Flashes and FloatersAPPROACH

ENT, EYE, DENTAL · 19 SECTIONS

⚲

524 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Dysphagia And Odynophagia Throat Pain Ear Pain Foreign Body In Ear Or Nose Vision Loss Complaint Flashes And Floaters Atraumatic Eye Pain Red Eye Dental Abscess Concern Post Extraction Pain And Complications

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx86

HPI

›Symptom characterization

›Visual symptom type

›Flashes

›Floaters

›Curtain

›Haze

›Blurred vision

›Metamorphopsia

›Laterality

›Right eye

›Left eye

›Bilateral

›Baseline vision status

›Contact lenses

›Glasses

›Prior low vision

OPQRST

›Onset

›Sudden

›Gradual

›First episode

›Recurrent episodes

›Provocation and palliation

›Worse in dark

›Worse with eye movement

›Worse with posture change

›Triggered by cough

›Triggered by exertion

›Triggered by trauma

›Quality

›Flashes description

›Lightning streaks

›Arc

›Peripheral flicker

›Floaters description

›Spots

›Cobwebs

›Shower of black dots

›Region and radiation

›Visual field region

›Peripheral

›Central

›Superior field

›Inferior field

›Severity

›Vision change severity

›No vision loss

›Mild blur

›Moderate impairment

›Severe loss

›Functional impact

›Driving impairment

›Reading impairment

›Timing

›Duration per episode

›Seconds

›Minutes

›Hours

›Persistent

›Frequency

›Single episode

›Multiple daily

›Intermittent

›Progression

›Worsening

›Improving

›Stable

Associated symptoms

›Eye symptoms

›Eye pain

›Photophobia

›Redness

›Foreign body sensation

›Discharge

›Diplopia

›Neuro symptoms

›Headache

›Migraine aura history

›Weakness

›Numbness

›Speech change

›Gait change

›Systemic symptoms

›Fever

›Jaw claudication

›Scalp tenderness

›Polymyalgia rheumatica symptoms

›Pregnancy hypertension symptoms

02Alarm Features/alarm32

Immediate vision threat triggers

›Emergent triggers

›New flashes with new floaters

›Shower of floaters

›Curtain or shadow in visual field

›New visual field defect

›Sudden vision loss

›Recent eye trauma

›Eye surgery within weeks

Pain and inflammation triggers

›Pain red flags

›Severe eye pain with decreased vision

›Photophobia with decreased vision

›Ciliary flush

›Corneal opacity

›Hypopyon

Neurovascular triggers

›Neuro red flags

›New focal neurologic deficit

›Worst headache

›Altered mental status

›Transient monocular vision loss

›Giant cell arteritis red flags

›Age 50 years or older with new vision symptoms

›Jaw claudication

›Scalp tenderness

›Temporal artery tenderness

Vital sign danger thresholds

›High risk vitals

›SBP 180 mmHg or higher with neuro symptoms

›Fever 38.0 C or higher with ocular pain

›HR 120 or higher with significant bleeding concern

Anticoagulation and bleeding triggers

›Hemorrhage risk triggers

›Anticoagulant use with sudden floaters

›Known proliferative diabetic retinopathy with sudden floaters

›Sickle cell disease with sudden floaters

03Medications/meds19

Current medications relevant to ocular bleeding and inflammation

›Medication exposure profile

›Anticoagulants

›Warfarin

›Direct oral anticoagulants

›Antiplatelet agents

›Aspirin

›Clopidogrel

›Corticosteroids

›Chronic systemic steroids

›Recent high dose steroid course

›Diabetes medications

›Insulin

›Non insulin agents

Recent changes and contraindications

›Therapy interaction risks

›Recent start of anticoagulant

›Missed doses of anticoagulant

›Bleeding history on current regimen

›Sulfa allergy

›Pregnancy status for medication selection

04Diet/diet6

Exposures that influence vascular and neuro symptoms

›Dietary and intake patterns

›Caffeine intake increase

›Energy drink intake

›Hydration deficit

