Acute onset flashers and floaters: Difference between revisions
 
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==Background==
==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.
==Clinical Features==
*Floaters
*Floaters
**A sensation of gray or dark spots moving in the visual field
**A sensation of gray or dark spots moving in the visual field
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==Differential Diagnosis==
==Differential Diagnosis==
#Ocular causes
{{Acute onset flashers and floaters DDX}}
##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 ==
==Evaluation==
*Eye exam  
*[[Eye exam]]
**Stress on:  
**Stress on:  
***Visual acuity  
***Visual acuity  
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{{Retinal images}}
{{Retinal images}}


== Management ==
==Management==
===Suggested Approach for Referral of Patients With Presumed [[posterior vitreous detachment ]]===
*If concerned for mac-on [[retinal detachment]], must be emergently treated
 
*Otherwise, see disposition section for referral information
{| width="600" border="1" cellpadding="1" cellspacing="1"
|-
|
*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)
**High risk of [[Retinal Detachment]]
 
|-
|
*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


|}
==Disposition==
{{Presumed posterior vitreous detachment management}}


==See Also==
==See Also==
*[[Eye Algorithms (Main)]]
{{Eye algorithms}}


==Source==
==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.
#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.


[[Category:Ophtho]]
[[Category:Ophthalmology]]
[[Category:Symptoms]]

Latest revision as of 18:17, 4 February 2026

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

  • If concerned for mac-on retinal detachment, must be emergently treated
  • Otherwise, see disposition section for referral information

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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