Our eyes are one of the most important organs in the body, as they give us the ability to see.
However, there are many medical conditions that can compromise our vision, some of which result in decreased ability to concentrate or loss of vision itself.
Most disorders that affect the eye will likely affect vision in some way, with random floaters or flashes being relatively common.
These can appear as flashes of light in the corner of the eye, flashes of light in peripheral vision, or even flashes of light in both eyes.
Photopsy can present as a retinal detachment when examined by an optometrist or ophthalmologist . However, it can also be a sign of uveal melanoma .
Photopsies are a visual phenomenon experienced by individuals with a variety of ocular or optical pathologies. In layman’s terms, they represent flashing lights and can be divided into unstructured or structured photopsies, the latter referring to geometric shapes.
This condition is extremely rare (5–7 per 1 million people will be affected, typically Northern Europeans with blue eyes and fair skin). The photopsy must be investigated immediately.
These flashes are common among many people and are not / should not be a cause for alarm. The top three factors that tend to increase photopsies were bright light, fatigue, and stress.
Occasionally a flash of light can occur in the eye in healthy people without eye or medical problems. Most people discover during childhood that pressing or rubbing the eyes often causes bright or flashing lights, colors, and shapes to appear.
This occurs because pressure on the eye mechanically stimulates the nerves in the retina, the area that perceives vision at the back of the eye. Some people also experience brief photopsia with rapid eye movements.
In an otherwise healthy young adult, these flashes of light are generally harmless and rarely indicate an underlying medical or eye disorder.
Symptoms of photopsies
Simple visual pseudohallucinations are also known as phosphenes or photopsies, and consist of unformed geometric patterns or light phenomena.
In photoreceptor disease, these phenomena have been described as many generalized flashing, pulsing, or bright lights (snow on a television screen, as opposed to simple flashes).
In a previous survey of patients with retinal vision loss, the majority reported spontaneous visual phenomena, with simple phenomena occurring more frequently than complex phenomena involving formed images.
Patients with retinitis pigmentosa (RP) have confirmed experiences of these phenomena, most commonly described as slow localized spots or shapes with semicircles, but also as rapid flashes of light, static noise, or fluorescence.
Photopsies tend to increase in the absence of visual and light stimuli, and therefore it seems logical to assume that patients with retinitis pigmentosa with more advanced vision loss will experience photopsies more frequently.
Photopsy and other symptoms
When the vitreous fluid in the eye rubs or pulls on the retina, it can appear as a flash of light or rays. This sensation can also be experienced if you have been hit in the eye and see a bright light before regaining vision.
Photopsy is the symptom of seeing flashes of light and is essentially harmless, but it can be a sign of more serious complications in other parts of the body that require urgent medical attention.
Many patients with retinitis pigmentosa at some point during the course of their disease have flashes of light or photopsies. These are reported to occur in the mid-perimeter field of view, often adjacent to areas of relative or absolute scotomas.
These photopsies are described as tiny, flashing or bright lights, or as a coarse grain that is shiny to vision.
The phenomenon is similar to that reported by ophthalmic migraine patients, except that, although retinal disease expands over the years, photopsies are generally stationary within the field.
Also, unlike ophthalmic migraine, photopsies can be continuous rather than episodic. As the scotomas become denser over the years, the photopsies diminish and eventually disappear.
In a retrospective survey of symptoms and findings in 500 patients with retinitis pigmentosa, Heckenlively et al. flashes of light were reported in 170 (35%).
Since 8 patients in this series had retinal detachments, the symptom of light flashes should be considered an indication for a careful examination of the fundus.
The cellular or tissue correlates underlying photopsies in retinitis pigmentosa are unknown, but may include photoreceptor dysfunction, neurite outbreak, aberrant synapse formation, and secondary retinal remodeling, all of which occur as a sequel to degeneration. of the photoreceptor.
Symptoms such as photopsia and / or increased vitreous floaters with acute posterior vitreous detachment may indicate the development of a retinal tear.
Causes of photopsies
The most common cause of central photopsies is neovascular macular degeneration. They usually last for several seconds or longer, repetitive starbursts, twinkles, pinwheels, or strobes.
Healthy people can also experience flashes that are generally harmless. If you rubbed your eyes, you would get a similar appearance of bright or sparkling lights, colors, and shapes.
This happens because as we press on the eyes, it puts pressure on the optic nerves of the retina and the areas of vision that the eye perceives.
Other causes of central flashes are diseases that affect the posterior pole, such as late retinitis pigmentosa, multifocal choroiditis, Best’s disease, and papilledema. Causes of photopsy include:
- Posterior vitreous detachment (most common).