›Alcohol binge exposure

›Recent fasting

05Review of Systems/ros24

Eye and ENT

›Eye and adjacent symptoms

›Red eye

›Eye pain

›Photophobia

›Discharge

›Contact lens use symptoms

Neuro

›Neurologic symptoms

›Headache

›Visual aura

›Weakness

›Numbness

›Speech change

›Balance change

Cardiovascular and systemic

›Systemic symptoms

›Chest pain

›Palpitations

›Syncope

›Fever

›Weight loss

Rheumatologic and vascular

›Vasculitis symptoms

›Jaw claudication

›Scalp tenderness

›Proximal muscle pain

›New temporal headache

06Collateral History and Family History/chafh10

Collateral and reliability

›Source quality

›Patient report reliability

›Witness corroboration

›Outside records available

Family history

›Heritable and vascular risk

›Retinal detachment in first degree relative

›Connective tissue disorder

›Marfan syndrome

›Ehlers Danlos syndrome

›Early stroke in first degree relative

07Risk Factors/rf22

Ocular risk factors

›Retinal tear and detachment risks

›High myopia

›Prior retinal tear

›Prior retinal detachment

›Lattice degeneration history

›Prior cataract surgery

›Recent posterior capsulotomy

Systemic risk factors

›Bleeding and vascular risks

›Diabetes mellitus

›Hypertension

›Anticoagulant use

›Sickle cell disease

›Hypercoagulable state

Trauma and exposure risks

›Mechanical triggers

›Blunt eye trauma

›Penetrating eye trauma

›High impact sports exposure

›Occupational eye hazard exposure

Special populations

›Pregnancy related risks

›Preeclampsia risk

›Severe hypertension risk

›Hypercoagulability risk

08Differential Diagnosis/ddx71

Life threatening

›Vision threatening emergencies

›Retinal detachment (H33.0)

›Curtain or shadow

›Peripheral field loss

›New flashes

›New floaters

›Retinal tear (H33.3)

›New flashes with floaters

›Vitreous pigment

›Vitreous hemorrhage

›Vitreous hemorrhage (H43.1)

›Sudden floaters

›Haze

›Reduced fundus view

›Central retinal artery occlusion (H34.1)

›Sudden painless severe vision loss

›Afferent pupillary defect

›Acute angle closure glaucoma (H40.21)

›Severe eye pain

›Halos

›Nausea

›High intraocular pressure

›Endophthalmitis (H44.0)

›Recent intraocular surgery or injection

›Pain with decreased vision

›Hypopyon

›Giant cell arteritis (M31.6)

›Age 50 years or older

›Jaw claudication

›New headache

Common

›Frequent causes

›Posterior vitreous detachment (H43.81)

›Flashes

›New floaters

›Weiss ring

›Migraine with aura (G43.1)

›Bilateral scintillating scotoma

›Gradual spread over minutes

›Followed by headache

›Vitreous syneresis

›Chronic floaters

›No flashes

›Stable symptoms

›Dry eye disease (H04.12)

›Fluctuating blur

›Irritation

›Worse with screens

Less common

›Other diagnoses

›Uveitis anterior (H20.0)

›Photophobia

›Ciliary flush

›Cells and flare

›Optic neuritis (H46)

›Pain with eye movement

›Color desaturation

›Afferent pupillary defect

›Ocular ischemic syndrome (H35.82)

›Carotid disease

›Dull ache

›Midperipheral hemorrhages

›TIA amaurosis fugax (G45.3)

›Transient monocular vision loss

›Vascular risk factors

Mimics and pitfalls

›Diagnostic pitfalls

›Migraine aura misattributed to retinal detachment

›Aura bilateral

›Aura lasts 5 to 60 minutes

›Positive visual phenomena

›Floaters after trauma

›Open globe risk

›Retinal tear risk

09Past Medical History/pmh16

Ocular history

›Prior eye disease and procedures

›Prior retinal detachment

›Prior retinal tear and laser

›Cataract surgery history

›Intravitreal injections history

›Glaucoma history

Systemic history

›Relevant comorbidities

›Diabetes mellitus (E11.9)

›Hypertension (I10)

›Atrial fibrillation (I48.91)

›Sickle cell disease (D57.1)

