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ULY CLINIC

11 Septemba 2025, 23:45:23

Light Flashes [Photopsias]

Light flashes, also called photopsias, are a cardinal symptom of potentially vision-threatening retinal detachment, though they may arise from other ocular or neurologic disorders. Patients describe them as spots, stars, lightning-type streaks, or arcs of light. Flashes may appear suddenly or gradually, in one area of the visual field or diffusely, and they may signal temporary or permanent visual impairment.

Photopsias usually result from mechanical or inflammatory stimulation of the retina or optic pathways. A common mechanism is traction on the retina caused by separation of the posterior vitreous membrane: the inner layer detaches from the retina while the outer layer remains attached. Hemorrhage from a torn retinal capillary or strands of condensed vitreous in liquefied vitreous can also trigger flashes.

Prompt recognition and management are vital, since untreated retinal detachment can progress to irreversible visual loss.

Emergency Interventions

Limit eye and body movement until retinal detachment is excluded.
Place patient at rest with head slightly elevated; avoid sudden head or ocular motion.
Protect the eye from further trauma (e.g., shield if penetrating injury suspected).
Arrange urgent ophthalmologic consultation; same-day evaluation is required if retinal detachment is suspected.
If trauma is present, stabilize the patient, assess for globe rupture, and avoid pressure on the eye.

History and Physical Examination

History

Onset and timing of flashes: sudden vs. gradual.
Location: localized vs. throughout visual field.
Associated symptoms: floaters, curtain-like vision loss, eye pain, headache, nausea, photophobia.
Ocular history: corrective lenses, prior eye surgery or trauma, high myopia, family history of retinal problems.
Systemic history: diabetes, hypertension, migraine, connective-tissue disorders.
Occupational/recreational exposure: activities causing eye strain or repetitive head motion.

Physical Examination

Inspect lids, lashes, conjunctiva, and sclera for trauma or hemorrhage.
Check cornea, anterior chamber, iris, and lens clarity.
Assess pupils: size, shape, light and accommodation responses, consensual reflex.
Test visual acuity in each eye separately.
Perform confrontation visual field testing; note if patient reports flashes during testing.
Examine fundus with ophthalmoscope for retinal tears, detachment, or vitreous hemorrhage.
If trauma suspected, use a shield and avoid pressure until rupture is excluded.

Medical Causes of Photopsias

Cause	Typical Onset / Pattern	Characteristics of Flashes	Associated Features	Urgent Concerns
Retinal detachment	Sudden or progressive	Localized flashes ± floaters; may precede or accompany “curtain” of vision loss	Painless, possible visual-field defect	Ophthalmic emergency – prompt repair
Posterior vitreous detachment	Sudden	Brief, peripheral flashes; often unilateral	Floaters common; vision usually preserved	Monitor for retinal tear
Migraine aura	Gradual (5–30 min)	Zig-zag lines, scintillating scotomas, or shimmering lights	Followed by throbbing unilateral headache, nausea, photophobia	Usually benign; exclude retinal disease if atypical
Head trauma (“seeing stars”)	Immediate after impact	Sparkling or white flashes	Pain at injury site, headache, dizziness, sometimes LOC changes	Evaluate for ocular or intracranial injury
Other ocular inflammation (uveitis, chorioretinitis)	Variable	Flashes with blurred vision or floaters	Photophobia, redness, ocular discomfort	Treat underlying cause

Special Considerations

Retinal detachment requires surgical repair (e.g., pneumatic retinopexy, scleral buckle, vitrectomy). Explain procedure and need for postoperative activity/position restrictions.
In posterior vitreous detachment without tear, reassure patient; schedule follow-up to detect delayed retinal tear.
For migraine, place patient in a quiet, dark room; give prescribed analgesic or triptan.
After ocular trauma, protect eye and refer urgently.

Patient Counseling

Report any increase in flashes, new floaters, or curtain-like shadow immediately.
After retinal surgery, wear eye shield/patch as advised and avoid heavy lifting, bending, or vigorous eye movement until cleared.
Maintain regular eye exams, especially with diabetes, hypertension, or high myopia.
Explain that occasional brief flashes with aging (due to vitreous changes) can be benign, but persistent or worsening symptoms need prompt review.

Pediatric Pointers

Children may describe flashes as “sparkles” or “lights.”
Post-traumatic photopsias are common; always exclude retinal injury or non-accidental trauma.
Retinal detachment in children is rare but often linked to trauma or congenital anomalies—urgent ophthalmology referral is essential.

References

Gerstenblith AT, Rabinowitz MP. The Wills Eye Manual. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.
Roy FH. Ocular Differential Diagnosis. 6th ed. Panama: Jaypee–Highlights Medical Publishers; 2012.
Levin LA, Albert DM. Ocular Disease: Mechanisms and Management. London: Saunders/Elsevier; 2010.
Biswas J, Krishnakumar S, Ahuja S. Manual of Ocular Pathology. New Delhi: Jaypee–Highlights Medical Publishers; 2010.
Arrenberg AB, Stainier DY, Baier H, Huisken J. Optogenetic control of cardiac function. Science. 2010;330:971–4.
Chaudhury D, Walsh JJ, Friedman AK, et al. Rapid regulation of depression-related behaviours by control of midbrain dopamine neurons. Nature. 2013;493:532–6.