Acute onset flashers and floaters - Revision history

Danbot: Add verified PubMed references (PMIDs 19934426, 36658378)

2026-03-22T10:53:03Z

Add verified PubMed references (PMIDs 19934426, 36658378)

← Older revision		Revision as of 10:53, 22 March 2026
Line 1:		Line 1:
	==Background==		==Background==
	[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]		[[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		*Photopsia is defined as a visual phenomenon characterized by the perception of flashes of light or flickering in the visual field<ref>Hollands H, et al. Acute-onset floaters and flashes: is this patient at risk for retinal detachment? JAMA. 2009 Nov 25;302(20):2243-9. PMID 19934426</ref><ref>Powell SK, et al. Presentations to eye emergency departments with flashes and floaters differ dependent on incident solar radiation. Ir J Med Sci. 2023 Oct;192(5):2527-2532. PMID 36658378</ref>
	*Acute onset flashers and floaters is a common ED complaint, especially in older adults		*Acute onset flashers and floaters is a common ED complaint, especially in older adults
	*The critical EM concern is ruling out [[retinal detachment]] and vitreous hemorrhage, which are sight-threatening		*The critical EM concern is ruling out [[retinal detachment]] and vitreous hemorrhage, which are sight-threatening

Danbot: Strip excess bold

2026-03-22T09:35:44Z

Strip excess bold

← Older revision		Revision as of 09:35, 22 March 2026
Line 3:		Line 3:
	*Photopsia is defined as a visual phenomenon characterized by the perception of flashes of light or flickering in the visual field		*Photopsia is defined as a visual phenomenon characterized by the perception of flashes of light or flickering in the visual field
	*Acute onset flashers and floaters is a common ED complaint, especially in older adults		*Acute onset flashers and floaters is a common ED complaint, especially in older adults
	*The critical EM concern is ruling out ~~'''~~[[retinal detachment]]~~'''~~ and ~~'''~~vitreous hemorrhage~~'''~~, which are sight-threatening		*The critical EM concern is ruling out [[retinal detachment]] and vitreous hemorrhage, which are sight-threatening
	*Most common cause is ~~'''~~posterior vitreous detachment (PVD)~~'''~~, which is benign but has ~10-15% risk of associated retinal tear		*Most common cause is posterior vitreous detachment (PVD), which is benign but has ~10-15% risk of associated retinal tear
	*Risk factors for retinal detachment: myopia (nearsightedness), prior cataract surgery, prior retinal detachment in other eye, trauma, family history, increasing age		*Risk factors for retinal detachment: myopia (nearsightedness), prior cataract surgery, prior retinal detachment in other eye, trauma, family history, increasing age

Line 36:		Line 36:

	===Sight-Threatening===		===Sight-Threatening===
	*~~'''~~[[Retinal detachment]]~~'''~~: flashes, floaters, visual field curtain, decreased acuity		*[[Retinal detachment]]: flashes, floaters, visual field curtain, decreased acuity
	*~~'''~~[[Vitreous hemorrhage]]~~'''~~: sudden dense floaters, decreased acuity, absent or diminished red reflex		*[[Vitreous hemorrhage]]: sudden dense floaters, decreased acuity, absent or diminished red reflex
	*~~'''~~Retinal tear~~'''~~ (without detachment): may progress to detachment if untreated		*Retinal tear (without detachment): may progress to detachment if untreated

	===Other===		===Other===
Line 48:		Line 48:
	==Evaluation==		==Evaluation==
	===Bedside Exam===		===Bedside Exam===
	*~~'''~~Visual acuity~~'''~~ (each eye separately) — decreased acuity suggests macular involvement		*Visual acuity (each eye separately) — decreased acuity suggests macular involvement
	*~~'''~~Visual field confrontation test~~'''~~ — detect curtain or field defect		*Visual field confrontation test — detect curtain or field defect
	*~~'''~~Pupillary exam~~'''~~: RAPD suggests significant retinal pathology		*Pupillary exam: RAPD suggests significant retinal pathology
	*~~'''~~[[Direct ophthalmoscopy]]~~'''~~: look for blood in vitreous (obscured view = vitreous hemorrhage), retinal tears, detached retina		*[[Direct ophthalmoscopy]]: look for blood in vitreous (obscured view = vitreous hemorrhage), retinal tears, detached retina
	*~~'''~~Slit lamp exam~~'''~~: look for pigmented cells ("tobacco dust") in anterior vitreous — highly suspicious for retinal tear		*Slit lamp exam: look for pigmented cells ("tobacco dust") in anterior vitreous — highly suspicious for retinal tear
	*~~'''~~Intraocular pressure~~'''~~: may be low with retinal detachment		*Intraocular pressure: may be low with retinal detachment