›Autoimmune disease

Baseline function

›Baseline status

›Baseline visual acuity

›Driving baseline

›Work and safety impact baseline

10Physical Exam/exam49

Initial assessment

›General and vitals

›Toxic appearance

›Fever pattern

›Blood pressure severity

›Heart rhythm irregularity

Eye exam core

›Vision and pupils

›Visual acuity each eye

›With correction if available

›Pinhole if needed

›Pupils

›Size symmetry

›Afferent pupillary defect

›Color vision screening

›Red desaturation

›Ishihara if available

›External and motility

›Eyelids

›Conjunctiva

›Extraocular movements

›Pain with eye movement

›Visual fields

›Confrontation fields

›New field defect pattern

Slit lamp and anterior segment

›Anterior segment findings

›Corneal clarity

›Fluorescein uptake

›Anterior chamber

›Cells

›Flare

›Lens status

›Phakic

›Pseudophakic

Intraocular pressure and contraindications

›Pressure and globe integrity

›Intraocular pressure if no open globe concern

›Avoid tonometry if open globe suspected

›Open globe signs

›Peaked pupil

›Seidel sign

›Prolapsed tissue

Posterior segment

›Fundus and vitreous

›Red reflex

›Vitreous hemorrhage signs

›Vitreous pigment

›Optic disc appearance

›Macula appearance

›Peripheral retina assessment

›Dilated exam if trained and available

›Retinal tear suspicion features

›Retinal detachment suspicion features

11Lab Studies/labs22

Targeted labs by suspected etiology

›Hemorrhage and systemic disease evaluation

›CBC

›Anemia severity assessment

›Platelet count assessment

›INR if warfarin

›Supratherapeutic anticoagulation concern

›Bleeding risk stratification

›Glucose

›Hyperglycemia support for diabetic retinopathy context

›Acute metabolic trigger screening

›Vasculitis evaluation

›ESR

›Elevated supports giant cell arteritis risk

›Normal does not exclude giant cell arteritis

›CRP

›Elevated supports giant cell arteritis risk

›Normal does not exclude giant cell arteritis

›Pregnancy related evaluation

›Pregnancy test if status unknown

›Preeclampsia evaluation if hypertensive

›Urine protein testing

›CMP for end organ injury

12Imaging/img31

Scoring Systems

›Decision support for vascular and neuro etiologies

›ABCD2 score for TIA local protocol dependent

›Age

›Blood pressure

›Clinical features

›Duration

›Diabetes

›Ocular trauma imaging decision local protocol dependent

›Open globe suspicion overrides decision tools

›High velocity mechanism increases imaging threshold

MRI

›MRI indications for neuro ocular syndromes

›Optic neuritis concern

›MRI brain and orbits with contrast

›Demyelinating disease assessment

›Stroke pathway with visual symptoms

›MRI brain with diffusion weighted imaging

›Vascular imaging selection local protocol dependent

›CT indications for trauma and acute neuro

›Orbital trauma

›CT orbits without contrast

›Foreign body detection

›Acute neuro red flags

›CT head without contrast

›CT angiography selection local protocol dependent

Ultrasound

›Ocular ultrasound pathways

›POCUS ocular ultrasound if limited fundus view

›Retinal detachment pattern

›Vitreous hemorrhage pattern

›Contraindications and caution

›Avoid if open globe suspected

›Minimal pressure technique if used

13Special Tests/spec17

Bedside ophthalmic testing

›Focused bedside tests

›Dilated fundus exam if trained and available

›Retinal tear evaluation

›Retinal detachment evaluation

›Slit lamp exam

›Cells and flare for uveitis

›Corneal staining pattern

›Shafer sign assessment

›Vitreous pigment suggests retinal tear

›Requires slit lamp expertise

POCUS ocular exam

›POCUS ocular ultrasound technique

›High frequency linear probe

›Generous gel and minimal pressure

›Dynamic scanning with eye movements

›Key findings

›Retinal detachment tethered to optic disc

›Vitreous hemorrhage mobile echoes

14ECG/ecg8

Indications in visual symptom presentations

›ECG context

›Palpitations with transient vision loss

›Syncope with visual complaints

›Suspected embolic event

High risk patterns

›ECG red flags

›Atrial fibrillation

›Acute ischemia pattern

›High grade AV block

15Assessment/ax19

Problem representation

›Working problem statement

›Flashes and floaters without vision loss

›Flashes and floaters with vision loss

›Floaters with haze

›Transient monocular vision loss

Risk stratification

›High risk features present

›Curtain or field defect