- Retinal tear and retinal detachment.
- Macular degeneration
- Neovascularización coroidea.
- Retinitis pigmentosa.
- Coriorretinopatía serosa central.
- Intraocular lens reflections.
- Severe cough
- Hypoglycemia .
- Vertebrobasilar insufficiency.
- Charles Bonnet syndrome.
Other possible causes
- Head trauma
- Tumor ocular o cerebral.
- Optic neuritis, or inflammation of the nerves of the eye.
- Macular degeneration
- Low blood pressure .
- Low blood sugar
- Transient ischemic attack (mini-stroke).
- Certain medications ( digoxin , quetiapine, and paclitaxel).
Photopsies and Migraines: What’s the Connection?
Migraines and photopsies often occur together. Photopsies can occur for a number of other reasons. For example, people with migraines who experience an aura often report flashing lights (photopsies) in one or both eyes as the headache develops.
These flashes appear similar to floaters, looking like flickering lights, but often only on one side of your vision and in an irregular pattern.
It will most likely obscure vision on one side and usually disappear after 10 to 20 minutes. It could also be followed by a headache.
This type of flash can be caused by a migraine, as it can be the result of a spasm of blood vessels in the brain. Rapid eye movement can accompany flashing episodes as well.
Less frequently, the flashes of light can occur without a subsequent headache, a condition called an ocular migraine.
Photopsy is generally seen in the elderly, as it rarely occurs in young, healthy adults. The following are some conditions that can cause flashes to occur:
Posterior vitreous detachment
Vitreous fluid is a gel-like substance that fills the back of the eye. Small fibers release the vitreous to the retina. As we age, the vitreous shrinks and may partially or completely detach from the retina.
This contraction can pull on the retina as it separates, stimulating the nerves in the eye and producing what is perceived as flashing light.
Despite the rather scary name, posterior vitreous detachment is a common age-related eye change, this condition usually occurs in the 60s, and those who are myopic are at higher risk.
People who are nearsighted are at higher risk for the disease. Vision loss rarely occurs with posterior vitreous detachment, and flashes of light usually disappear within 1 to 3 months.
However, an eye exam is needed to detect complications, such as vitreous bleeding or a retinal tear.
Under normal circumstances, the eye is filled with the vitreous gel that gives it its shape and form. This gel sticks to the retina at the back of the inside of the eye. As one ages (beyond the youthful stage), the vitreous gel begins to liquefy in the center.
The liquefied gel becomes weaker over time, making it unable to support the much heavier gel around it. In extreme conditions, the peripheral vitreous gel collapses into the liquefied gel in the center, sometimes forcing it to detach from the retina.
The outer gel breaks down into smaller pieces that form eye floaters in the liquefied gel. This mainly occurs if too much vitreous gel has liquefied in the center.
According to studies and research, most individuals will have posterior vitreous detachments by the time they reach 80 years of age.
Fortunately, however, posterior vitreous detachment does not always lead to a detached or torn retina.
If the posterior vitreous detachment process occurs gradually and slowly, the patient will not be at risk of detached retina. In addition to this, the light flashes and the pressure on the retina decreases once the posterior vitreous gel has completely detached.
Retinal tear or detachment
A tear in the retina of the eye that causes the vitreous to leak through the tear and lift the retina from the back of the eye. It is known to affect approximately 14 percent of people with posterior vitreous detachment.
Retinal tears can occur due to eye injury or surgery, but they can also be the result of diabetic eye disease. It usually appears as flashes of light in the affected eye, with the possibility of seeing floaters, spots, or shadows.
The retina depends on the stimulation of light to produce an electrical impulse that the brain can interpret. The electrical impulse can be interpreted as an image or simply as pure light.
However, mechanical stimulation of the retina is interpreted as a flash of light in the brain.
As mentioned above, mechanical stimulation may be due to the retina being pulled, detached, or torn due to extreme posterior vitreous detachments.
The flashes of light interpreted from this may be short-lived or continue indefinitely depending on how detachment occurs. These blinks, however, decrease as the retina repairs or heals.
Urgent medical attention is needed to prevent permanent vision loss with a tear or tear of the retina. Treatment options include surgery, laser treatment, and cryopexy, a freezing technique that seals the retinal tear.
Blow to the head
A strong blow to the head can also cause photopsia, although of short duration. This, however, happens if the blow was strong enough to cause the vitreous gel to shake, a phenomenon commonly known as “stargazing.”
