. It was even worse than that of the clergyman, who was always ready to admit that his fears were unreasonable. I examined his eyes very carefully, and found them absolutely normal. The vision was perfect both for the near-point and the distance. The color perception, the fields and the tension were normal; and under a strong magnifying glass I could find no opacities in the vitreous. In short, there were absolutely no symptoms of any disease. I told the patient there was nothing wrong with his eyes, and I also showed him an advertisement of a quack medicine in a newspaper which gave a great deal of space to describing the dreadful things likely to follow the appearance of floating specks before the eyes, unless you began betimes to take the medicine in question at one dollar a bottle. I pointed out that the advertisement, which was appearing in all the big newspapers of the city every day, and probably in other cities, must have cost a lot of money, and must, therefore, be bringing in a lot of money. Evidently there must be a great many people suffering from this symptom, and if it were as serious as was generally believed, there would be a great many more blind and insane people in the community than there were. The patient went away somewhat comforted, but at eleven o’clock—his first visit had been at nine—he was back again. He still saw the floating specks, and was still worried about them. I examined his eyes again as carefully as before, and again was able to assure him that there was nothing wrong with them. In the afternoon I was not in my office, but I was told that he was there at three and at five. At seven he came again, bringing with him his family physician, an old friend of mine. I said to the latter:
“Please make this patient stay at home. I have to charge him for his visits, because he is taking up so much of my time; but it is a shame to take his money when there is nothing wrong with him.” What my friend said to him I don’t know, but he did not come back again.

I did not know as much about muscae volitantes then as I know now, or I might have saved both of these patients a great deal of uneasiness. I could tell them that their eyes were normal, but I did not know how to relieve them of the symptom, which is simply an illusion resulting from mental strain. The specks are associated to a considerable extent with markedly imperfect eyesight, because persons whose eyesight is imperfect always strain to see; but persons whose eyesight is ordinarily normal may see them at times, because no eye has normal sight all the time. Most people can see muscae volitantes when they look at the sun, or any uniformly bright surface, like a sheet of white paper upon which the sun is shining. This is because most people strain when they look at surfaces of this kind. The specks are never seen, in short, except when the eyes and mind are under a strain, and they always disappear when the strain is relieved. If one can remember a small letter on the Snellen test card by central fixation, the specks will immediately disappear, or cease to move; but if one tries to remember two or more letters equally well at one time, they will reappear and move.
Usually the strain that causes muscae volitantes is very easily relieved.

November 1924

QUESTION—Is a great amount of floating specks indicative of cataract? When I am weary these look like a flock of bees crossing my eyeballs.
ANSWER—No. Your particular strain produces floating specks. A different strain produces cataract

April 1925

When a patient stares or strains to see by looking at a light-colored surface he may see, or imagine he sees, floating black specks, strings of black thread or small light-colored globules resembling tears. The floating specks may be apparently a quarter of an inch or more in size and they may be of any shape.
The ability to see or imagine floating specks may occur in children or in adults of any age. Some children have been known to lie on their backs on the ground, look up at light colored clouds and amuse themselves for hours by watching what appeared to be floating specks.
Many nervous people have been made very unhappy, consciously or unconsciously imagining that they see these floating specks.
The cause of floating specks is an imperfect memory of perfect sight. Persons with normal vision who have never been conscious of floating specks can be taught how to imagine them by straining – to imagine letters, colors or other objects imperfectly.

Conversely, patients who are conscious of floating specks are unable to image them and perfect sight at the same time.
In the treatment of floating specks it is important to convince the patients thoroughly that they are only imagined and not seen. It helps very much to impress on the patient’s mind that to see these floating specks requires a sufficient strain to lose a perfect imagination of all objects seen, remembered or imagined at all times and in all places.

QUESTION—Are floating specks serious? Sometimes they just flood my eyes like clouds of dust and greatly frighten me.
ANSWER—Floating specks are not serious. They are always imagined and never seen.

April 1928

Question—Is a great amount of floating specks indicative of cataract? When I am weary these look like a flock of bees crossing my eyeballs.
Answer—No. Your particular strain produces floating specks. A different strain produces cataract.

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