Flashes and floaters — management priorities
Structured for Australian optometry practice.
Clinical decision support only
OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.
Quick answer
- The key question is whether symptoms are consistent with posterior vitreous change alone or retinal tear / detachment risk.
- New onset floaters with flashes, a curtain, or peripheral field loss needs prompt dilated retinal assessment.
- Look for Shafer sign, vitreous haemorrhage, retinal breaks, and reduced peripheral view.
- Escalate same day when there is field loss, haemorrhage, tear suspicion, or inadequate retinal view.
Common causes
- Posterior vitreous detachment.
- Retinal tear or early retinal detachment.
- Vitreous haemorrhage.
- Migraine aura when bilateral and transient without true vitreous symptoms.
Red flags (must not miss)
- Curtain, veil, or new peripheral field defect.
- Sudden increase in floaters or dense shower of black spots.
- Shafer sign, vitreous pigment, or haemorrhage.
- Reduced view of the peripheral retina.
- Recent trauma or high myopia with new symptoms.
Use OptoGuide™ to guide this decision during consult.
What to check
- Clarify onset, laterality, flashes pattern, floaters burden, and any field loss.
- Measure acuity and assess pupils for asymmetry.
- Dilated fundus examination with careful peripheral retinal assessment.
- Look for pigment cells, haemorrhage, holes, tears, or subretinal fluid.
- Document whether the retinal view is complete or limited.
When to refer
- Same day if retinal tear, detachment, vitreous haemorrhage, or field defect is suspected.
- Urgent referral if symptoms are new and the peripheral retina cannot be confidently assessed.
- Routine follow-up only when the picture is clearly uncomplicated and the retina is fully examined.
Initial management
- Triage by retinal risk, not by symptom annoyance alone.
- Explain warning symptoms that should trigger immediate review if the initial exam is benign.
- Arrange timely follow-up when the assessment supports uncomplicated vitreous change.
Clinical basis
This guidance reflects standard optometric clinical reasoning based on:
- Australian optometry clinical practice patterns
- Australian medicines regulation and PBS prescribing context
- Common ophthalmology referral standards
- Evidence-based clinical training and practice
Use OptoGuide™ during consult for structured clinical guidance.