Diagnosis: Vitreous detachment
This patient has a posterior vitreous detachment (PVD) of the right eye (OD). Development of PVD is a normal age-related change. The vitreous, which fills the posterior segment of the eye is firmly attached to the retina. Over time it loses its viscous consistency and begins to liquify. As this happens, it detaches from the retina, hence, the term vitreous detachment. Fortunately, detachment of the vitreous has no visual consequence. However, as the vitreous detaches from the retina, it may tug on the retina causing a retinal tear. Any retinal stimulation whether traction or a frank tear causes flashing lights, which is why this is an important symptom to ask about. If a retinal tear does develop, fluid can accumulate underneath it making it larger and eventually leading to a retinal detachment which causes acute vision loss and is a surgical emergency. However, if a retinal tear is identified before progression to retinal detachment, it can be repaired with laser in the office. Therefore, any patient with new onset floaters should have a dilated eye exam by an ophthalmologist to rule on retinal tear or detachment. Flashing lights should prompt urgent ophthalmic evaluation.
Retinal detachments are more common in myopic eyes, or eyes that are nearsighted. This is because anatomically, myopic eyes tend to be longer and therefore the retina, which covers the entire extent of the posterior pole, is more prone to detachment.
Other retinal conditions, such as bleeding into the vitreous (or vitreous hemorrhage), can cause floaters but are often also associated with decreased vision. Patients with poorly controlled diabetes can develop vitreous hemorrhages and retinal detachments.
Floaters are not associated with cataract as this is part of the anterior segment of the eye.
Retinal tear with surrounding laser:
References and Additional Resources:
- “Eyewiki: Posterior vitreous detachment. Available at: https://eyewiki.aao.org/Posterior_vitreous_detachment.
- Gariano RF, Kim C. Evaluation and Management of Suspected Retinal Detachment. Am Fam Physician. 2004;69(7):1691-1699.
- Gelston, CD. Common Eye Emergencies. Am Fam Physician. 2013;88(8):515-519.
Case 3 Index
Case 3: Introduction
Case 3: Physical Exam
Case 3: Ophtho Visit