Flashing eye??

[Lucie W]

Wondered if there are any doctors on here?

My left eye has been flashing for about half an hour. It's like a TV screen when there is no signal - that black and white fuzz. This has happened twice before, once about 2 months ago and once about 6 weeks ago. One of the times I was driving and had to pull over until it had passed, as I couldn't see the road. It isn't painful or anything, but I just wondered if it could be a sign of a neurological problem? Does anyone else get this?

Thanks,Lucie

[sjwb]

First off, go and see an optometrist.
Secondly, I had a similar event and it turned out to be 'just one of those things' with no ill effects.
But do get it checked out; good luck.

[oilandwater]

Sounds like a classic migraine to me. A headache usually follows.
hth

[Google [bot]]

Sounds like a silent migraine. I get them from time to time, they last about 1/2 hour then clear. The silent bit meaning you don't get the headache (thank God).

[anonymous-user]

Flashing in the eys may be a detached retina, (I've had several), its one of the things I'm told to look for are you very myopic? se a specilist NOW.

[HUW JONES]

Hello,
If you can still read this from the info you provide could be retinal traction or possible (migraine) vascular visual disturbance. Whatever suggest you get it checked out soonish. HTH.

[968]

Lucie W said:

Wondered if there are any doctors on here?

My left eye has been flashing for about half an hour. It's like a TV screen when there is no signal - that black and white fuzz. This has happened twice before, once about 2 months ago and once about 6 weeks ago. One of the times I was driving and had to pull over until it had passed, as I couldn't see the road. It isn't painful or anything, but I just wondered if it could be a sign of a neurological problem? Does anyone else get this?

Thanks,Lucie

Sounds like classical migraine. I wouldn't bother with the optometrist, they aren't able to examine the peripheral retina reliably. Go to your local eye casualty, they will dilate and examine your retina for any tears, if there aren't any, it's most likely to be migrainous. If it persists, go and see your GP.

[DKL]

968 said:

Sounds like classical migraine. I wouldn't bother with the optometrist, they aren't able to examine the peripheral retina reliably. Go to your local eye casualty, they will dilate and examine your retina for any tears, if there aren't any, it's most likely to be migrainous. If it persists, go and see your GP.

Why do you persist running down professional colleagues?

There is plenty of evidence in the literature to show that optoms have at least the ability of SHOs in their referral accuracy but I am well aware of your opinion of us. It's your opinion and you're entitled to it.

More importantly on a general forum such as this to dismiss the primary eyecare that is available to the general public is a grave error and bordering on dangerous. The general public should be encouraged to seek professional help and that does not mean they all need to troop to their nearest casualty.

The eyecare is there and easily accessable with an established onward referral system - what's not to like?

People your local optometrist is very well placed to screen issues like this, it's not unusual. If there are any concerns then onward referral with the appropriate level of urgency is available and will be exercised. If there is any suggestion that you need to be at a hospital then that's were you will go.

Do not dismiss it, it's there for you. I don't understand why 968 has such a poor opinion of well trained professionals and a well established system.

Edited by DKL on Tuesday 16th June 23:14

[s1j1f1]

I agree. I have a mate who went for eye exam at Opticians. Found a retinal tear and mate had no symptoms. Think i would start there. Whats your beef 968?

[968]

DKL said:

Why do you persist running down professional colleagues?

I'm not running anyone down, I'm giving you a statement of fact, which is supported by the number of patients referred by their opticians because of flashes and floaters. Can you perform an indented examination with an indirect Ophthalmoscope? I seriously doubt it. If you can't, then you can't exclude a peripheral tear.

DKL said:

People your local optometrist is very well placed to screen issues like this, it's not unusual. If there are any concerns then onward referral with the appropriate level of urgency is available and will be exercised. If there is any suggestion that you need to be at a hospital then that's were you will go.

Do not dismiss it, it's there for you. I don't understand why 968 has such a poor opinion of well trained professionals and a well established system.

Edited by DKL on Tuesday 16th June 23:14

I think this speaks more about your personal sensitivity than my opinion of any other professional. This is a condition that is commonly referred by optometrists every day to the eye hospital service. They as you well know, CANNOT, exclude a tear or break in the retina without performing an indented examination with an indirect Ophthalmoscope and therefore cannot exclude a break. In this case it's quite appropriate for a patient to be seen in the eye casualty with new floaters or photopsia.

