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