Presenting complaint(s): flashes and/or floaters
An immediate referral to an ophthalmologist is indicated if:
(1) there is visual blurring
(2) there is a visual field defect
(3) pigmented granules ("tobacco dust") are seen in the anterior vitreous fluid on slit lamp exam
(4) a retinal detachment is seen on ophthalmoscopy
(5) vitreous hemorrhage is seen on ophthalmoscopy
If none of these findings are seen, then a nonemergence referral (the patient is seen within a few days) is appropriate. The patient should be instructed to return immediately if symptoms worsen or a visual field defect occurs.
If there are indications for immediate evaluation but some delay is expected, then the patient should lie face down with the side of the detachment to the pillow (the side opposite to the field defect) in order to minimize the detachment extending to the macula.
Possible modification: If the person has significant risk factors for retinal detachment, then I might be more aggressive.