I agree that the optometrist is a reasonable first port of call, and can manage simple anterior segment cases and sometimes make appropriate onward referrals for posterior segment cases, however, in this case the patient will end up being referred. The OP asked for a drs opinion about this, and as a Dr my opinion is that they need their posterior segment examined, in detail and so a visit to the optometrist will be wasted time as it will simply be introducing a needless step.

I applaud your willingness to examine such patients though, I wish your colleagues in the Greater Manchester area shared your willingness, if they did, we wouldn't have seen 35 patients with new floaters this previous weekend when I was on call.

Edited by 968 on Wednesday 17th June 09:01

[968]

s1j1f1 said:

I agree. I have a mate who went for eye exam at Opticians. Found a retinal tear and mate had no symptoms. Think i would start there. Whats your beef 968?

And what happened to your mate with the tear in the retina? I bet you he was referred to the local eye casualty, where the eye doctor on call performed laser treatment to seal the retinal tear.

[CBR]

968 said:

s1j1f1 said:

I agree. I have a mate who went for eye exam at Opticians. Found a retinal tear and mate had no symptoms. Think i would start there. Whats your beef 968?

And what happened to your mate with the tear in the retina? I bet you he was referred to the local eye casualty, where the eye doctor on call performed laser treatment to seal the retinal tear.

Having referred a patient with a retinal hole ( recent head trauma + flashes no floaters) to a casulaty eye department with a retinal hole, to have her sent home without treatment with a review in 6/52. The next day the retina detached and she was re referred to another eye casualty, so I guess not all your colleagues are as good as you at detecting peripheral retinal tears.

By all means suggest the patients first port of call is casualty, but please do not judge all Optometrists on the basis of some supposedly poor referrals. Over cautious referral is safe for the patient, if an Optometrist detects a retinal tear/detachment it becomes an emergency referral.

If you wish to be judged by other professionals on the basis of what some of your colleagues do or have done, then remember Harold Shipman was not an Optometrist

[DKL]

DKL said:

Why do you persist running down professional colleagues?

968 said:

I'm not running anyone down, I'm giving you a statement of fact, which is supported by the number of patients referred by their opticians because of flashes and floaters. Can you perform an indented examination with an indirect Ophthalmoscope? I seriously doubt it. If you can't, then you can't exclude a peripheral tear.

Perhaps not but that what we have you lot for! What we can do is identify those that need more urgent attention and get then to you asap.
You may be surprised at the number of optoms who are very capable of indented indirect and worse still the number of patients I have sent to various hospitals around the country who return the following week with stories of surgery being delayed due to no staff, no slots, broken equipment etc etc.

DKL said:

People your local optometrist is very well placed to screen issues like this, it's not unusual. If there are any concerns then onward referral with the appropriate level of urgency is available and will be exercised. If there is any suggestion that you need to be at a hospital then that's were you will go.

Do not dismiss it, it's there for you. I don't understand why 968 has such a poor opinion of well trained professionals and a well established system.

968 said:

I think this speaks more about your personal sensitivity than my opinion of any other professional. This is a condition that is commonly referred by optometrists every day to the eye hospital service. They as you well know, CANNOT, exclude a tear or break in the retina without performing an indented examination with an indirect Ophthalmoscope and therefore cannot exclude a break. In this case it's quite appropriate for a patient to be seen in the eye casualty with new floaters or photopsia.

This is simply to redress a single line comment that MAY mean a cursory reader feels attending their optom is a complete waste of time.

Do you have an idea of the number of people who come in asking for a "quick look" because of flashes and floaters? Mainly this is because they don't want to be bothered with a multi hour wait in casualty. Realistically how high a priority will they be in a busy, general A+E dept. Despite our differences what neither of us want is anyone not being seen because of a poor sentence or not wanting a long wait or having catastrophic detachment because of poor primary care action. We are supposed to be on the same side for the good of the patient!

968 said:

I agree that the optometrist is a reasonable first port of call, and can manage simple anterior segment cases and sometimes make appropriate onward referrals for posterior segment cases, however, in this case the patient will end up being referred. The OP asked for a drs opinion about this, and as a Dr my opinion is that they need their posterior segment examined, in detail and so a visit to the optometrist will be wasted time as it will simply be introducing a needless step.

Good lord do you do patronising professionally? simple, sometimes......
So they wanted a "Dr's" opinion. You and I both know the OP wanted informed professional opinion.
I'd put my knowledge up against your average GP all day every day, but they're Drs all the same.
Equally would I meet your "criteria"? The university that awarded my PhD would suggest I should. Or do you want the "real" doctor verses the "medical" discussion too?
It's a rhetorical question as I have no intention or geting into that.

