Flashes and Floaters — When to Seek Urgent Assessment
New flashes of light or a sudden increase in floaters should always be assessed urgently — same day or next day — until a retinal tear or detachment has been excluded.
Most patients who present with these symptoms have a posterior vitreous detachment — a natural age-related change that does not require treatment. But a small number have a retinal tear, and without prompt laser treatment that tear can progress to a retinal detachment requiring major surgery.
The difference between those two outcomes often comes down to how quickly the patient is assessed.
A/Prof Adrian Hunt provides same-day or next-day assessment for new flashes and floaters at Eye Surgeons Miranda in Miranda, or patients can present to Sydney Eye Hospital emergency after hours.
New Flashes and Floaters — See Us Today or Tomorrow
If you have developed new flashes or floaters, or a sudden increase in existing floaters, call the rooms now on (02) 8544 0719. We will see you same day or next day.
Do not wait to see if symptoms settle. A retinal tear can progress to detachment within days, and early treatment is a simple laser procedure. Late presentation may require major surgery.
What Flashes and Floaters Actually Are
The eye is filled with a clear gel called the vitreous. In younger eyes this gel is firmly attached to the retina. With age — often from the mid-40s onwards — the gel begins to shrink and liquefy, and eventually the outer layer peels away from the surface of the retina.
Think of the vitreous as a jelly filling the eye. As we age, the outer skin of that jelly peels away from the retina. Most of the time it comes away cleanly, and that is an uncomplicated posterior vitreous detachment. But occasionally, as it peels, it catches on the retina and pulls a tear. The tear itself can be sealed quickly with laser. If it is not treated, fluid gets through that tear, under the retina leading to a retinal detachment — which is a far more serious problem requiring major surgery.
Floaters are shadows cast on the retina by clumps of vitreous gel or debris that form as the gel collapses. They appear as spots, threads, cobwebs, or rings that move as the eye moves.
Flashes are caused by the vitreous pulling on the retina as it detaches. The mechanical stimulation of the retina is interpreted by the brain as light — commonly seen as brief arcs or streaks in the peripheral vision, often more noticeable in the dark.
Uncomplicated Posterior Vitreous Detachment
Most patients who present with new flashes and floaters turn out to have a posterior vitreous detachment with no retinal tear, and need no treatment.
Those patients often describe a few floaters, sometimes a ring or a cluster, and brief arc-like flashes at the edge of the vision that come and go quickly. The flashes are usually short and sharp, like a lightning bolt glimpsed off to one side. Over the following months the floaters commonly become less noticeable, though they do not always disappear altogether.
None of that can be relied upon before the eye has been examined. Symptoms alone cannot separate an uncomplicated vitreous detachment from one that has torn the retina, and only a dilated examination of the peripheral retina can.
When Are Flashes and Floaters a Medical Emergency?
Some symptoms are more worrying than others. Call us same day if you notice any of the following:
- A sudden shower of many new floaters — particularly dark inky streaks
- Flashes that are persistent rather than brief, occasional and reducing in frequency
- A shadow, curtain, or dark area anywhere in your vision — this is an emergency
- Any reduction in vision
- You are significantly short-sighted (myopic) or have previously had cataract surgery
If you have a shadow or curtain in your vision, do not wait — call immediately on (02) 8544 0719.
Why Early Assessment Matters
If the assessment finds a tear, it is sealed with laser in the rooms and that is the end of it. If a tear has been left long enough for the retina to detach, laser is no longer enough and a considerably more invasive procedure is usually needed. The symptoms are identical in both cases, which is why the timing of the assessment matters more than the severity of what you noticed. In a retinal detachment, however, a dull grey shadow can appear from the periphery and move towards the centre.
Chronic Floaters — When They Don't Go Away
For most patients, floaters from a posterior vitreous detachment become less noticeable over weeks to months as they settle further from the retina and the brain adapts. Some patients continue to find floaters bothersome — particularly large, dense floaters that persistently drift across the line of sight.
If floaters remain a significant problem after the acute period has passed, this can be discussed at a follow-up appointment with A/Prof Hunt.
Frequently Asked Questions — Flashes and Floaters
I've had floaters for years — do I still need to be seen?
Long-standing stable floaters that have not changed are much less likely to represent a new problem. However, if you notice a sudden increase in floaters, new flashes, or any change from your baseline, that change should be assessed promptly regardless of your history.
My floaters seem to be settling — should I still come in?
Yes. The floaters themselves settling does not mean a retinal tear is absent — tears do not heal on their own. If you have new flashes and floaters, the retina needs to be examined with pupil dilation to confirm that no tear is present, regardless of whether symptoms seem to be improving.
I only have floaters — no flashes. Is that less urgent?
Floaters without flashes are still worth assessing promptly, particularly if they appeared suddenly or in large numbers. A dense shower of new floaters can indicate bleeding from a retinal vessel at the site of a tear, even without noticeable flashes.
Will I need my pupils dilated?
Yes. A dilated retinal examination is essential to properly assess the peripheral retina for tears. You will need someone to drive you home after the appointment, as dilation affects near vision and light sensitivity for several hours.