Flashes of Light & Floaters

Flashes of light and floaters may be the presentation in a number of ocular and neurologic disorders. The most frequently encountered presentation of flashes of light is associated with migraine disorders. Flashes with floaters usually indicate a vitreoretinal traction disorder that may lead to retinal detachment.

Differential Diagnosis

• Migraine
  –Migraine variants may cause visual phenomena such as flashes of light
  –Flashes are usually in the form of jagged lines called fortifications
  –In most instances, the flashes are followed by some form of headache
• Cerebral disorders
  –Variations of TIAs may also present as balls or flashes of light
  –Formed hallucinations often manifest as flashes
  • Retinal damage
    –Retinal breaks may lead to retinal detachment and may manifest as variable flashes of light
    –Floating objects are almost always seen
    –Usually described as resembling gnats; represent liberated red blood cells and/or retinal pigment epithelial cells
  • Posterior vitreous separation or detachment (PVD)
    –PVD is most frequently associated with age but may present with trauma
    –Patients describe a spider web or tailed floater that may have been associated with a lightning-type flash of light off to one side
    –PVDs may be isolated or associated with a retinal break
  • Hypoxic states
    –Retinal neovascularization liberates red blood cells into the vitreous
    –Occurs with diabetic retinopathy, prematurity, and sickle cell anemia
  • Cells in the vitreous
    –Secondary to a number of different inflammatory ocular conditions manifesting as uveitis
    –Cells escaping from intraocular neoplasm or intraocular retinal vascular tumors

  Workup and Diagnosis

  • History
    –Onset, duration, description
    –History of trauma near the head and/or eyes
    –Associated symptoms such as headache, ocular pain,
  • photophobia
    –PMH-known systemic diseases (e.g., hypertension, diabetes, thyroid disease)
  • Physical exam
    –Mental status (possibility of hallucinations or TIA)
    –Visual acuity and confrontation visual fields
    –Perform pupillary evaluation
    –Perform extraocular muscle evaluation
  • Dilated retinal/funduscopic evaluation
    –Usually performed by an ophthalmologist
    –Indicated if redness, pain, and photophobia are present, to rule out uveitis
    –Indicated stat (with either binocular indirect ophthalmoscopy and/or three-mirror fundus lens evaluation) to rule out a retinal tear
    –Indicated with history consistent with retinal neovascularization (vitreous hemorrhage may be subtle or poorly visualized at the periphery)
  • CT or MRI to rule out intraocular neoplasia

  Treatment

  • Migraines
    –Acute treatment: NSAIDs, analgesics, serotonin agonists, ergotamines
    –Chronic therapy: β-blockers, calcium channel blockers, tricyclic antidepressants
  • Posterior vitreous detachment: Education and follow-up visits to ensure that retinal breaks do not develop
  • Retinal tear and/or detachment: Education and urgent retinal consultation for laser/cryopexy/retinal reattachment
  • Retinal neovascularization: Usually necessitates laser photocoagulation and often vitrectomy to evacuate the vitreous hemorrhage to save vision
  • Uveitis
    –Requires topical, subconjunctival, or intravitreal steroid treatment, as well as a comprehensive workup for cause
    –May require systemic immunosuppressive treatment

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Floaters

Read excerpts from these other book chapters related to Floaters:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Floaters

• Back to symptom: Floaters: Introduction (review 18 causes)
• Next Book Extract About Floaters: HALLUCINATIONS (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Floaters

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: HALLUCINATIONS (Differential Diagnosis in Primary Care)

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