Welcome to question of the day #40

Eyetools question of the day #40

This is often bilateral but characterized by the 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, or vitreous. 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.