II. Epidemiology

  1. Common over age 35 years

III. Pathophysiology

  1. Solid aggregates accumulate in the vitreous

IV. Risk Factors

  1. Older age
  2. Myopia

V. Symptoms

  1. Fine gray-black dots, blobs, specks, clouds, cobwebs, strands or strings in visual field
  2. Most easily seen when patient looks at a white wall or blue sky
  3. Movement of Floaters lags eye movement

VI. Causes

  1. No significant increase in number, Vision Loss or Light Flashes
    1. Normal aging
  2. Rapid increase in number or associated Light Flashes or Vision Loss
    1. Retinal Detachment (abrupt and severe floater onset)
    2. Posterior Vitreous Detachment (Risk for Retinal Detachment)
    3. Diabetic Retinopathy or intraocular Hemorrhage
    4. Uveitis or Choroidal inflammation

VII. Differential Diagnosis

  1. Scotomas (Blind Spots)
    1. Do not lag eye movement

VIII. History

  1. See Light Flashes for common history components
  2. Blank spots that do not lag eye movement
    1. Scotoma (Retinal detachement, Optic Nerve or cortical cause)
  3. Significant increase in Floaters
    1. Retinal Detachment, Retinal Hemorrhage or Choroidal inflammation

IX. Exam

  1. See Light Flashes for common exam components

X. Findings: Red Flags

  1. See Light Flashes for common red flag components

XI. Management: Ophthalmology Referral

  1. Emergent referral indications
    1. New or increased Floaters with Acute Vision Loss (or visual field cuts)
  2. Urgent referral indications
    1. New or significantly increased Floaters or
    2. Floaters with risk factors for Retinal Detachment or Vitreous Hemorrhage
      1. Near-sighted (especially high Myopia)
      2. Diabetes Mellitus
      3. Previous Retinal disease

XII. References

  1. Trobe (2012) Physicians Guide to Eye care, p. 45-47
  2. Noble (2001) Primary Care Medicine, p. 1701
  3. Gariano (2004) Am Fam Physician 69:1691-8 [PubMed]

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