Approach to Flashes, Floaters, Spots¶

Jonathan A. Barnett

Key Points¶

This flowchart is meant to serve as a guide. Bear in mind that there are always exceptions.
Scintillating or colorful lights/spots, especially if bilateral, are likely migrainous in nature.
A patient may say they see a visual disturbance in the left eye, when in reality it is in the left visual field of both eyes (indicating that it is a neurological issue, e.g., migraine). Ask if the patient has tried closing one eye to see if the visual phenomenon is actually in one eye.
Rapid onset of floaters, often preceded by a peripheral crescent-shaped light flash, is classic for posterior vitreous detachment. A black curtain or veil that comes down in the vision is classic for retinal detachment.