Floaters and flashes

Acute onset monocular floaters and or flashes or ocular in origin and caused by floaters or cobwebs.

Floaters are a sensation of gray or dark spots moving in the visual field caused by light pending at the interface of fluid pockets in the vitreous jelly or cells located within the vitreous.

Floaters may persist for months to years in chronic uncomplicated posterior vitreous detachment.

Flashes described as mononuclear, brief and repeated flashes of white light in the peripheral visual field and/or related to traction on the peripheral retina from areas of tightly adherent vitreous jelly.

Differential diagnosis for acute floaters and or flashes: Posterior vitreous detachment, retinal tear or retinal detachment, posterior uveitis.

Differential diagnosis for predominately floaters: Vitreous hemorrhage secondary to proliferative retinopathy.

Differential diagnosis for predominately flashes: Oculodigital stimulation, rapid eye movements, neovascular age-related macular degeneration.

Differential diagnoses for acute floaters and or flashes from on ocular causes: Migraine aura, occipital lobe disorders, postural hypotension.

In a meta-analysis the prevalence of retinal tears among patients with flashes but no floaters is almost identical to those who presented with floaters but no flashes, about 13.5% (Hollands H).

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