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ULY CLINIC

ULY CLINIC

20 Septemba 2025, 03:36:18

Visual floaters

Visual floaters
Visual floaters
Visual floaters


Visual floaters are particles of blood, cellular debris, or vitreous condensations that drift within the vitreous humor. When these enter the visual field, they appear as spots, dots, or thread-like shapes.

  • Chronic floaters are often benign and commonly occur in elderly or myopic patients.

  • Sudden onset floaters are an ocular emergency, as they may indicate retinal detachment or vitreous hemorrhage.


Emergency interventions

  • Sudden floaters accompanied by flashes of light or curtain-like visual loss require immediate ophthalmology consultation.

  • Restrict eye movements until diagnosis is confirmed to prevent further retinal injury.


History and Physical Examination

History

  • Duration and onset: sudden vs gradual.

  • Associated symptoms: flashes of light, blurred vision, eye pain, photophobia.

  • Predisposing factors: myopia, prior eye trauma, corrective lens use.

  • Systemic history: diabetes mellitus, hypertension, granulomatous diseases.

  • Medication and allergy history as appropriate.


Physical Examination

  • Inspect eyelids, conjunctiva, and sclera for edema, bruising, or trauma.

  • Assess visual acuity (Snellen chart or symbols).

  • Evaluate pupillary response and fundoscopic appearance to detect retinal abnormalities.


Medical causes

Cause

Onset

Key Features

Associated Findings

Pathophysiology

Management

Retinal detachment

Sudden

Floaters, light flashes, curtain-like visual loss

Painless, progressive vision loss, gray detached retina on fundoscopy

Separation of retina from choroid

Emergency surgery (scleral buckle, vitrectomy)

Posterior uveitis

Gradual

Floaters with blurred vision and eye pain

Photophobia, conjunctival injection

Inflammation of uveal tract

Corticosteroids, immunosuppressive therapy as indicated

Vitreous hemorrhage

Sudden

Shower of red/black dots or haze

Reduced visual acuity, may follow trauma, diabetic retinopathy, or retinal vessel rupture

Bleeding into vitreous cavity

Identify and treat underlying cause; may require vitrectomy


Special considerations

  • Encourage bed rest and maintain a calm environment.

  • If eye patches are necessary, ensure patient safety and orientation.

  • Positioning: support head with pillows or towels to minimize strain.

  • Avoid eye rubbing, straining, or sudden movements.

  • Provide sensory stimulation such as audio devices if vision is significantly impaired.


Patient counseling

  • Educate the patient to avoid touching or rubbing the eyes.

  • Advise limiting sudden head or eye movements.

  • Emphasize the importance of immediate reporting of new flashes, floaters, or curtain-like visual loss.


Pediatric pointers

  • Visual floaters in children commonly follow ocular trauma causing retinal detachment or vitreous hemorrhage.

  • They may also result from benign congenital vitreous debris with no other clinical symptoms.

  • Prompt ophthalmology referral is recommended for acute or progressive cases.


References

  1. Biswas J, Krishnakumar S, Ahuja S. Manual of Ocular Pathology. New Delhi, India: Jaypee — Highlights Medical Publishers; 2010.

  2. Eagle RC Jr. Eye Pathology: An Atlas and Text. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.

  3. Gerstenblith AT, Rabinowitz MP. The Wills Eye Manual. Philadelphia, PA: Lippincott Williams & Wilkins; 2012.

  4. Levin LA, Albert DM. Ocular Disease: Mechanisms and Management. London, UK: Saunders Elsevier; 2010.

  5. Roy FH. Ocular Differential Diagnosis. Clayton, Panama: Jaypee — Highlights Medical Publishers, Inc.; 2012.

  6. Biswas J, Krishnakumar S, Ahuja S. Manual of Ocular Pathology. New Delhi, India: Jaypee – Highlights Medical Publishers; 2010.

  7. Eagle RC Jr. Eye Pathology: An Atlas and Text. Philadelphia (PA): Lippincott Williams & Wilkins; 2011.

  8. Gerstenblith AT, Rabinowitz MP. The Wills Eye Manual. 7th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2012.

  9. Levin LA, Albert DM. Ocular Disease: Mechanisms and Management. London (UK): Saunders Elsevier; 2010.

  10. Roy FH. Ocular Differential Diagnosis. Clayton, Panama: Jaypee – Highlights Medical Publishers, Inc.; 2012.

  11. Kanski JJ, Bowling B. Clinical Ophthalmology: A Systematic Approach. 9th ed. London (UK): Elsevier; 2011.

  12. American Academy of Ophthalmology. AAO Basic and Clinical Science Course. San Francisco (CA): AAO; 2021.

  13. Foroozan R. Retinal detachment and vitreous disorders. Ophthalmol Clin North Am. 2018;31:45–60.

  14. Morgan ML, Katsnelson J. Ophthalmology Review Manual. 5th ed. Philadelphia (PA): Wolters Kluwer; 2017.

  15. American Optometric Association. Comprehensive Eye and Vision Examination Guidelines. St. Louis (MO): AOA; 2020.

  16. Wong TY, Mitchell P. The eye in systemic disease. Lancet. 2007;370:1361–1373.

  17. Choudhury P, Choudhury A. Pediatric ocular emergencies. Indian J Ophthalmol. 2011;59:97–103.

  18. Taylor D. Geriatric ophthalmology: Age-related changes in vision and ocular anatomy. Clin Geriatr Med. 2015;31:285–300.

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