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    Flashes and Floaters: Ahmed Shahab M08082

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    Ahmed Shahab
    This document discusses flashes and floaters in the eye. It defines floaters as entoptic images caused by opacities in the vitreous humor. Common causes include vitreous condensations from aging or myopia, posterior vitreous detachment, or remnants of the hyaloid artery. Evaluation involves examination of the eye and blood tests to check for underlying conditions. Treatment options for floaters include pars plana vitrectomy or laser vitreolysis to disrupt the floaters. Flashes are sensations of flashing lights caused by mechanical stimulation of photoreceptors, often due to traction from retinal detachment, tears or detachment of the posterior vitreous. Migraines can also cause flashes known

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    Flashes and Floaters: Ahmed Shahab M08082

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    Ahmed Shahab
    60 views15 pages
    This document discusses flashes and floaters in the eye. It defines floaters as entoptic images caused by opacities in the vitreous humor. Common causes include vitreous condensations from aging or myopia, posterior vitreous detachment, or remnants of the hyaloid artery. Evaluation involves examination of the eye and blood tests to check for underlying conditions. Treatment options for floaters include pars plana vitrectomy or laser vitreolysis to disrupt the floaters. Flashes are sensations of flashing lights caused by mechanical stimulation of photoreceptors, often due to traction from retinal detachment, tears or detachment of the posterior vitreous. Migraines can also cause flashes known

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    This document discusses flashes and floaters in the eye. It defines floaters as entoptic images caused by opacities in the vitreous humor. Common causes include vitreous condensations from aging or myopia, posterior vitreous detachment, or remnants of the hyaloid artery. Evaluation involves examination of the eye and blood tests to check for underlying conditions. Treatment options for floaters include pars plana vitrectomy or laser vitreolysis to disrupt the floaters. Flashes are sensations of flashing lights caused by mechanical stimulation of photoreceptors, often due to traction from retinal detachment, tears or detachment of the posterior vitreous. Migraines can also cause flashes known

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    60 views15 pages

    Flashes and Floaters: Ahmed Shahab M08082

    Uploaded by

    Ahmed Shahab
    This document discusses flashes and floaters in the eye. It defines floaters as entoptic images caused by opacities in the vitreous humor. Common causes include vitreous condensations from aging or myopia, posterior vitreous detachment, or remnants of the hyaloid artery. Evaluation involves examination of the eye and blood tests to check for underlying conditions. Treatment options for floaters include pars plana vitrectomy or laser vitreolysis to disrupt the floaters. Flashes are sensations of flashing lights caused by mechanical stimulation of photoreceptors, often due to traction from retinal detachment, tears or detachment of the posterior vitreous. Migraines can also cause flashes known

    Copyright:

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    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 15

    Flashes and Floaters

    Ahmed Shahab
    M08082
    Anatomy of the Vitreous Compartment
    •Occupies 80% of the volume of the
    eye.
    •It helps to keep the retina in place
    against the choroid and helps in
    refraction . ( refractive power 1.336)
    Vitreous humor has the following
    composition:
    water (99%),
    a network of collagen fibrils,
    large molecules of hyaluronic acid,
    peripheral cells (hyalocytes),
    inorganic salts,
    sugar,
    and ascorbic acid.
    •The hyaloid canal is a remnant of the
    hyaloid artery(a branch of the
    primitive dorsal ophthalmic artery)
    Floaters
    •Floaters are entoptic images of
    opacities in the vitreous
    •They can appear as little dots,
    circles, lines, cobwebs, clouds, or
    a puff of smoke- especially against
    a bright background such as a
    diffusely illuminated wall or the
    blue sky .
    •These floaters move around and
    seem to dart about like flies as
    the eye is moved , that is why
    they’re called 'muscae volitantes'.
    Causes
    Vitreous condensations (degenerative – age,
    myopia)

    Posterior vitreous detachment (PVD)


    Congenital (remnants of the hyaloid artery)

    Flecks of protein (ndYAG – post.


    capsulotomy)

    Blood (vitreous hemorrhage due to retinal


    vascular disease)

    Detached retinal operculae

    Aggregated WBC clumps (pan-uveitis,


    post.uveitis, pars planitis)

