What causes flashing lights in my eye and how is it treated?

Flashing Lights in the Eye: Causes and Treatment

Flashing lights in the eye (photopsia) are most commonly caused by posterior vitreous detachment (PVD), but can also indicate serious conditions like retinal tears or detachment that require immediate ophthalmologic evaluation. 1

Common Causes of Flashing Lights

• Posterior Vitreous Detachment (PVD): Most common cause, typically occurring in people aged 45-65, with earlier onset in men, people with trauma history, and those with myopia 1
• Retinal tears or detachment: 8-22% of patients with acute PVD symptoms have a retinal tear at initial examination 1
• Migraine with aura: Characterized by visual disturbances including flashing lights, often preceding headache 2
• Migraine aura without headache: Visual symptoms without subsequent headache 2
• Ocular ischemia: Reduced blood flow to the eye 1
• Vitreomacular traction: Can cause visual disturbances including photopsia 1

Warning Signs Requiring Immediate Evaluation

Seek immediate ophthalmologic care if flashing lights are:

• New onset or increasing in frequency
• Accompanied by sudden increase in floaters
• Associated with a shadow or curtain in peripheral vision
• Accompanied by visual field loss
• Occurring with vitreous hemorrhage 1

Diagnostic Approach

1. Complete dilated fundus examination: Essential to assess for retinal tears or detachment, with careful examination of peripheral retina where most tears occur (88% in superior quadrants) 1

2. Optical coherence tomography (OCT): May be used to evaluate macular integrity 1

3. Visual field testing: To map any scotomas or visual field defects 1

Treatment Based on Underlying Cause

For Posterior Vitreous Detachment (PVD) without complications:

• Typically requires no specific treatment
• Patient education about warning signs
• Follow-up examination is recommended as 2-5% of patients may develop retinal breaks in subsequent weeks 1

For Retinal Tears or Detachment:

• Immediate referral to ophthalmologist
• Laser photocoagulation or cryotherapy for retinal tears
• Surgical intervention for retinal detachment 3

For Migraine-Related Photopsia:

• Migraine management strategies
• Identification and avoidance of triggers
• Medication as prescribed by neurologist or primary care physician 2

Patient Education and Follow-up

Even if the initial examination is normal, follow-up is crucial as:

• Approximately 80% of patients who develop breaks after an initially normal examination had either pigmented cells, hemorrhage, or new symptoms 1
• Patients should be instructed to return immediately if they experience new or worsening symptoms

Special Considerations

• Contact Lens Wearers: May need to temporarily discontinue contact lens use if diagnosed with contact lens-related keratoconjunctivitis 4
• Medication-Induced Visual Disturbances: Some medications, including those with anticholinergic properties, can cause pupil dilation and potentially trigger angle closure in susceptible individuals 4

Prevention

• Regular eye examinations, especially for those with risk factors for retinal problems
• Prompt evaluation of new visual symptoms
• Proper eye protection to prevent trauma

Remember that while many cases of photopsia are benign, some represent serious conditions that can lead to permanent vision loss if not promptly addressed. When in doubt, an ophthalmologic evaluation is warranted.