Dr. Huntley's
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Visual floaters are particles of blood or cellular debris that move about in the vitreous. As these enter the visual field, they appear as spots or dots. Chronic floaters may occur normally in elderly or myopic patients. However, the sudden onset of visual floaters commonly signals retinal detachment, an ocular emergency.
If the patient’s condition permits, obtain a drug and allergy history. Ask about any nearsightedness (a predisposing factor), use of corrective lenses, eye trauma, or other eye disorders. Also ask about a history of granulomatous disease, diabetes mellitus, or hypertension, which may have predisposed him to retinal detachment, vitreous hemorrhage, or uveitis. If appropriate, inspect his eyes for signs of injury, such as bruising or edema, and determine his visual acuity. (See Testing visual acuity, page 630.)
Floaters and light flashes appear suddenly in the portion of the visual field where the retina is detached from the choroid. As the retina detaches further (a painless process), gradual vision loss occurs, likened to a cloud or curtain falling in front of the eyes. Ophthalmoscopic examination reveals a gray, opaque, detached retina with an indefinite margin. Retinal vessels appear almost black.
Uveitis may cause visual floaters accompanied by gradual eye pain, photophobia, blurred vision, and conjunctival injection.
Rupture of retinal vessels produces a shower of red or black dots or a red haze across the visual field. Vision is suddenly blurred in the affected eye, and visual acuity may be greatly reduced.
Encourage bed rest and provide a calm environment. Depending on the cause, the patient may require eye patches, surgery, or a corticosteroid or other drug therapy. If bilateral eye patches
are necessary — as with retinal detachment — you will need to ensure the patient’s safety. You should identify yourself when you approach the patient, and orient him to time frequently. Provide sensory stimulation, such as a radio or tape player. Place pillows or towels behind the patient’s head to maintain the appropriate patient position. Be sure to warn him not to touch or rub his eyes and to avoid straining or sudden movements.
Visual floaters in children usually follow trauma that causes retinal detachment or vitreous hemorrhage. However, they may also result from vitreous debris, a benign congenital condition with no other signs or symptoms.
Elderly patients may experience increased myopia caused by lens changes. Also, the closest distance at which one can see clearly slowly decreases with age.
Read excerpts from these other book chapters related to Vision loss:
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1 
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