History and examination (of floaters)

History:

• duration of floaters
• any associated visual loss
• it is important to differentiate a floater (which is slightly dissociated from ocular movement) from a blind spot (scotoma)
• size and shape of floater(s) may reflect severity
  • a small ring is consistent with a posterior vitreous detachment
  • a vitreous haemorrhage may present with multiple, large floaters
• multiple floatres suggests presence of the following (1)
  • red blood cells
  • pigment cells
  • pigment granules (of retinal pigment epithelium)
• other conditions e.g. myopia associated with an increased incidence of retinal tears. If pain occurs then this is suggestive of uveitis.

Examination

• a thorough eye examination is needed, includung:
  • measurement of visual acuity
  • pupillary light reaction
  • confrontation fields
  • slit lamp biomicroscopy
  • dilated fundoscopy
  • examination of the fundus with indirect ophthalmoscopy and scleral depression (1)
• red blood cells in the vitreous signify severed retinal vessels.

Reference:

• (1) Margo et al. Posterior vitreous detachment, how to approach sudden-onset floaters and flashing lights. Postgrad Med 2005; 117(3).