View source for Acute onset flashers and floaters

== DDX ==
#Ocular causes
##Floaters and/or flashes
###[[Posterior Vitreous Detachment]]
###Retinal tear or [[Retinal Detachment]]
###[[Posterior Uveitis]]
##Predominantly floaters
###Vitreous hemorrhage secondary to proliferative retinopathy
##Predominantly flashes
###Oculodigital stimulation
###Rapid eye movements
###Neovascular age-related macular degeneration
#Nonocular causes
##[[Migraine]] aura (classic)
##Migraine aura (acephalgicmigraine)
##Occipital lobe disorders
##Postural hypotension

== Diagnosis ==

*Eye exam 
**Stress on: 
***Visual acuity 
***Visual field confrontation test 
***Direct ophthalmoscopy 
***Slit lamp

== Management  ==

Suggested Approach for Referral of Patients With Presumed PVD 

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*Floaters and/or flashes with “red flag” sign of acute [[Retinal Detachment]] 
**Monocular visual field loss (“curtain of darkness”)

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*Same-day (immediate) referral to retinal surgeon (minutes may matter) 
**High risk of [[Retinal Detachment]]

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*New-onset floaters and/or flashes with high-risk features: 
**Subjective or objective visual reduction examination 
**Vitreous hemorrhage or vitreous pigment on slitlamp examination

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*Same-day referral to ophthalmologist or retinal surgeon

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*New-onset floaters and/or flashes without high-risk features

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*Referral to ophthalmologist within 1 to 2 weeks 
**Counsel patient regarding high-risk features 

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*Recently diagnosed uncomplicated posterior vitreous detachment with 
**New shower of floaters 
**New subjective visual reduction

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*Rereferral to ophthalmologist to rule out new retinal tear or detachment 
**Contact ophtho to help determine urgency

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*Stable symptoms of floaters and/or flashes for several weeks to months, not particularly bothersome to the patient and without high-risk features

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*Elective referral to ophthalmologist 
**Counsel patient regarding high-risk features that should prompt urgent reassessment

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