Optician India

Welcome to question of the day #40

Why do patients sometimes complain of a transient, scum-like blurring of vision?

This is often bilateral, but characterized by involvement of only one eye at a time, in most cases. More problematic when in a bright-light situation, or when reading.

Some patients develop mechanisms for relieving the scum such as:

Eye drops

Splashing water into the eyes

Forceful blinks

Quick eye movements.

Almost always the cause is a media problem involving the tear film, orvitreous. Perform careful evaluation of corneal wetting and tear quality using the slit-lamp, keratometry and retinoscopy.

Perform careful assessment, looking for vitreous membranes and floaters using:

Direct ophthalmoscopy

Slit-lamp biomicroscopy

Binocular indirect ophthalmoscopy

Retinoscopy.

Management if a wetting problem:

Lubrication and lavage

Lid hygiene.

Management if a vitreous problem:

Reassurance and patient education

Laser photodisruption of larger condensates (controversial)

Vitrectomy (controversial)

Teach the patient to ‘chin tuck and rhythmically self-indent’ the eye to move the floaters out of their line of sight.