›Reduced visual acuity

›Vitreous hemorrhage suspicion

›Trauma mechanism

›Anticoagulation

›Lower risk features present

›Longstanding stable floaters

›Typical bilateral migraine aura pattern

›Normal visual acuity and fields

Diagnostic uncertainty

›Alternative diagnoses under consideration

›Migraine aura versus retinal pathology

›Uveitis versus angle closure

›Neuro ischemia versus ocular cause

16Plan/plan43

First 5 minutes

›Immediate workflow

›Visual acuity each eye prioritized

›Pupils and afferent pupillary defect check

›Visual field screening

›Analgesia if painful eye

›Antiemetic if nausea

Diagnostic sequencing

›Diagnostic plan

›If open globe suspected

›Eye shield

›NPO

›Avoid tonometry

›CT orbits without contrast

›If retinal tear or detachment suspected

›Urgent ophthalmology consultation

›POCUS ocular ultrasound if limited fundoscopy and no open globe

›If vitreous hemorrhage suspected

›Ophthalmology consultation timing urgent

›INR check if warfarin

›If giant cell arteritis suspected

›High dose corticosteroids immediately local protocol dependent

›ESR and CRP

›Ophthalmology and rheumatology coordination local protocol dependent

›If TIA suspected

›Stroke pathway activation local protocol dependent

›Antithrombotic selection local protocol dependent

Therapeutics

›Symptom control and disease specific therapy

›Painful red eye pathway

›If angle closure suspected

›Acetazolamide IV or PO 500 mg if no contraindication

›Topical beta blocker local protocol dependent

›Topical alpha agonist local protocol dependent

›Avoid if sulfa allergy severe for acetazolamide

›If uveitis suspected

›Cycloplegic drops local protocol dependent

›Topical steroid only with ophthalmology guidance

›Bleeding risk mitigation

›Anticoagulation reversal only for life threatening bleeding or directed by specialist

›Avoid empiric reversal for isolated vitreous hemorrhage without specialist input

Monitoring and reassessment

›Reassessment loop

›Repeat visual acuity after analgesia

›Repeat visual fields if symptoms progress

›Repeat pupil exam if neurologic concern evolves

›Escalate immediately if new curtain or worsening field loss

17Disposition/dispo21

Ophthalmology timing and level of care

›Emergent ophthalmology and likely transfer

›Retinal detachment suspected

›Retinal tear suspected

›Vitreous hemorrhage with reduced vision

›Endophthalmitis suspected

›Open globe suspected

›Giant cell arteritis suspected with vision symptoms

Observation and inpatient considerations

›Admission or observation local protocol dependent

›TIA or stroke evaluation required

›Severe hypertension with neurologic symptoms

›Unreliable follow up with high risk ocular findings

Discharge criteria

›Discharge with urgent follow up

›Typical posterior vitreous detachment features

›Normal visual acuity

›No visual field defect

›No vitreous hemorrhage signs

›Ophthalmology follow up within 24 to 72 hours local protocol dependent

›Discharge with routine follow up

›Longstanding stable floaters

›No flashes

›No change from baseline

18Discharge Instructions/di22

Copy discharge instructions

›Summary

›You were seen for flashes and or floaters

›These symptoms can be benign

›These symptoms can also signal a retinal tear or retinal detachment

›Activity

›Avoid high impact activity until eye follow up

›Do not drive if vision is impaired

›Medications

›Use acetaminophen for pain if needed

›Avoid new blood thinning medicines unless prescribed

›Follow up

›Ophthalmology follow up within the timeframe provided

›Bring this visit summary to the eye appointment

›Return immediately

›New curtain or shadow in vision

›New or worsening visual field loss

›Sudden decrease in vision

›Rapid increase in floaters

›New severe eye pain

›New severe headache

›New weakness

›New speech difficulty

19References/r6

Guidelines and key sources

›Reference set

›American Academy of Ophthalmology Preferred Practice Pattern posterior vitreous detachment retinal breaks and lattice degeneration 2020

›American Academy of Ophthalmology Preferred Practice Pattern rhegmatogenous retinal detachment 2019

›American Academy of Ophthalmology Preferred Practice Pattern primary open angle glaucoma suspect and angle closure disease guidance 2020

›American College of Rheumatology guideline for management of giant cell arteritis 2021

