2. “I’M SEEING THINGS”
Patients with this problem often use words such as “flashes,” “floaters” “worms,” or “lights,” and various colors and unusual shapes to describe what they see. When this phenomenon is accompanied by decreased visual acuity, emergent or urgent referral is required. Normal vision in a patient who reports “seeing things” calls for careful consideration of the etiology and referral if the diagnosis is uncertain or the suspected disorder is sight-threatening (see Table).4,12-14 Migraine and psychiatric disorders should be considered if suggested by history. (Patients with ocular migraine—which may or may not be associated with a headache—may also report seeing light patterns off to one side, typically lasting 20 to 45 minutes.)
Vitreous or retinal detachment
Patients with vitreous detachment, which is far more common and less serious than retinal detachment, report seeing new floaters or peripheral flashing lights in one eye. Risk factors for vitreous detachment include myopia, older age, eye trauma, and previous eye surgery.4 Physical examination and visual acuity will be normal unless there is an accompanying retinal detachment.12
A full ophthalmologic evaluation is indicated to detect or rule out a retinal detachment or tear—which has been found to co-occur with acute vitreous detachment in 14% of cases.13 Those who present with decreased visual acuity or a visual field defect or who describe a “curtain of darkness” are at risk for retinal detachment and require a same-day referral.13
Like patients with vitreous detachment, those with a retinal detachment will report new floaters or peripheral flashing lights (see Figure 2).12 The presence of vitreous hemorrhage or pigment, which can be seen in a slit lamp exam, is associated with increased risk for retinal detachment, as is a subjective report of vision loss.13
When retinal detachment is suspected, immediate referral to an ophthalmologist is needed.13 Reattachment surgery has good outcomes, especially if it is performed prior to macular involvement or within the first three days of macular detachment.14
Continue for the second problem... "My eye hurts and is red"