Benign disorders

Idiopathic vitreous floaters

Mild, stable floaters that come into the field of view intermittently and move as the eye moves

Often shaped like cells or strands

Translucent

May be more noticeable under certain lighting conditions (eg, in bright sunlight)

Normal vision

May occur in both eyes, although not synchronously

Normal eye examination

History and physical examination, including ophthalmic examination if diagnosis is unclear

Serious vitreous and retinal disorders

Retinal detachment

Sudden, spontaneous, continuous shower of lightning-like flashes (photopsias)

Curtain of vision loss moving across the visual field, visual field defect (usually starts peripherally)

Abnormal retinal examination (eg, detached retina appears as a pale billowing parachute)

Possible risk factors (eg, recent trauma, eye surgery, severe myopia)

Indirect ophthalmoscopy by an ophthalmologist after pupillary dilation

Retinal tear

Sudden, spontaneous photopsias (continuous shower of lightning-like flashes)

May occur in the periphery of the retina and may be visible only by indirect ophthalmoscopy

Indirect ophthalmoscopy by an ophthalmologist after pupillary dilation

Vitreous detachment

Sudden increase in unilateral floaters in patients with average age of 50–75 years

Floaters that are cobweb-like

Often one large floater that moves in and out of central vision

Spontaneous photopsias

Indirect ophthalmoscopy by an ophthalmologist after pupillary dilation

Vitreous hemorrhage

History of proliferative diabetic retinopathy or trauma

Loss of vision that may affect entire visual field

Loss of red reflex

Indirect ophthalmoscopy by an ophthalmologist after pupillary dilation

Vitreous inflammation (eg, cytomegalovirus, Toxoplasma, or fungal chorioretinitis)

Pain

Loss of visual acuity

Loss of vision affecting the entire visual field

Retinal lesions (sometimes cotton-like) that do not conform to an arterial or a venous territory

Risk factors (eg, immunocompromise, injection drug use)

Decreased red reflex

May be bilateral

Evaluation and testing as directed by an ophthalmologist, based on suspected cause

Nonocular disorders

Ocular migraine

Bilateral, synchronous, flashing lights often zigzagging on the peripheral field for 10–20 minutes

Possible blurring of central vision

Possible headache after visual symptoms

Possible migraine history

History and physical examination, including ophthalmic evaluation