›American Heart Association American Stroke Association guideline for early management of acute ischemic stroke 2019 update

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Flashes and FloatersAPPROACH

ENT, EYE, DENTAL · 19 SECTIONS

⚲

524 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx86

HPI

›Symptom characterization

›Visual symptom type

›Flashes

›Floaters

›Curtain

›Haze

›Blurred vision

›Metamorphopsia

›Laterality

›Right eye

›Left eye

›Bilateral

›Baseline vision status

›Contact lenses

›Glasses

›Prior low vision

OPQRST

›Onset

›Sudden

›Gradual

›First episode

›Recurrent episodes

›Provocation and palliation

›Worse in dark

›Worse with eye movement

›Worse with posture change

›Triggered by cough

›Triggered by exertion

›Triggered by trauma

›Quality

›Flashes description

›Lightning streaks

›Arc

›Peripheral flicker

›Floaters description

›Spots

›Cobwebs

›Shower of black dots

›Region and radiation

›Visual field region

›Peripheral

›Central

›Superior field

›Inferior field

›Severity

›Vision change severity

›No vision loss

›Mild blur

›Moderate impairment

›Severe loss

›Functional impact

›Driving impairment

›Reading impairment

›Timing

›Duration per episode

›Seconds

›Minutes

›Hours

›Persistent

›Frequency

›Single episode

›Multiple daily

›Intermittent

›Progression

›Worsening

›Improving

›Stable

Associated symptoms

›Eye symptoms

›Eye pain

›Photophobia

›Redness

›Foreign body sensation

›Discharge

›Diplopia

›Neuro symptoms

›Headache

›Migraine aura history

›Weakness

›Numbness

›Speech change

›Gait change

›Systemic symptoms

›Fever

›Jaw claudication

›Scalp tenderness

›Polymyalgia rheumatica symptoms

›Pregnancy hypertension symptoms

02Alarm Features/alarm32

Immediate vision threat triggers

›Emergent triggers

›New flashes with new floaters

›Shower of floaters

›Curtain or shadow in visual field

›New visual field defect

›Sudden vision loss

›Recent eye trauma

›Eye surgery within weeks

Pain and inflammation triggers

›Pain red flags

›Severe eye pain with decreased vision

›Photophobia with decreased vision

›Ciliary flush

›Corneal opacity

›Hypopyon

Neurovascular triggers

›Neuro red flags

›New focal neurologic deficit

›Worst headache

›Altered mental status

›Transient monocular vision loss

›Giant cell arteritis red flags

›Age 50 years or older with new vision symptoms

›Jaw claudication

›Scalp tenderness

›Temporal artery tenderness

Vital sign danger thresholds

›High risk vitals

›SBP 180 mmHg or higher with neuro symptoms

›Fever 38.0 C or higher with ocular pain

›HR 120 or higher with significant bleeding concern

Anticoagulation and bleeding triggers

›Hemorrhage risk triggers

›Anticoagulant use with sudden floaters

›Known proliferative diabetic retinopathy with sudden floaters

›Sickle cell disease with sudden floaters

03Medications/meds19

Current medications relevant to ocular bleeding and inflammation

›Medication exposure profile

›Anticoagulants

›Warfarin

›Direct oral anticoagulants

›Antiplatelet agents

›Aspirin

›Clopidogrel

›Corticosteroids

›Chronic systemic steroids

›Recent high dose steroid course

›Diabetes medications

›Insulin

›Non insulin agents

Recent changes and contraindications

›Therapy interaction risks

›Recent start of anticoagulant

›Missed doses of anticoagulant

›Bleeding history on current regimen

›Sulfa allergy

›Pregnancy status for medication selection

04Diet/diet6

Exposures that influence vascular and neuro symptoms

›Dietary and intake patterns

›Caffeine intake increase

›Energy drink intake

›Hydration deficit

›Alcohol binge exposure

›Recent fasting

