eye disorders
Floaters
Evaluation of Floaters
The most important goal is to identify serious vitreous and retinal disorders. If these disorders cannot be ruled out, patients should be examined by an ophthalmologist using an indirect ophthalmoscope after pupillary dilation whenever possible. Recognizing ocular migraine is also helpful. History of present illnessshould ascertain onset and duration of symptoms and the shape and volume of floaters, as well as whether they are unilateral or bilateral and whether they have been preceded by trauma. The patient should try to distinguish floaters from lightning-like flashes of light (as in photopsias) or jagged lines across the visual field (as in migraine). Important associated symptoms include loss of vision (and its distribution in the visual field) and eye pain. Review of systemsshould seek symptoms of possible causes, such as headaches (ocular migraine) and eye redness (vitreous inflammation). should note Diabetes Mellitus (DM) (including Eye examination should be reasonably complete. Best corrected visual acuity is measured. The eyes are inspected for redness. Visual fields are assessed in all patients. However, recognition of visual field defects by bedside examination is very insensitive, so inability to show such a defect is not evidence that the patient has full visual fields. Extraocular movements and pupillary light responses are assessed. If patients have a red eye or eye pain, the corneas are examined under magnification afterfluoresceinstaining, and slit-lamp examination is done if possible. Ocular pressure is measured (tonometry). Ophthalmoscopy is the most important part of the examination; it is done after dilating the pupils. To dilate the pupils, the physician first makes sure to record pupillary size and light responses, then instills drops, usually 1 drop each of a short-actingalpha-adrenergic agonist and a cycloplegic. The pupils are fully dilated about 20 minutes after these drops are instilled. Ophthalmoscopy is done by a nonophthalmologist using a direct ophthalmoscope. An ophthalmologist does indirect ophthalmoscopy, which provides a more complete view of the retina, particularly the periphery. The following findings are of particular concern: Sudden increase in floaters Photopsias Loss of vision, diffuse or focal (visual field defect) Recent eye surgery or eye trauma Eye pain Loss of red reflex Abnormal retinal findings Retinal Detachment is suggested by sudden increases in floaters, photopsias, or any of its other, more specific characteristics (eg, visual field defects, retinal abnormalities). Bilateral synchronous symptoms suggest ocular migraine, although patients often have difficulty deciphering the laterality of their symptoms (eg, they often interpret scintillating scotoma of the left field of both eyes as left-eyed). Loss of red reflex suggests opacification of the vitreous (eg, vitreous hemorrhage or inflammation), but it also can be caused by advanced cataracts. Loss of vision suggests a serious disorder causing dysfunction of the vitreous or retina. Patients who require evaluation by an ophthalmologist may need testing. However, tests can be selected by or in conjunction with the ophthalmologist. For example, patients suspected of having chorioretinitis may require microbiologic testing. 