Some Causes of Floaters
Cause | Suggestive Findings* | Diagnostic Approach |
|---|---|---|
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 | ||
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 |
* Unilateral unless otherwise specified. | ||