Visual floaters

Visual floaters are particles of blood or cellular debris that move about in the vitreous. As they enter the visual field, they appear as spots or dots. Chronic floaters may occur normally in elderly or myopic patients. However, the sudden onset of visual floaters commonly signals retinal detachment, an ocular emergency.

Emergency interventions

History and physical examination

If the patient’s condition permits, obtain a drug and allergy history. Ask about nearsightedness (a predisposing factor), use of corrective lenses, eye trauma, or other eye disorders. Also ask about a history of granulomatous disease, diabetes mellitus, or hypertension, which may have predisposed him to retinal detachment, vitreous hemorrhage, or uveitis. If appropriate, inspect his eyes for signs of injury, such as bruising or edema, and determine his visual acuity. (See Testing visual acuity, page 803.)

Medical causes

Retinal detachment

Floaters and light flashes appear suddenly in the portion of the visual field where the retina is detached from the choroid. As the retina detaches further (a painless process), the patient develops gradual vision loss, likened to a cloud or curtain falling in front of the eyes. Ophthalmoscopic examination reveals a gray, opaque, detached retina with an indefinite margin. Retinal vessels appear almost black.

Uveitis (posterior)

This disorder may cause visual floaters accompanied by gradual eye pain, photophobia, blurred vision, and conjunctival injection.

Vitreous hemorrhage

Rupture of the retinal vessels produces a shower of red or black dots or a red haze across the visual field. Vision suddenly becomes blurred in the affected eye, and visual acuity may be greatly reduced.

Special considerations

Encourage bed rest and provide a calm environment. Depending on the cause of the floaters, the patient may require eye patches, surgery, or a corticosteroid or other drug therapy. If bilateral eye patches are necessary—as in retinal detachment—ensure the patient’s safety. Identify yourself when you approach the patient, and orient him to time frequently. Provide sensory stimulation, such as a radio or tape player. Place pillows or towels behind the patient’s head to maintain the appropriate patient position. Warn him not to touch or rub his eyes and to avoid straining or sudden movements.

Pediatric pointers

Visual floaters in children usually follow a traumatic injury that causes retinal detachment or vitreous hemorrhage. However, they may also result from vitreous debris, a benign congenital condition with no other signs or symptoms.

Geriatric pointers

Elderly patients may experience increased myopia caused by lens changes. In elderly or myopic patients, chronic floaters may occur normally.

Book Source Details

• Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.

Other Book Chapters Related to Vision changes

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Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2008 Williams & Wilkins.

More About Causes of Vision changes

• Back to symptom: Vision changes: Introduction (review 2057 causes)
• Next Book Extract About Vision changes: Eye pain [Ophthalmalgia] (Professional Guide to Signs & Symptoms (Fifth Edition))
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More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9

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