Differential Diagnosis for Intermittent Floaters and Squiggly Lines in Vision

Single Most Likely Diagnosis

• Posterior Vitreous Detachment (PVD): This condition is characterized by the separation of the vitreous gel from the retina, which is a common occurrence with aging. It often presents with symptoms of floaters and flashes of light due to the mechanical stimulation of the retina by the detaching vitreous.

Other Likely Diagnoses

• Vitreous Degeneration: As people age, the vitreous gel in the eye can degenerate, leading to the formation of floaters. This condition is similar to PVD but may not involve a complete detachment.
• Migraine with Aura: Some individuals experience visual disturbances, including seeing squiggly lines or zigzags (aura), before a migraine headache. These visual symptoms are usually temporary and can be accompanied by other neurological symptoms.
• Ocular Migraine: This condition involves visual disturbances similar to those in migraines with aura but without the headache. The visual symptoms can include seeing floaters or squiggly lines.

Do Not Miss Diagnoses

• Retinal Detachment: Although less common, a retinal detachment is a medical emergency that can present with sudden onset of floaters and flashes of light, along with a curtain or shadow descending over the field of vision. Prompt treatment is necessary to preserve vision.
• Retinal Tear: A tear in the retina can lead to retinal detachment if not treated promptly. Symptoms can include sudden increase in floaters, flashes of light, and a decrease in vision.
• Central Retinal Artery Occlusion: This is a blockage of the central retinal artery, leading to sudden, painless loss of vision in one eye. While it may not typically present with just floaters and squiggly lines, any sudden visual disturbance warrants immediate medical attention.

Rare Diagnoses

• Ocular Lyme Disease: In rare cases, Lyme disease can affect the eyes, leading to various symptoms including floaters and visual disturbances.
• Syphilis: Neurosyphilis can cause a range of visual symptoms, including floaters and changes in vision, though this is relatively rare.
• Multiple Sclerosis: This autoimmune disease can affect the optic nerve and lead to a variety of visual symptoms, including disturbances that might be described as seeing floaters or squiggly lines, though this is not a common primary presentation.