A series of heat waves between the eyes can also cause flashes in some people. Heat waves can be caused by blood spasms passing through blood vessels to and within the brain.
A headache or migraine can follow after that. Some patients may experience flashes of light for a few minutes and never have a headache after that. This condition is called an ophthalmic migraine.
Flashes in the eyes can also occur as a symptom of digital toxicity, especially in older people. This usually happens with older people who take medicine for heart-related conditions.
Alternative nonocular causes of photopsies, such as ophthalmic migraine, hypoglycemia, vertebrobasilar insufficiency, metastatic central nervous system adenocarcinoma, and severe cough, should also be considered as unusual but possible causes of photopsies.
However, these etiologies are more likely to cause central or bilateral photopsies and present other systemic symptoms. The functional side effects of chemotherapeutic agents should be considered in patients who develop ocular symptoms while undergoing chemotherapy.
When does eye flash become a medical emergency?
Almost everyone (even those with perfectly healthy eyes) notices a few flashes and spots from time to time.
This is completely normal. However, if you see spotty showers and floaters accompanied by flashes of light inside the eye, make an appointment with an eye care professional for specialized treatment.
Such signs are early symptoms of posterior vitreous detachment, whereby the vitreous can be pulled away from the retina. Another possible reason for this could be that the retina is being displaced from the inner lining of the eye.
This lining is the main source of oxygen, nutrients and blood, essential compounds necessary for the proper functioning of the eye.
The retina is the most important and delicate part of the eye. If the vitreous gel pulls on it, it could tear the delicate area. The gel-like substance can also push the retina into the eye socket, causing a condition known as retinal detachment.
According to a study published in Ophthalmology, 39.7% of patients who experienced the sudden symptoms of light flashes and / or eye floaters had posterior vitreous detachment, while 8.9% received a diagnosis of a torn retina.
Separate research on it also shows that 50% of patients with retinal damage consequently develop retinal detachment, which almost always leads to significant vision loss.
If caught early, an eye surgeon can reattach the detached retina or repair the retinal tear to restore vision. This is the reason why ophthalmologists recommend seeking medical attention as soon as you begin to see flashes of light inside your eyes.
Posterior vitreous detachments commonly known as PVD are more common and are not as risky as retinal detachments. Symptoms of posterior vitreous detachments include the sudden appearance of floaters.
Medical researchers believe that extreme vitreous detachments can pull on the retina, causing retinal detachment.
Photopsies or flashes of light may occur if the retina receives mechanical (non-visual) stimulation. This mainly occurs if the retina is torn, pulled, or detached. The patient may see random sparks, flashing lights, or lightning when this happens.
When to see a doctor
Older people can experience flashes on or off for several weeks or months and it can be a complication of a pre-existing condition such as diabetes.
It is important to see your doctor if you experience sudden flashing episodes to get a more accurate diagnosis. The following are some of the symptoms that should prompt you to see a medical professional, such as an optometrist.
Diagnosis of photopsies in the eye
A doctor can give you an accurate diagnosis of why your eye is flashing. They will likely use special drops to dilate the pupil and get a better view of the retinal and vitreous fluid.
There are several eye-related tests that your doctor can perform to evaluate the condition of the eye.
Treatment of ocular photopsies
Treatment will often depend on your specific situation and what may be causing your eyes to flash.
Flashes are not considered a life-threatening condition, but your doctor will make sure there is no direct damage to the eye by conducting an eye exam.
Over time, the flashes will resolve on their own, and treatment will likely address the underlying condition that led to the flashing eyes to begin with.
There is no specific treatment for retinal vitreous fluid separation, but laser or freezing therapy and even surgery may be required for retinal tears.
Precautionary tips for light flashes in the eye
In general, it’s good practice to see your doctor for any serious medical problems, and that includes problems with your vision, too.
If you experience a sudden onset of flashes, it is recommended to see your doctor immediately, as it may be a sign of another serious problem. Some examples of warning signs or symptoms to seek medical attention include:
- Blurred or reduced vision
- Eye pain.
- Soft spot.
- Mental confusion.
- New or worse headache.
- Nausea or vomiting
Photopsia most often originates within the eye itself, but it can also occur due to disorders that affect the visual nerve pathways in the brain.
Consult your doctor if you experience flashes of light to determine the cause and appropriate treatment, if necessary.
Seek immediate medical attention if you have an existing eye disease, or the flashes of light are accompanied by warning signs or symptoms, including: blurred or reduced vision, eye pain, dizziness, mental weakness or confusion, new or new headache. worsens and nausea or vomiting.