Flashes and Floaters.pptVIP

Flashes and Floaters Hong Woon SJUH Flashes and Floaters Flashes AND Floaters occurring together Virtually pathognomic for Posterior Vitreous Detachment Flashes and Floaters ΔΔ Flashes or Floaters Posterior Vitreous detachment Migraine Aura Other causes of flashes and floaters Taking a history of flashes or floaters When to refer Flashes or Floaters PVD Disciform Choroidal melanoma CMV retinitis CRVO Digoxin toxicity Optic nerve compression Optic neuritis AION Pituitary tumour Migraine Aura Charles Bonnet Syndrome Vitreous syneresis PVD Vitreous haemorrhage Asteroid hyalosis Posterior uveitis Entopic phenomenon CMV retinitis Know how to diagnose confidently PVD Migraine aura without headache High index of suspicion not PVD or migraine aura if: Unusual features to flashes or floaters Other symptoms Posterior Vitreous Detachment (PVD) Anatomy of vitreous Mechanism of PVD Epidemiology Symptoms Signs Complications Anatomy of vitreous Mainly water (99%) Collagen filaments and hyaluronic acid Strongly attached at vitreous base Firm attachments at optic disc Attachments to retina decrease with age Vitreous degeneration and syneresis Depolymerisation of hyaluronic acid Release water Pockets of liquefied vitreous Collagen filaments aggregate Fibrils Collapse of gel (syneresis) Visible as small floaters Posterior Vitreous Detachment Posterior vitreous detached from retina Accumulation of lacunae Fluid escapes into retrohyaloid space Large floater Weiss’ ring Posterior hyaloid membrane PVD: predisposing factors Age Myopia Cataract surgery Trauma Posterior uveitis PVD: natural aging change If PVD present 73% chance of PVD in fellow eye if greater than 60 years of age Symptoms of PVD None Flashes alone Floaters alone Flashes and Floaters Symptoms of complication Vitreous haemorrhage Retinal detachment Photopsia from PVD Peripheral arcs of light (Moore’s lightening streak) Occurs on eye movement Dim – seen best in dim lighting Very brief, but recurr