Do flashing lights from retinal detachment occur spontaneously or with specific eye movements like blinking?

Flashing Lights in Retinal Detachment: Spontaneous vs. Movement-Triggered

Flashing lights from retinal detachment typically occur spontaneously and are not specifically triggered by eye movements like blinking. 1 These photopsias (flashes of light) result from mechanical stimulation of the retina when vitreous traction pulls on the retina, and they can occur regardless of eye movement.

Characteristics of Flashing Lights in Retinal Detachment

Mechanism and Presentation

• Flashing lights occur due to vitreoretinal traction during posterior vitreous detachment (PVD), which can lead to retinal breaks and detachment 1
• These flashes typically:
  • Appear as brief flashes in peripheral vision
  • Occur spontaneously without requiring specific eye movements 2
  • May be more noticeable in dim lighting conditions
  • Often described as "lightning streaks" or "camera flashes"

Distinguishing Features

• Unlike flashes triggered by eye movements (which can occur in migraine or other conditions), retinal detachment flashes:
  • Persist regardless of eye position
  • May be accompanied by new floaters or a "shower" of floaters 1, 2
  • Can be associated with a progressive peripheral visual field defect (often described as a "curtain" or "shadow") 3, 4

Clinical Significance and Evaluation

Warning Signs Requiring Urgent Assessment

• Sudden onset of flashes and/or floaters
• Peripheral visual field loss
• Decreased visual acuity 1

Examination Components

• Comprehensive dilated fundus examination with scleral depression is essential 1, 2
• Evaluation of the vitreous status, with attention to:
  • Presence of pigment (tobacco dust)
  • Vitreous hemorrhage
  • Vitreous syneresis 1
• B-scan ultrasonography when media opacity prevents clear visualization 2, 5

Management Considerations

Follow-up Recommendations

• Patients presenting with acute PVD symptoms and no retinal breaks have approximately 2% chance of developing retinal breaks in subsequent weeks 1
• Selected patients, particularly those with vitreous pigment, hemorrhage, or visible vitreoretinal traction, should return for a second examination within 6 weeks following symptom onset 1

Patient Education

• All patients with symptoms should be instructed to contact their ophthalmologist promptly if they experience:
  • Increase in flashes or floaters
  • New or worsening peripheral visual field loss
  • Decreased visual acuity 1, 2

Common Pitfalls and Caveats

• Delayed diagnosis: Flashing lights may be mistakenly attributed to migraine, leading to delayed evaluation
• Incomplete examination: Failure to perform dilated fundoscopy with scleral depression can miss peripheral retinal breaks
• Inadequate follow-up: Even when initial examination is negative, patients with persistent symptoms should be re-examined within 6 weeks 1
• Misinterpretation of symptoms: Patients may not recognize the significance of flashing lights and delay seeking care

Remember that early intervention for retinal breaks can prevent progression to retinal detachment, significantly improving visual outcomes and quality of life 3, 4.