05Review of Systems/ros24

Eye and ENT

›Eye and adjacent symptoms

›Red eye

›Eye pain

›Photophobia

›Discharge

›Contact lens use symptoms

Neuro

›Neurologic symptoms

›Headache

›Visual aura

›Weakness

›Numbness

›Speech change

›Balance change

Cardiovascular and systemic

›Systemic symptoms

›Chest pain

›Palpitations

›Syncope

›Fever

›Weight loss

Rheumatologic and vascular

›Vasculitis symptoms

›Jaw claudication

›Scalp tenderness

›Proximal muscle pain

›New temporal headache

06Collateral History and Family History/chafh10

Collateral and reliability

›Source quality

›Patient report reliability

›Witness corroboration

›Outside records available

Family history

›Heritable and vascular risk

›Retinal detachment in first degree relative

›Connective tissue disorder

›Marfan syndrome

›Ehlers Danlos syndrome

›Early stroke in first degree relative

07Risk Factors/rf22

Ocular risk factors

›Retinal tear and detachment risks

›High myopia

›Prior retinal tear

›Prior retinal detachment

›Lattice degeneration history

›Prior cataract surgery

›Recent posterior capsulotomy

Systemic risk factors

›Bleeding and vascular risks

›Diabetes mellitus

›Hypertension

›Anticoagulant use

›Sickle cell disease

›Hypercoagulable state

Trauma and exposure risks

›Mechanical triggers

›Blunt eye trauma

›Penetrating eye trauma

›High impact sports exposure

›Occupational eye hazard exposure

Special populations

›Pregnancy related risks

›Preeclampsia risk

›Severe hypertension risk

›Hypercoagulability risk

08Differential Diagnosis/ddx71

Life threatening

›Vision threatening emergencies

›Retinal detachment (H33.0)

›Curtain or shadow

›Peripheral field loss

›New flashes

›New floaters

›Retinal tear (H33.3)

›New flashes with floaters

›Vitreous pigment

›Vitreous hemorrhage

›Vitreous hemorrhage (H43.1)

›Sudden floaters

›Haze

›Reduced fundus view

›Central retinal artery occlusion (H34.1)

›Sudden painless severe vision loss

›Afferent pupillary defect

›Acute angle closure glaucoma (H40.21)

›Severe eye pain

›Halos

›Nausea

›High intraocular pressure

›Endophthalmitis (H44.0)

›Recent intraocular surgery or injection

›Pain with decreased vision

›Hypopyon

›Giant cell arteritis (M31.6)

›Age 50 years or older

›Jaw claudication

›New headache

Common

›Frequent causes

›Posterior vitreous detachment (H43.81)

›Flashes

›New floaters

›Weiss ring

›Migraine with aura (G43.1)

›Bilateral scintillating scotoma

›Gradual spread over minutes

›Followed by headache

›Vitreous syneresis

›Chronic floaters

›No flashes

›Stable symptoms

›Dry eye disease (H04.12)

›Fluctuating blur

›Irritation

›Worse with screens

Less common

›Other diagnoses

›Uveitis anterior (H20.0)

›Photophobia

›Ciliary flush

›Cells and flare

›Optic neuritis (H46)

›Pain with eye movement

›Color desaturation

›Afferent pupillary defect

›Ocular ischemic syndrome (H35.82)

›Carotid disease

›Dull ache

›Midperipheral hemorrhages

›TIA amaurosis fugax (G45.3)

›Transient monocular vision loss

›Vascular risk factors

Mimics and pitfalls

›Diagnostic pitfalls

›Migraine aura misattributed to retinal detachment

›Aura bilateral

›Aura lasts 5 to 60 minutes

›Positive visual phenomena

›Floaters after trauma

›Open globe risk

›Retinal tear risk

09Past Medical History/pmh16

Ocular history

›Prior eye disease and procedures

›Prior retinal detachment

›Prior retinal tear and laser

›Cataract surgery history

›Intravitreal injections history

›Glaucoma history

Systemic history

›Relevant comorbidities

›Diabetes mellitus (E11.9)

›Hypertension (I10)

›Atrial fibrillation (I48.91)

›Sickle cell disease (D57.1)

