Floaters - Differential Diagnosis Framework



What?

Vitreous Floaters:

• Microscopic collagen fibers within the vitreous that tend to clump and cast shadows on the retina, appearing as floaters to the patient.

• Acute-onset flashes and floaters with visual field defect are suggestive of retinal detachment.



Described by Patients As:

• Black spots or specks in the vision

• Spots in the eyes

• Straight and curved lines

• Cobwebs

• Strings

• "O" or "C"-shaped blobs



Retinal Detachment:

Symptoms: Sudden

	• Unilateral flashing lights

	• Floaters

Risk factors for floaters:

	• Myopia

	• Cataract surgery

	• Retinal lattice degeneration

	• Retinal breaks

	• Positive family history

	• Have had inflammation (swelling) inside the eye



Flashes DDX:

Ophthalmic:

• Posterior vitreous detachment

• Retinal tear/hole

• Retinal detachment

• Optic neuritis - photopsia on eye movement, retrobulbar pain

Non-Ophthalmic:

• Migraine - scintillating scotomas, colored lights, bilateral, evolves over 5 to 30 minutes before resolving with onset of a headache, normal visual acuity

• Postural hypotension - bilateral temporary dimming of vision and light-headedness

• Occipital tumors/Occipital lobe disorders

• Vertebrobasilar transient ischemic attacks



Floaters DDX:

Ophthalmic:

• Vitreous syneresis

• Vitreous hemorrhage

• Posterior vitreous detachment

• Retinal detachment

• Vitritis

• Tear film debris



• With time the vitreous, begins to liquify (Vitreous syneresis) and contract.

• As the vitreous contracts, it peels away from the retina (posterior vitreous detachment)

• 50% of 65-year-olds will have a PVD in one or both eyes.

• A person developing a PVD in one eye is likely to develop a PVD in the other eye within the following 18 months.

• Sometimes, as the vitreous pulls away from the retina, a retinal tear or detachment may occur.



#Floaters #Differential #Diagnosis #Ocular #ophthalmology