Floaters in eye

Visual floaters

Visual floaters appear as spot and dots in the visual field. It is associated with cellular debris or particles of blood that move about in vitreous. Elderly or myopic patients may suffer from chronic floaters. It may present as migraines scintillations which last for a few seconds or minutes. An ocular emergency such as retinal detachment may present as sudden onset of visual floaters, spiders, threads, cobwebs, worms or dark streaks.It is important to obtain patient’s allergy and drug history. Ask the patient regarding trauma to the eyes, use of corrective lens and pathological eye condition. A patient who suffers from hypertension and diabetes mellitus as well as granulomatous disease has a high chance of developing uveitis, vitreous haemorrhage and retinal detachment.

It is also important to check the eyes of the patient for any signs of injury such as edema or bruising and the visual acuity. The presence of any visual floaters shouldn’t be dismissed as harmless. Proper and careful examination of the retina and vitreous is important identifying the origin and nature of the floaters and in guiding the management. Any patient who presents with new onset of floater should be assumed to suffer from retinal detachment until it is ruled out by peripheral examination of the retina with indirect ophthalmoscope.

The differential diagnosis of visual floaters are vitreous haemorrhage, uveitis (posterior) and retinal detachment.

Vitreous haemorrhage is presented with rupture of retinal vessel which cause red haze or shower of black and red dots across the visual field. In affected eye, the visual acuity will be reduced greatly while the vision will suddenly turn blur.

Posterior uveitis is presented with visual floaters as well as a gradual onset of pain in the eye, blurred vision, photophobia or conjunctival injection.

In retinal detachment, light flashes and floaters may suddenly appear in a portion of the visual field that is associated with detachment of the retina. Gradual loss of vision (curtain falling in front of the visual field) may occur as the retina detached further. An opaque, grey, detached retina with irregular margin is detected on ophthalmoscopic exam. The retinal vessel will appear black.

Visual floater may also present in children as a result of trauma following vitreous haemorrhage or retinal detachment. It may also be associated with congenital benign conditions such as vitreous debris with the absence of other signs and symptoms.


Photopsia

Photopsia is also known as light flashes. It is a cardinal symptoms of retinal detachment which may lead to vision threatening. Photopsia may present throughout the visual field or just locally. It may occur alone or present with floaters. Patient typically complain of seeing stars, spots or lightning-typed streaks.

The light flashes may occur suddenly or gradually. The onset of the condition is an indication of temporary or permanent impairment of the vision. The present of light flashes indicates the splitting of the posterior vitreous membrane into two different layers. ( the inner and outer layers).In this case the outer layer remain fix to the retina while the inner layer is detached from the retina. It is typically perceived in total darkness or subdued lightning. The sensation of the light flashes may occur as a result from strands of solid vitreous which float in the local pool of liquid vitreous or hemorrhage as a result of tear in the retinal capillary or from the vitreous traction on the retina.

The history and examination may include asking the patient when did the patient start noticing light flashes? can the patient shows/pinpoint the location of the light flashes?

do the light flashes occur throughout the field of vision? It is also important to ask the patient to describe fully and completely regarding any headache and pain in the eyes. Patient should also informed the physician regarding any use of corrective lens. It is also worth mentioning if the patient or any family member suffer from a previous medical history of vision and eye problems. Special attention should be taken for patient who suffer from diabetes or hypertension as they may also suffer from retinopathy with a possibility of retinal detachment.

Occupational history is important as the stress of the eye/eye strain due to job stress may also lead to photopsia/ light flashes.

A complete vision and eye examination are performed. These examination are performed if patient present with traumatic episodes. The lashes, lid, tear puncta and external eye are inspected for any abnormalities. Sclera and iris are also inspected for any sign of bleeding. The sizes and shape of the pupil are observed. Consensual light response, accommodation and light reaction are checked for both eyes. Any light flashes that are reported by the patients are documented.

The differential diagnosis of light flashes/photopsia may include vitreous detachment, retinal detachment, migraine headache, head trauma and cytomegalovirus retinitis.

Vitreous detachment usually involves one eye at a time. in this case, that sudden onset of light flashes may be accompany by visual floaters.

Retinal detachment may also cause photopsia/light flashes. The spot of light/floaters are usually localized in the part of visual filed where retinal detachment occurred. Patient may feel like a curtain covering his visual field which is also known as painless visual impairment when the macular region is involved in the retinal detachment.

The classical sign of migraine headache may include light flashes that is accompanied by aura, Patient will later suffer from severe unilateral throbbing headache which last for 1- 12 hours. This headache may be accompanied by nausea and vomiting, photopsia, dizziness, slight confusion as well as paraesthesia, affecting the hands, lip or faces.

Patient may complain of “seeing star” after being involved in a minor head trauma. Besides that, patient may also complained of generalized dizziness and headache as well as pain which is localized at the injury sites.At the later stage patient may suffer from nausea and vomiting and loss his consciousness.

Immunocompromised patient is more susceptible for symptomatic cytomegalovirus infection. The cytomegalovirus infection may also leads to cytomegalovirus retinitis and patient present with a visual symptoms such as loss of peripheral vision, decreased or blurred vision,blind spots, flashes of light ( which indicates retinal detachment ) and floaters.

In pediatric point of view, children may suffer from photopsia /light flashes after minor trauma.


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Comments 1 comment

Steen Rasmussen 21 months ago

I have lost my eyesight completely in my left eye after years of domistic violence being punched in my head, sight went in some 8-10 weeks after dianosed when I went for a eye test.

I now also see similar effects in my other eye, blurred lines and curved lines looking at an amstler grid and an increase in floaders. It has left me with no deept perception and unable to see details i.e food on a plate.

How long will I have my limited sight left ???

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