›Autoimmune disease

Baseline function

›Baseline status

›Baseline visual acuity

›Driving baseline

›Work and safety impact baseline

10Physical Exam/exam49

Initial assessment

›General and vitals

›Toxic appearance

›Fever pattern

›Blood pressure severity

›Heart rhythm irregularity

Eye exam core

›Vision and pupils

›Visual acuity each eye

›With correction if available

›Pinhole if needed

›Pupils

›Size symmetry

›Afferent pupillary defect

›Color vision screening

›Red desaturation

›Ishihara if available

›External and motility

›Eyelids

›Conjunctiva

›Extraocular movements

›Pain with eye movement

›Visual fields

›Confrontation fields

›New field defect pattern

Slit lamp and anterior segment

›Anterior segment findings

›Corneal clarity

›Fluorescein uptake

›Anterior chamber

›Cells

›Flare

›Lens status

›Phakic

›Pseudophakic

Intraocular pressure and contraindications

›Pressure and globe integrity

›Intraocular pressure if no open globe concern

›Avoid tonometry if open globe suspected

›Open globe signs

›Peaked pupil

›Seidel sign

›Prolapsed tissue

Posterior segment

›Fundus and vitreous

›Red reflex

›Vitreous hemorrhage signs

›Vitreous pigment

›Optic disc appearance

›Macula appearance

›Peripheral retina assessment

›Dilated exam if trained and available

›Retinal tear suspicion features

›Retinal detachment suspicion features

11Lab Studies/labs22

Targeted labs by suspected etiology

›Hemorrhage and systemic disease evaluation

›CBC

›Anemia severity assessment

›Platelet count assessment

›INR if warfarin

›Supratherapeutic anticoagulation concern

›Bleeding risk stratification

›Glucose

›Hyperglycemia support for diabetic retinopathy context

›Acute metabolic trigger screening

›Vasculitis evaluation

›ESR

›Elevated supports giant cell arteritis risk

›Normal does not exclude giant cell arteritis

›CRP

›Elevated supports giant cell arteritis risk

›Normal does not exclude giant cell arteritis

›Pregnancy related evaluation

›Pregnancy test if status unknown

›Preeclampsia evaluation if hypertensive

›Urine protein testing

›CMP for end organ injury

12Imaging/img31

Scoring Systems

›Decision support for vascular and neuro etiologies

›ABCD2 score for TIA local protocol dependent

›Age

›Blood pressure

›Clinical features

›Duration

›Diabetes

›Ocular trauma imaging decision local protocol dependent

›Open globe suspicion overrides decision tools

›High velocity mechanism increases imaging threshold

MRI

›MRI indications for neuro ocular syndromes

›Optic neuritis concern

›MRI brain and orbits with contrast

›Demyelinating disease assessment

›Stroke pathway with visual symptoms

›MRI brain with diffusion weighted imaging

›Vascular imaging selection local protocol dependent

›CT indications for trauma and acute neuro

›Orbital trauma

›CT orbits without contrast

›Foreign body detection

›Acute neuro red flags

›CT head without contrast

›CT angiography selection local protocol dependent

Ultrasound

›Ocular ultrasound pathways

›POCUS ocular ultrasound if limited fundus view

›Retinal detachment pattern

›Vitreous hemorrhage pattern

›Contraindications and caution

›Avoid if open globe suspected

›Minimal pressure technique if used

13Special Tests/spec17

Bedside ophthalmic testing

›Focused bedside tests

›Dilated fundus exam if trained and available

›Retinal tear evaluation

›Retinal detachment evaluation

›Slit lamp exam

›Cells and flare for uveitis

›Corneal staining pattern

›Shafer sign assessment

›Vitreous pigment suggests retinal tear

›Requires slit lamp expertise

POCUS ocular exam

›POCUS ocular ultrasound technique

›High frequency linear probe

›Generous gel and minimal pressure

›Dynamic scanning with eye movements

›Key findings

›Retinal detachment tethered to optic disc

›Vitreous hemorrhage mobile echoes

14ECG/ecg8

Indications in visual symptom presentations

›ECG context

›Palpitations with transient vision loss

›Syncope with visual complaints

›Suspected embolic event

High risk patterns

›ECG red flags

›Atrial fibrillation

›Acute ischemia pattern

›High grade AV block

15Assessment/ax19

Problem representation

›Working problem statement

›Flashes and floaters without vision loss

›Flashes and floaters with vision loss

›Floaters with haze

›Transient monocular vision loss

Risk stratification

›High risk features present

›Curtain or field defect

›Reduced visual acuity

›Vitreous hemorrhage suspicion

›Trauma mechanism

