Ocular migraine vs retinal detachment — differentiation
Structured for Australian optometry practice.
Clinical decision support only
OptoGuide™ supports professional judgement and does not diagnose or replace clinician responsibility.
Quick answer
- The main distinction is transient visual aura with recovery versus retinal symptoms such as flashes, floaters, curtain, or persistent field loss.
- Migraine-type visual disturbance is often bilateral or homonymous in description; retinal detachment is typically monocular and mechanical in character.
- New floaters, field defect, or persistent monocular symptoms should shift concern toward retinal pathology.
- Refer urgently when retinal tear or detachment cannot be confidently excluded.
Common causes
- Migraine aura with transient positive visual phenomena.
- Posterior vitreous detachment with flashes and floaters.
- Retinal tear or retinal detachment.
- Other transient visual disturbance mistaken for retinal disease.
Red flags (must not miss)
- Curtain, veil, or persistent peripheral field loss.
- New floaters with flashes in one eye.
- Monocular symptoms that do not fully resolve.
- Reduced retinal view, Shafer sign, or vitreous haemorrhage.
- History suggesting retinal risk rather than transient aura.
Use OptoGuide™ to guide this decision during consult.
What to check
- Monocular versus binocular or homonymous symptom pattern.
- Duration, recurrence, and full recovery between episodes.
- Presence of floaters, curtain, or field loss.
- Pupils, confrontation fields, and dilated retinal examination.
- Whether the peripheral retina has been fully assessed.
When to refer
- Same day if retinal tear or detachment remains in the differential.
- Urgent retinal review when symptoms are monocular, persistent, or linked to floaters or field loss.
- Routine observation only when the history and exam clearly support benign migraine-type aura.
Initial management
- Use the symptom pattern to decide whether the problem is neurological-visual aura or retinal traction.
- Do not label new monocular flashes as migraine without a retinal assessment.
- Document laterality, duration, associated floaters, and retinal view quality clearly.
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.