7 responses to “Approach to the patient with flashes and/or floaters”

  1. As far as things that have changed my practice, the lead in this area would be the use of bedside ultrasound to diagnose retinal tears. I practice in an area where on call ophthalmology can be several hours away and ultrasound has been an invaluable tool in helping decide on the urgency of referral. This probably deserves a mention in any discussion of initial diagnosis of retinal tear. Here is one summary: http://www.emdocs.net/ultrasound-for-retinal-detachment/

  2. Another common cause of “flashes” are the random lights that are sometimes perceived just before sleep (hypnagogic phenomenon). Although sometimes distressing for patients, they are completely benign and are diagnosed by history: a patient reports experiencing sudden brief lights in the dark, always in the transition from consciousness to sleep.

  3. I am having a bit of trouble with the table. I thought that acephalgic migraines were unaccompanied by a headache, which is the primary distinction between them and migraines with aura.

  4. Thanks for a clearly written and practical approach to ‘flashes and floaters’, which I commonly encounter in family practice and have found difficult to stratify as to acuity, most especially between PVD and retinal tears/detachment. The clinical pearls in Hx and exam are helpful.

    I agree with the comment above: perhaps an error in the table info on acephalgic migraine?

  5. Where does optometry fit into this equation? In many rural towns access to ophthalmology is more difficult, but patients can often see their optometrist urgently for a posterior chamber exam to rule-out a retinal tear/detachment.

  6. Great overview of a common presentation.
    Much appreciated the clarity in nailing down a differential diagnosis.

  7. I wonder about the role of optometry in a situation, which I think is urgent. How about sending a patient to see their optometrist the same day and contacting ophthalmology urgently or non urgently based on the optometrist’s findings. Being able to talk to an ophthalmologist right away is not a practical option for the place where I practice.

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