Discriminate characteristics of photopsia in posterior vitreous detachment, retinal tears and retinal detachment

Aims:  To characterize photopsia in posterior vitreous detachment (PVD), retinal tears (RT) and rhegmatogenous retinal detachment (RRD).
Methods:  Seventy seven patients presenting to an eye emergency department and vitreoretinal clinic with photopsia had documentation of their symptoms.
Results:  A total of 27 patients had PVD alone, 7 had RTs and 25 RRD. In patients with isolated PVD, photopsia were temporal (94%), lasting seconds (81%) and vertically orientated (59%) flashes. Patients with photopsia located in quadrants other than temporal were more likely to have RRD ( p  = 0.0003). Patients with an oblique or horizontal orientation of their photopsia were likely to have RRD or RT ( p  = 0.001, specificity 96%, sensitivity 40%).
Conclusions:  Most patients with PVD have a typical presentation of photopsia, with temporal, vertically orientated, momentary flashes. Patients with RTs or RRD may describe subtle differences in their photopsia which may raise the index of suspicion for the presence of a complication from PVD.