Acute onset flashers and floaters: Difference between revisions

(Created page with " ==DDX== #PVD (most common) ##Concern for Retinal Detachment #Classic Migraine #Acephalgic migraine (no HA) #Occipital lobe disorders ##Ischemia or infarction ##hem...")
 
 
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==Background==
[[File:Schematic diagram of the human eye en.png|thumb|Eye anatomy.]]
*Photopsia is defined as a visual phenomenon characterized by the perception of flashes of light or flickering in the visual field.


==DDX==
==Clinical Features==
#[[PVD]] (most common)
*Floaters
##Concern for [[Retinal Detachment]]
**A sensation of gray or dark spots moving in the visual field
#Classic [[Migraine]]
**Caused either by light bending at the interface of fluid pockets in the vitreous jelly or cells located within the vitreous
#Acephalgic migraine (no HA)
**May persist for months to years
#Occipital lobe disorders
*Flashes
##Ischemia or infarction
**Monocular, repeated, brief flashes of white light in the peripheral visual field
##hemorrhage
**related to traction on the peripheral retina from areas of tightly adherent vitreous jelly
##arteriovenous malformation
##seizure disorder
##neoplasm may present
##Postural hypotension


==Diagnosis==
==Differential Diagnosis==
*Eye exam
{{Acute onset flashers and floaters DDX}}
**Stress on:
 
***Visual acuity
==Evaluation==
***Visual field confrontation test
*[[Eye exam]]
***Direct ophthalmoscopy
**Stress on:  
***Visual acuity  
***Visual field confrontation test  
***[[Direct ophthalmoscopy]]
***Slit lamp
***Slit lamp
{{Retinal images}}


==Management==
==Management==


==Disposition==
{{Presumed posterior vitreous detachment management}}
==See Also==
{{Eye algorithms}}
==References==
<references/>
#Hollands H, Johnson D, Brox AC, Almeida D, Simel DL, Sharma S. Acute-Onset Floaters and Flashes: is this patient at risk for retinal detachment? JAMA. 2009;302(20):2243-2249.


Suggested Approach for Referral of Patients With Presumed PVD
[[Category:Ophthalmology]]
#Floaters and/or flashes with “red flag” sign of acute retinal detachment
[[Category:Symptoms]]
##Same-day referral to retinal surgeon as minutes may matter; high risk of
Monocular visual field loss (“curtain of darkness”) having retinal detachment
New-onset floaters and/or flashes with high-risk features including Same-day referral to ophthalmologist or retinal surgeon for dilated eye
Subjective or objective visual reduction examination
Vitreous hemorrhage or vitreous pigment on slitlamp examination
New-onset floaters and/or flashes without high-risk features Referral to ophthalmologist for dilated eye examination within 1 to 2 weeks;
counsel patient regarding high-risk features that should prompt urgent
reassessment
Recently diagnosed uncomplicated posterior vitreous detachment with Rereferral to ophthalmologist to rule out new retinal tear or detachment.
New shower of floaters The ophthalmologist should be contacted to help determine urgency.
New subjective visual reduction
Stable symptoms of floaters and/or flashes for several weeks to months,
not particularly bothersome to the patient and without high-risk features
Elective referral to ophthalmologist; counsel patient regarding high-risk
features that should prompt urgent reassessment

Latest revision as of 20:14, 21 May 2025

Background

Eye anatomy.
  • Photopsia is defined as a visual phenomenon characterized by the perception of flashes of light or flickering in the visual field.

Clinical Features

  • Floaters
    • A sensation of gray or dark spots moving in the visual field
    • Caused either by light bending at the interface of fluid pockets in the vitreous jelly or cells located within the vitreous
    • May persist for months to years
  • Flashes
    • Monocular, repeated, brief flashes of white light in the peripheral visual field
    • related to traction on the peripheral retina from areas of tightly adherent vitreous jelly

Differential Diagnosis

Acute onset flashers and floaters

Evaluation

Retinal Images

Management

Disposition

Referral of patients with presumed posterior vitreous detachment

Clinical Assessment Disposition
  • Floaters and/or flashes with “red flag” sign of acute Retinal Detachment
    • Monocular visual field loss (“curtain of darkness”)
  • Same-day (immediate) referral to retinal surgeon (minutes may matter)
  • New-onset floaters and/or flashes with high-risk features:
    • Subjective or objective visual reduction examination
    • Vitreous hemorrhage or vitreous pigment on slitlamp examination
  • Same-day referral to ophthalmologist or retinal surgeon
  • New-onset floaters and/or flashes without high-risk features
  • Referral to ophthalmologist within 1 to 2 weeks
    • Counsel patient regarding high-risk features
  • Recently diagnosed uncomplicated posterior vitreous detachment with
    • New shower of floaters
    • New subjective visual reduction
  • Rereferral to ophthalmologist to rule out new retinal tear or detachment
    • Contact ophtho to help determine urgency
  • Stable symptoms of floaters and/or flashes for several weeks to months, not particularly bothersome to the patient and without high-risk features
  • Elective referral to ophthalmologist
    • Counsel patient regarding high-risk features that should prompt urgent reassessment

See Also

Eye Algorithms

References

  1. Hollands H, Johnson D, Brox AC, Almeida D, Simel DL, Sharma S. Acute-Onset Floaters and Flashes: is this patient at risk for retinal detachment? JAMA. 2009;302(20):2243-2249.
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