Visual floaters

Visual floaters are particles of blood or cellular debris that move about in the vitreous. As these 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 Actions

Sudden onset of visual floaters may signal retinal detachment. Does the patient also see flashing lights or spots in the affected eye? Is he experiencing a curtainlike loss of vision? If so, notify an ophthalmologist immediately. Restrict his eye movements until the diagnosis is made.

History

If the patient’s condition permits, obtain a drug and allergy history. Ask about any 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.

Physical assessment

If appropriate, inspect the patient’s eyes for signs of injury, such as bruising or edema, and determine his visual acuity. (See Testing visual acuity, page 691.)

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), gradual vision loss occurs, 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)

Uveitis may cause visual floaters accompanied by gradual eye pain, photophobia, blurred vision, and conjunctival injection. Associated posterior scar formation distorts the shape of the pupil.

Vitreous hemorrhage

Rupture of retinal vessels produces a shower of red or black dots or a red haze across the visual field. Vision is suddenly 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, the patient may require eye patches, surgery, a corticosteroid, or other drug therapy. If bilateral eye patches are necessary — as with retinal detachment — you will need to ensure the patient’s safety. Place pillows or towels behind the patient’s head to maintain the appropriate patient position.

Pediatric pointers

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

Geriatric pointers

Elderly patients may experience increased myopia caused by lens changes. Also, the closest distance at which one can see clearly slowly decreases with age.

Patient counseling

If both of the patient’s eyes are patched, you should identify yourself when you approach him and orient him to time frequently. Provide sensory stimulation, such as a radio or tape player. Be sure to warn him not to touch or rub his eyes and to avoid straining or sudden movements.

Pictures

Book Source Details

• Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Vision loss: Introduction (review 645 causes)
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More About This Book: Title: Signs & Symptoms: A 2-in-1 Reference for Nurses Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-318-1

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