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http://www.revoptom.com/content/c/20600/
VOLUME 2, NUMBER 41
MARCH 5, 2012

SYMPTOMS OF FLASHES AND FLOATERS MAY BE INDICATIVE OF A POSTERIOR VITREOUS SEPARATION, RETINAL TEAR OR A RETINAL DETACHMENT. DIFFERENTIATING THE DIAGNOSIS VIA A KEY CLINICAL SIGN IS CRITICAL.

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You should perform several diagnostic tests, including visual acuity, pupillary testing, confrontation fields and a dilated fundus examination, on all patients who present with complaints of flashes and floaters to rule out the presence of a retinal tear or detachment.

However, in addition to the aforementioned testing, you must be especially careful to examine the patient's vitreous for the presence of pigment. Pigment in the vitreous exhibits a very specific appearance that is often referred to as "tobacco dust" or "Shafer's sign." Although this pearl has been known for a long time, it has saved me on many occasions when a view of the retina was difficult or I was unable to locate a small retinal tear.

The presence of Shafer's sign suggests that pigment from the retina or RPE has dislodged, which significantly increases the probability that the patient has a retinal tear or detachment. Even if you are unable to locate a tear, be sure to refer any patient who complains of floaters and flashes and presents with Shafer's sign to a retina specialist for further evaluation.
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