968 said:

I applaud your willingness to examine such patients though, I wish your colleagues in the Greater Manchester area shared your willingness, if they did, we wouldn't have seen 35 patients with new floaters this previous weekend when I was on call.

I'm surprised you feel your local lot don't/won't see these people. Perhaps you might be surprised if you knew how many are screened out before they get to the HES.
In some places you are saying all flashes/floaters should go straight to A+E, above that it would be good if we would see them.
The problems I've encountered generally revolve around communication between primary and secondary care. If the HES say what they want then they are more likely to get those and not the rest which will just waste your time.
Equally we need to make sure we follow the guidelines so you see what you need to and what needs urgent treatment.
What primary/secondary communication goes on up north? Sadly there isn't a lot in most places which is a shame for all concerned.

I shan't persue this further, people will get bored!

Lucie W - hope you have been seen (by whomever you choose) and sorted out successfully.

Edited by DKL on Wednesday 17th June 21:51

[DKL]

968 said:

s1j1f1 said:

I agree. I have a mate who went for eye exam at Opticians. Found a retinal tear and mate had no symptoms. Think i would start there. Whats your beef 968?

And what happened to your mate with the tear in the retina? I bet you he was referred to the local eye casualty, where the eye doctor on call performed laser treatment to seal the retinal tear.

Isn't that exactly what is supposed to happen? The system can work.

[968]

DKL said:

Perhaps not but that what we have you lot for! What we can do is identify those that need more urgent attention and get then to you asap.
You may be surprised at the number of optoms who are very capable of indented indirect and worse still the number of patients I have sent to various hospitals around the country who return the following week with stories of surgery being delayed due to no staff, no slots, broken equipment etc etc.

Anecdotal stories. Probably macular off detachments that would make no difference whether repaired immediately or within 2 weeks. All mac on detachments are done within 48 hours, without exception. And I'd be amazed if our local optoms could perform an indented exam. Really amazed. Since most SHOs and SpRs aren't that great at it.

DKL said:

This is simply to redress a single line comment that MAY mean a cursory reader feels attending their optom is a complete waste of time.
Do you have an idea of the number of people who come in asking for a "quick look" because of flashes and floaters? Mainly this is because they don't want to be bothered with a multi hour wait in casualty. Realistically how high a priority will they be in a busy, general A+E dept. Despite our differences what neither of us want is anyone not being seen because of a poor sentence or not wanting a long wait or having catastrophic detachment because of poor primary care action. We are supposed to be on the same side for the good of the patient!

That's not what I said and you know it. I said and clarified that in this case, it is an added step that is unecessary and would be better if the patient just has their posterior segment examined in detail. I know exactly how many people come in for examination for floaters, because they normally attend casualty shortly afterwards with a note from the optician saying please exclude a tear. You might be able to make the decision to discharge someone with floaters, but the majority of your colleagues are not, and will not take the responsibility. Most of them only dilate with tropicamide and therefore have no confidence in examining the peripheral retina, so they refer, which is fine.

DKL said:

Good lord do you do patronising professionally? simple, sometimes......
So they wanted a "Dr's" opinion. You and I both know the OP wanted informed professional opinion.
I'd put my knowledge up against your average GP all day every day, but they're Drs all the same.
Equally would I meet your "criteria"? The university that awarded my PhD would suggest I should. Or do you want the "real" doctor verses the "medical" discussion too?
It's a rhetorical question as I have no intention or geting into that.

More oversensitive drivel. Keep going.

DKL said:

I'm surprised you feel your local lot don't/won't see these people. Perhaps you might be surprised if you knew how many are screened out before they get to the HES.
In some places you are saying all flashes/floaters should go straight to A+E, above that it would be good if we would see them.
The problems I've encountered generally revolve around communication between primary and secondary care. If the HES say what they want then they are more likely to get those and not the rest which will just waste your time.
Equally we need to make sure we follow the guidelines so you see what you need to and what needs urgent treatment.
What primary/secondary communication goes on up north? Sadly there isn't a lot in most places which is a shame for all concerned.

I shan't persue this further, people will get bored!

Lucie W - hope you have been seen (by whomever you choose) and sorted out successfully.

