II. Epidemiology
- Common over age 35 years
III. Pathophysiology
- Solid aggregates accumulate in the vitreous
IV. Risk Factors
- Older age
- Myopia
V. Symptoms
- Fine gray-black dots, blobs, specks, clouds, cobwebs, strands or strings in Visual Field
- Most easily seen when patient looks at a white wall or blue sky
- Movement of Floaters lags eye movement
VI. Causes
- No significant increase in number, Vision Loss or Light Flashes
- Normal aging
- Rapid increase in number or associated Light Flashes or Vision Loss
- Retinal Detachment (abrupt and severe floater onset)
- Posterior Vitreous Detachment (Risk for Retinal Detachment)
- Diabetic Retinopathy or intraocular Hemorrhage
- Uveitis or Choroidal inflammation
VII. Differential Diagnosis
- Scotomas (Blind Spots)
- Do not lag eye movement
VIII. History
- See Light Flashes for common history components
- Blank spots that do not lag eye movement
- Scotoma (Retinal detachement, Optic Nerve or cortical cause)
- Significant increase in Floaters
- Retinal Detachment, Retinal Hemorrhage or Choroidal inflammation
IX. Exam
- See Light Flashes for common exam components
X. Findings: Red Flags
- See Light Flashes for common red flag components
XI. Management: Ophthalmology Referral
- Emergent referral indications
- New or increased Floaters with Acute Vision Loss (or Visual Field cuts)
- Urgent referral indications
- New or significantly increased Floaters or
- Floaters with risk factors for Retinal Detachment or Vitreous Hemorrhage
- Near-sighted (especially high Myopia)
- Diabetes Mellitus
- Previous Retinal Disease
XII. References
- Trobe (2012) Physicians Guide to Eye care, p. 45-47
- Noble (2001) Primary Care Medicine, p. 1701
- Gariano (2004) Am Fam Physician 69:1691-8 [PubMed]