Browse categories and answer follow-up questions to refine your symptom profile.
History
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
Alarm Features
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
Medications
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
Diet
Exposures that influence vascular and neuro symptoms
Dietary and intake patterns
Caffeine intake increase
Energy drink intake
Hydration deficit
Alcohol binge exposure
Recent fasting
Review of Systems
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
Collateral History and Family History
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
Risk Factors
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
Differential Diagnosis
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
Past Medical History
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
Physical Exam
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
Lab Studies
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
Imaging
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
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
Special Tests
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
ECG
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
Assessment
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
Plan
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
Disposition
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
Discharge Instructions
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
References
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
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.