	===Bedside Ultrasound (POCUS)===		===Bedside Ultrasound (POCUS)===
Line 66:		Line 66:
	===Retinal Detachment===		===Retinal Detachment===
	*'''Macula-on detachment''' (macula still attached): ophthalmologic emergency — same-day or next-day repair for best visual outcomes		*'''Macula-on detachment''' (macula still attached): ophthalmologic emergency — same-day or next-day repair for best visual outcomes
	*~~'''~~Macula-off detachment~~'''~~: urgent but not emergent (macula already detached); repair within 24-72 hours		*Macula-off detachment: urgent but not emergent (macula already detached); repair within 24-72 hours
	*Position patient with detachment side down (gravity helps keep retina in place)		*Position patient with detachment side down (gravity helps keep retina in place)
	*Emergent ophthalmology consultation		*Emergent ophthalmology consultation

Danbot: Expanded with EM-focused content: red flags for retinal detachment, POCUS guidance, management by diagnosis, disposition with referral timing

2026-03-20T23:36:32Z

Expanded with EM-focused content: red flags for retinal detachment, POCUS guidance, management by diagnosis, disposition with referral timing

@@ Line 1: / Line 1: @@
 ==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.
+*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, cobwebs, or strands 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
+*Caused either by light bending at the interface of fluid pockets in the vitreous jelly or cells/blood located within the vitreous
-**May persist for months to years
+*May persist for months to years
-*Flashes
+*New onset of many floaters ("shower of floaters") or sudden increase in existing floaters is more concerning than a single new floater
-**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
+===Flashes (Photopsia)===
 ==Differential Diagnosis==
 {{Acute onset flashers and floaters DDX}}
 ==Evaluation==
-*[[Eye exam]]
+===Bedside Exam===
-**Stress on:
+*'''Visual acuity''' (each eye separately) — decreased acuity suggests macular involvement
-***Visual acuity
+*'''Visual field confrontation test''' — detect curtain or field defect
-***Visual field confrontation test
+*'''Pupillary exam''': RAPD suggests significant retinal pathology
-***[[Direct ophthalmoscopy]]
+*'''[[Direct ophthalmoscopy]]''': look for blood in vitreous (obscured view = vitreous hemorrhage), retinal tears, detached retina
-***Slit lamp
+*'''Slit lamp exam''': look for pigmented cells ("tobacco dust") in anterior vitreous — highly suspicious for retinal tear
 {{Retinal images}}
 ==Management==
-*If concerned for mac-on [[retinal detachment]], must be emergently treated
+===Retinal Detachment===
-*Otherwise, see disposition section for referral information
+*'''Macula-on detachment''' (macula still attached): ophthalmologic emergency — same-day or next-day repair for best visual outcomes
 ==Disposition==
 {{Presumed posterior vitreous detachment management}}
 ==See Also==
 {{Eye algorithms}}
 ==References==

Rossdonaldson1: /* Management */

2026-02-04T18:17:50Z

Management

← Older revision		Revision as of 18:17, 4 February 2026
Line 25:		Line 25:

	==Management==		==Management==
			*If concerned for mac-on [[retinal detachment]], must be emergently treated
			*Otherwise, see disposition section for referral information

	==Disposition==		==Disposition==

Rossdonaldson1: /* Background */

2025-05-21T20:14:33Z

Background

← Older revision		Revision as of 20:14, 21 May 2025
Line 1:		Line 1:
	==Background==		==Background==
	[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]		[[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==		==Clinical Features==

Rossdonaldson1: /* Background */

2020-12-16T20:47:10Z

Background

← Older revision		Revision as of 20:47, 16 December 2020
Line 1:		Line 1:
	==Background==		==Background==
			[[File:Schematic diagram of the human eye en.png\|thumb\|Eye anatomy.]]

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* See Also */

2019-04-03T05:11:28Z

Rossdonaldson1 at 05:11, 14 September 2017

2017-09-14T05:11:00Z

← Older revision		Revision as of 05:11, 14 September 2017
Line 23:		Line 23:

	==Management==		==Management==
	~~{{Presumed posterior vitreous detachment management}}~~

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

	==See Also==		==See Also==

Rossdonaldson1 at 05:09, 14 September 2017

2017-09-14T05:09:53Z

← Older revision		Revision as of 05:09, 14 September 2017
Line 24:		Line 24:
	==Management==		==Management==
	{{Presumed posterior vitreous detachment management}}		{{Presumed posterior vitreous detachment management}}

			==Disposition==

	==See Also==		==See Also==

Rossdonaldson1: /* Background */

2017-09-14T05:08:19Z

Background

← Older revision		Revision as of 05:08, 14 September 2017
Line 1:		Line 1:
	==Background==		==Background==

			==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

← Older revision		Revision as of 05:11, 3 April 2019
Line 28:		Line 28:

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

	==References==		==References==