15 How Soon Should a Patient With Floaters Be Examined and How Should I Manage a Patient With an Acute Posterior Vitreous Detachment?

15


QUESTION


HOW SOON SHOULD A PATIENT WITH FLOATERS BE EXAMINED AND HOW SHOULD I MANAGE A PATIENT WITH AN ACUTE POSTERIOR VITREOUS DETACHMENT?


Karen M. Gehrs, MD


Floaters are a common symptom and, fortunately, most patients with floaters do not have significant vitreoretinal pathology. However, because some floaters may be associated with vision-threatening conditions, it is important to have a protocol for triaging and managing patients with floaters in a timely fashion.


Triage


Most physicians delegate patient triage to their staff; however, physicians should provide staff with clear guidelines regarding the triage of patients with floaters. Staff should be encouraged to discuss with a physician any patient who does not fit the triage guidelines or any patient who does not follow the guidelines. In general, when a patient calls complaining of the acute onset of floaters, he or she should be advised to come in the same day. Table 15-1 provides additional suggested triage guidelines. Once scheduled, a patient should be given emergency contact information and counseled to call back sooner than scheduled if his or her symptoms worsen or if new symptoms develop. The triage encounter should be documented in the patient’s chart.





Table 15-1


Suggested Guidelines for Triaging Patients With Floaters







  1. Create a triage template that prompts staff to ask pertinent questions and record pertinent positive and negative symptoms and history.
  2. Checklist for pertinent symptoms:

    □ New onset floaters or a change or worsening of chronic floaters


    □ Duration of floaters


    □ Associated symptoms (ie, photopsias, decreased central vision, and peripheral vision loss)


    □ History of prior retinal breaks or detachments in the symptomatic eye and fellow eye


    □ Family history of retinal detachment


    □ History of trauma in the symptomatic eye


    □ Type(s) and date(s) of prior ocular surgery (including yttrium-aluminum-garnet capsulotomy) in the symptomatic eye


    □ Pain, redness, or photophobia, which may indicate uveitis, including endophthalmitis, in a patient who has had recent eye surgery or systemic illness


    □ History of systemic conditions that may predispose to problems that cause floaters (eg, diabetes with vitreous hemorrhage, AIDS with potential for cytomegalovirus retinitis, collagen vascular disease with the potential for uveitis)


  3. In general, patients with new onset floaters of less than 2 weeks duration should be instructed to come within 24 hours, preferably the same day. This is especially true if the patient has associated symptoms of photopsia, central or peripheral vision loss, ocular pain, redness, photophobia, history of recent eye surgery or trauma, history of a systemic condition that could predispose to vitreous hemorrhage, intraocular infection, or noninfectious intraocular inflammation.
  4. Patients with subacute floaters (> 2 weeks but < 6 weeks) without associated photopsias; central or peripheral vision loss; and no pain, redness, or photophobia should be told to come in within 1 week and should call back and come in the same day if photopsias, vision loss, pain, redness, or photophobia develop before the scheduled appointment.
  5. Patients with floaters of more than 6 weeks duration are more difficult to triage.

    a. In general, if floaters are worsening or if there is associated central or peripheral vision loss, photopsias, or a systemic condition with the potential for infection, hemorrhage, or inflammation, the patient should be told to come in the same day.


    b. Evaluation of chronic floaters with no associated symptoms or underlying systemic condition of concern can be scheduled within 1 month with instructions to call back before the scheduled appointment if symptoms worsen or new concerning symptoms (reviewed with the patient in lay terms) develop.

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Apr 3, 2020 | Posted by in OPHTHALMOLOGY | Comments Off on 15 How Soon Should a Patient With Floaters Be Examined and How Should I Manage a Patient With an Acute Posterior Vitreous Detachment?

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