    Intraocular foreign body (penetrating injury,


    shrapnel)
    Retinal Pigment ( tobacco dust pigment in
    RD)
    Penetrating trauma
    Evaluation
    • Physical examination
    – Blood pressure (high blood pressure may be associated with floaters)
    – Inspect the eye noting the nature of redness, if present. This will help
    diagnose for uveitis which may cause floaters
    – Visual functional Questionaire (VFQ)to assess degree of disability
    – Visual field testing - to detect either a contraction (a local or general
    reduction in the area of field) or a scotoma (an island of loss within the field).
    – Ophthalmoscopy and slit lamp examination
    • Blood tests
    – Full blood count may help diagnose leukemia which can cause floaters
    – Blood sugar to diagnose diabetes which increases the risk of diabetic
    retinopathy, retinal detachment and vitreous hemorrhage
    – ANA and dsDNA antibodies to diagnose systemic lupus erythematosus which
    may cause autoimmune uveitis and floaters
    – Hemoglobin electrophoresis may help diagnose sickle cell anemia
    Management
    Pars Plana Viterrectomy

    •Outpatient procedure
    •3 instruments used.
    •Light is used to illuminate the vitreous
    cavity, then a tubular device cuts the
    vitreous and sucks it out while another
    device replaces it with saline solution.
    •Pars plana vitrectomy has been
    reported to be a highly effective
    treatment for floaters with complete
    resolution of symptoms recorded in
    93.3% of patients in one study (Eye
    2002; 16,:21-26) and 100% of patients
    in another study (Retina 2000;20:591-
    6)
    Management
    Laser surgery

    •ND YAG laser used to disrupt floaters


    •This procedure called laser vitreolysis
    •It uses a high energy acoustic (sound-
    wave) pulse close to the floater. This
    energy pulse disrupts/blasts the
    floater.
    •YAG laser vitreolysis associated with
    reduced chances of success and
    greater complications
    •A recent study showed that laser
    surgery for floaters ameliorated
    symptoms in only a third of patients.
    Furthermore the clinical improvement
    was only moderate in degree,
    subjectively being graded at no greater
    than 50% by 93.3% of patients. In no
    patient was there complete resolution
    of symptoms. Laser treatment led to
    worsening of symptoms in 7.7% of
    patients (Eye 2002; 16,:21-26).
    Flashes
    Flashes (Photopsia)
    • A sensation of flashing lights.
    • Can occur as spots, lines, zigzags or specks.
    • Can present in association with ocular pain, headaches,
    loss of visual acuity or field loss.
    • The retinal photoreceptor cells are incapable of perceiving
    pain, pressure, or temperature. The only stimulus that the
    retina responds to is 'light'. So when the retinal
    photoreceptors experience mechanical stimulation, they
    send a signal to the brain in the form of disorganized light,
    which is perceived by the brain as a 'flash'.
    Causes
    Traction secondary to:
    • Retinal Detachment
     Tractional RD most
    common cause of flashes ,
    however all 3 types of RD
    do cause it.
    • Retinal Tear
    • Posterior Vitreous
    Detachment
    • Trauma
    Causes
    • Migraine:
    – Occurs due to spasm of blood vessels in the brain.
    – Consists of prodrome, headache phase, and a resolution phase.
    – Associated with dizziness and vertigo
    – May or may not be associated with headaches.
    – scintillating scotoma. 'Scintillating' means 'sparkling flashes' and
    'scotoma' means 'a non-seeing area'. It usually begins as a shimmering
    arc of white or colored lights.
    – The arc of light gradually enlarges, becomes more obvious, and may
    take the form of a definite zig-zag pattern.
    – On occasion, this is preceded or followed by a spreading zone of
    visual loss
    Evaluation
    • Clinical history
    • Fundoscopy/Slit lamp
    • B scan ultrasound
    Treatment
    • Treat the cause
    • For migraine , treat with B1 blockers to cause
    vasodilation
    • For RD, Cryopexy or Laser Treatment followed by:
    – Vitrectomy: Usually referred to as a trans pars plana
    vitrectomy (TPPV). Removal and replacement of the
    vitreous with gas or silicone oil
    – Scleral Buckle
    – Pneumatic Retinopexy: positioning a gas bubble over
    the repaired retinal tear
    The end

    Thank you

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