Edited by DKL on Wednesday 17th June 21:51

Being involved in the primary care provision for a large sector of the NW I can tell you rather emphatically that most optoms do not and WILL not take responsibility for these patients, because of the liabilities of making a mistake and the lack of technical expertise required to examine someone adequately to the ora serrata. I've also worked at Moorfields where they operate a similar system with the referring optoms, ie refer directly new onset floaters and photopsia.

As I say, I applaud you for not referring all these patients, but I sincerely hope for your license sake that you are examining them with indentation, because if you miss a tear which subsequently becomes a detachment, and take that responsibility, it will mean a whole heap of trouble for you.

[bbeye]

Ahem!

I am an optometrist who indents and examines by Binocular Indirect Ophthalmoscopy. I have other skills, most of which optometrists possess - many of which would be beyond the skills and ability of junior doctors within eye units. I am quite adept at anterior segment examination with a 3- and 4-mirror gonio as well as punctum plug insertion/removal etc .... I can diagnose eye problems and filter out those that need immediate care. In addition, I have forty years worth of experience in the profession to call upon when any ocular condition arises. Don't dismiss us primary care practitioners because we have have to sell spectacles to supplement the lousy fees that the NHS pay use because there's so little in the pot to pay us after the fatcat ophthalmologists have had their pay on the way back to the eye hospital after an easy morning picking up lovely fees at the local private hospital.

Edited by bbeye on Wednesday 17th June 23:33

Edited by bbeye on Wednesday 17th June 23:38

[968]

CBR said:

Having referred a patient with a retinal hole ( recent head trauma + flashes no floaters) to a casulaty eye department with a retinal hole, to have her sent home without treatment with a review in 6/52. The next day the retina detached and she was re referred to another eye casualty, so I guess not all your colleagues are as good as you at detecting peripheral retinal tears.

Again another anecdotal story. Both you and I have no idea about the circumstances. For a start, a 'hole' does not need treatment, and carries an extremely low risk of retinal detachment, even a hole ontop of a schisis. A tear, however, does need to be treated, so was it a hole or a tear? If it was an operculated hole then a review appointment with a 6/52 is not unreasonable. However, if there was a tear, it should have been treated. Also it seems odd that there was a hole/tear one day and a detachment the next. The natural history of detachments are usually slower than that.

Who saw the patient? Was it an SHO, or a junior SpR with little experience, what were the other associated signs? Lots and lots of factors. Easy to post an anecdotal story on the internet. I could do exactly the same in reverse, but it's not productive, and the OP wanted advice. You and your colleague have completely overreacted in an oversentitive way.

[968]

bbeye said:

Ahem!

I am an optometrist who indents and examines by Binocular Indirect Ophthalmoscopy. I have other skills, most of which optometrists possess - many of which would be beyond the skills and ability of junior doctors within eye units. I am quite adept at anterior segment examination with a 3- and 4-mirror gonio as well as punctum plug insertion/removal etc .... I can diagnose eye problems and filter out those that need immediate care. In addition, I have forty years worth of experience in the profession to call upon when any ocular condition arises. Don't dismiss us primary care practitioners because we have have to sell spectacles to supplement the lousy fees that the NHS pay use because there's so little in the pot to pay us after the fatcat ophthalmologists have had their pay on the way back to the eye hospital after an easy morning picking up lovely fees at the local private hospital.

Edited by bbeye on Wednesday 17th June 23:33

Edited by bbeye on Wednesday 17th June 23:38

Aha, the last few lines are the clincher and show what direction you are coming from. Do you have any idea about how Ophthalmologists work nowadays? Do you know about private practice or just a good line in keyboard warrior rubbish?

Quite odd that a few optoms have suddenly appeared to post their first contribution to PH on this particular thread, tonight. What a coincidence.

Please carry on slandering your colleagues. It does you credit. Oh and please disseminate your undoubtedly remarkable ability to indent to your colleagues, particularly in the NW and greater London areas.

Edited by 968 on Wednesday 17th June 23:43

[Xenocide]

oilandwater said:

Sounds like a classic migraine to me. A headache usually follows.
hth

Yep, I get that then normally get hit with feel st for a day or so.

[968]

Xenocide said:

oilandwater said:

Sounds like a classic migraine to me. A headache usually follows.
hth

Yep, I get that then normally get hit with feel st for a day or so.

Yes, ironically, despite the above banter, the most likely cause of the OPs particular symptoms is a migraine. All the retinal stuff is simply to exclude a retinal cause.