Flashes and Floaters

One of the most common problems prompting a visit to the ophthalmologist is the occurence of flashes and/or floaters. These symptoms are generally unassociated with vision-threatening conditions, but they may herald the development of future problems or signal the presence of a potentially dangerous, underlying condition. In the vast majority of patients these symptoms, especially the floaters, are an indication that the vitreous gel is undergoing the normal degenerative process in which the vitreous liquefies and separates from the retina.

While the floaters may be severe and can be described as "cobwebs", "flies", and "clouds", they tend to lessen over several months, although they may never disappear completely. Flashes are more concerning, since they may indicate the presence of a retinal tear. Tiny flashes that occur in the dark are less ominous than bright flashes that occur during the day. If the vitreous degeneration has led to a retinal tear or retinal detachment then urgent laser or surgery is indicated.

If these symptoms occur in a diabetic patient they may indicate bleeding into the vitreous gel from proliferative diabetic retinopathy. Laser surgery would be indicated to prevent further bleeding. These symptoms can also occur in the setting of intraocular inflammation, i.e. uveitis, in which case steroid medication is indicated to quiet the inflammation.

In younger patients flashes (less often floaters) and blurry vision may indicate the presence of migraines. Sometimes a neurologic work up is needed to make sure that the symptoms are not the result of a more serious neurologic condition.

In summary, although flashes and floaters are usually not indicative of a serious problem they need to be evaluated promptly in order to rule out more serious underlying conditions that may benefit from treatment.