›Anticoagulation

›Lower risk features present

›Longstanding stable floaters

›Typical bilateral migraine aura pattern

›Normal visual acuity and fields

Diagnostic uncertainty

›Alternative diagnoses under consideration

›Migraine aura versus retinal pathology

›Uveitis versus angle closure

›Neuro ischemia versus ocular cause

16Plan/plan43

First 5 minutes

›Immediate workflow

›Visual acuity each eye prioritized

›Pupils and afferent pupillary defect check

›Visual field screening

›Analgesia if painful eye

›Antiemetic if nausea

Diagnostic sequencing

›Diagnostic plan

›If open globe suspected

›Eye shield

›NPO

›Avoid tonometry

›CT orbits without contrast

›If retinal tear or detachment suspected

›Urgent ophthalmology consultation

›POCUS ocular ultrasound if limited fundoscopy and no open globe

›If vitreous hemorrhage suspected

›Ophthalmology consultation timing urgent

›INR check if warfarin

›If giant cell arteritis suspected

›High dose corticosteroids immediately local protocol dependent

›ESR and CRP

›Ophthalmology and rheumatology coordination local protocol dependent

›If TIA suspected

›Stroke pathway activation local protocol dependent

›Antithrombotic selection local protocol dependent

Therapeutics

›Symptom control and disease specific therapy

›Painful red eye pathway

›If angle closure suspected

›Acetazolamide IV or PO 500 mg if no contraindication

›Topical beta blocker local protocol dependent

›Topical alpha agonist local protocol dependent

›Avoid if sulfa allergy severe for acetazolamide

›If uveitis suspected

›Cycloplegic drops local protocol dependent

›Topical steroid only with ophthalmology guidance

›Bleeding risk mitigation

›Anticoagulation reversal only for life threatening bleeding or directed by specialist

›Avoid empiric reversal for isolated vitreous hemorrhage without specialist input

Monitoring and reassessment

›Reassessment loop

›Repeat visual acuity after analgesia

›Repeat visual fields if symptoms progress

›Repeat pupil exam if neurologic concern evolves

›Escalate immediately if new curtain or worsening field loss

17Disposition/dispo21

Ophthalmology timing and level of care

›Emergent ophthalmology and likely transfer

›Retinal detachment suspected

›Retinal tear suspected

›Vitreous hemorrhage with reduced vision

›Endophthalmitis suspected

›Open globe suspected

›Giant cell arteritis suspected with vision symptoms

Observation and inpatient considerations

›Admission or observation local protocol dependent

›TIA or stroke evaluation required

›Severe hypertension with neurologic symptoms

›Unreliable follow up with high risk ocular findings

Discharge criteria

›Discharge with urgent follow up

›Typical posterior vitreous detachment features

›Normal visual acuity

›No visual field defect

›No vitreous hemorrhage signs

›Ophthalmology follow up within 24 to 72 hours local protocol dependent

›Discharge with routine follow up

›Longstanding stable floaters

›No flashes

›No change from baseline

18Discharge Instructions/di22

Copy discharge instructions

›Summary

›You were seen for flashes and or floaters

›These symptoms can be benign

›These symptoms can also signal a retinal tear or retinal detachment

›Activity

›Avoid high impact activity until eye follow up

›Do not drive if vision is impaired

›Medications

›Use acetaminophen for pain if needed

›Avoid new blood thinning medicines unless prescribed

›Follow up

›Ophthalmology follow up within the timeframe provided

›Bring this visit summary to the eye appointment

›Return immediately

›New curtain or shadow in vision

›New or worsening visual field loss

›Sudden decrease in vision

›Rapid increase in floaters

›New severe eye pain

›New severe headache

›New weakness

›New speech difficulty

19References/r6

Guidelines and key sources

›Reference set

›American Academy of Ophthalmology Preferred Practice Pattern posterior vitreous detachment retinal breaks and lattice degeneration 2020

›American Academy of Ophthalmology Preferred Practice Pattern rhegmatogenous retinal detachment 2019

›American Academy of Ophthalmology Preferred Practice Pattern primary open angle glaucoma suspect and angle closure disease guidance 2020

›American College of Rheumatology guideline for management of giant cell arteritis 2021

›American Heart Association American Stroke Association guideline for early management of acute ischemic stroke 2019 update

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.