Patient guide
Flashes and floaters: when to be seen the same day
By Dr. Sam Khoury, Optometrist8 min read
Call the office the same day if any of these start: a sudden increase in floaters, new flashes of light (especially off to the side), sudden blurring. A shadow or curtain across part of your vision should not wait for office hours at all. Call the office at (609) 246-0236. If the office is closed, or you cannot reach us, go to a hospital emergency room — most have an ophthalmologist on call.
Most people with these symptoms are fine. But in a study of more than 8,000 patients who came in with a sudden change in floaters or flashes, roughly five in every hundred had a retinal tear and four already had a retinal detachment. That is about one in ten — not rare enough to wait out but not common enough to panic about.
What is usually happening
The inside of the eye is filled with a clear gel. With age it liquefies and shrinks, and at some point it peels away from the retina at the back. That event is a posterior vitreous detachment. It happens to almost everyone eventually, usually between 45 and 65, earlier if you are nearsighted or have had an injury.
The floaters are the collapsed gel casting a shadow. The flashes are the gel tugging on the retina as it separates — the retina cannot feel pain, so it reports the pull as light. On its own this needs no treatment, and the floaters usually become less noticeable over months.
The risk is what happens on the way out. Where the gel is stuck firmly, peeling away can tear the retina. A tear lets fluid pass underneath, and fluid underneath lifts the retina off — a detachment. That is the sequence worth interrupting, and it is why a symptom that is usually harmless still gets a same-day appointment.
Why waiting to see what happens is the wrong plan
You cannot tell the difference from the inside. A harmless vitreous detachment and one that has torn the retina produce the same flashes and the same floaters. There is no home test and no symptom that separates them. It takes a dilated examination.
And the window matters more than people expect. A retinal tear caught early is treated with a laser by a retinal specialist, in a single visit, and usually that is the end of it. Once it has progressed to a detachment it becomes operating-room surgery. More importantly, a detachment repaired before it reaches the macula — the small central part of the retina you read and recognize faces with — has a far better visual outcome than one repaired after. Central vision that has been detached often does not fully come back, even when the surgery succeeds.
That is the whole argument for the same-day appointment. Not that the odds are bad, but that the cost of being in the unlucky ten percent goes up sharply with each day.
Who is at higher risk
These raise the odds and should lower your threshold for calling:
- Nearsightedness, particularly a strong prescription — one of the strongest predictors of both an initial and a delayed tear
- Previous cataract surgery, especially within the past few months
- A tear or detachment in your other eye
- Lattice degeneration, if you have been told you have it
- Previous eye injury
- A family history of retinal detachment
- Being under 60, and being male — both carry a modestly higher rate
If any of these apply, do not wait to see whether the symptoms settle down.
If one of these applies to you, see what to watch for between exams.
What the visit involves
You will be dilated for this one. A tear almost always sits in the far periphery of the retina, and reaching that edge means a dilated examination with indirect ophthalmoscopy — usually with scleral depression, where gentle pressure on the outside of the eye rolls the very edge of the retina into view.
This is the situation where wide-field photography alone is not enough. A photograph is a flat image of a curved surface, it does not reliably reach the far edge, and it cannot be depressed or viewed in three dimensions. For these symptoms, drops are not optional.
One of the things being looked for is not the tear itself but a scattering of fine pigment granules floating in the gel — released when the retina tears. In one study of two hundred eyes, it was present in 23 of the 25 eyes that had a tear. Finding it means searching the periphery until the tear is located.
Plan on about an hour. Bring sunglasses, and arrange a driver if reading a dashboard would be difficult — vision stays blurry up close for roughly four hours afterwards.
What happens next
If a tear is found, you are referred to a retinal specialist and it is usually sealed within days, with a laser applied around the tear so fluid cannot get underneath. It is done in a clinic under anesthetic drops.
If a detachment is found, the referral goes the same day. Repair is surgical and the timing is driven by whether the macula is still attached.
If nothing is found — the likely outcome — you will still be asked to come back. That is not over-caution. About two in every hundred people with a clean first examination develop a tear in the following weeks, as the gel finishes separating. In the largest study of this, delayed tears showed up a median of about six weeks after the first examination — which is why its authors advise a second look within six weeks, and sooner for higher-risk eyes. If you are nearsighted, follow-up should run longer, because myopia is one of the strongest predictors of a delayed tear and they can appear months later.
And in the meantime: new symptoms restart the clock. A fresh shower of floaters, new flashes, or any shadow means calling again, regardless of how recently you were checked and told everything was fine.
Common questions
Is this an emergency? Should I go to the emergency room?
New flashes and floaters need a dilated eye examination the same day. When the office is open, call and it can usually be done here that day. If the office is closed, or you cannot reach us, go to a hospital emergency room — most have an ophthalmologist on call.
A shadow or curtain across your vision is different. That needs attention immediately, and an emergency room is the right call if you cannot reach an eye doctor quickly.
I have always had floaters. Is that the same thing?
No. Long-standing floaters that have not changed are common and are not the concern. What matters is a change — new floaters, a sudden increase in how many there are, or floaters arriving alongside flashes of light.
The flashes have stopped. Do I still need to be seen?
Yes. A tear does not announce itself by continuing to flash. Symptoms settling means the gel has finished pulling away — it tells you nothing about whether it did any damage on the way.
Can you tell from a retinal photograph instead of dilating?
Not for this. Wide-field imaging is useful for a great deal, but a tear in the far periphery can sit outside what a photograph reaches, and a photograph cannot be depressed or viewed in three dimensions. For these symptoms the dilated examination is the test, and imaging does not substitute for it.
Will the floaters go away?
Usually they become less noticeable rather than disappearing. The gel settles, and the brain gradually stops reporting a shadow that never changes. Most people find them much less intrusive within a few months. Floaters that persist and genuinely interfere with vision are worth mentioning, because there are options — but that can be discussed after the urgent questions have been answered.
Do I need a referral to be seen?
No. Call the office directly. If a tear or detachment is found, the referral to a retinal specialist is arranged from here, same day when needed.
Call the office
If any of this describes what you are seeing, call rather than book online, so the appointment can be scheduled immediately. If the office is closed, or you cannot reach us, go to a hospital emergency room — most have an ophthalmologist on call.
Khoury Eye Care, Hamilton Mall, 4403 Black Horse Pike, Mays Landing. Dilated examination and retinal imaging are done in this office.