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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.