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Approach to Flashes, Floaters, Spots

Jonathan A. Barnett

approach to flashers, floaters, spots

Approach to Flashes, Floaters, Spots Flowchart

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.