Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 7 Sept 2026Clinical review pending
!
A fixed shadow with new flashes
New flashes or floaters with a curtain, persistent visual loss or vitreous pigment may indicate a retinal break or detachment.
Action: Contact the emergency ophthalmic service immediately and arrange same-day assessment. Record acuity and the onset of the field change when feasible, but do not delay referral while attempting an examination beyond available equipment or competence.
Synopsis
Perform and interpret a focused assessment of new visual phenomena, identify retinal danger signs, and communicate the limits of examination and the urgency of onward care.
Clarify whether the symptom is a moving opacity, a flash, a fixed blind area or a gradually spreading visual pattern.
Establish onset, progression, eye involved and associated visual loss, then ask about myopia, trauma, surgery and previous retinal disease.
Measure each eye's acuity, compare pupils and screen fields without using normal findings to exclude a peripheral tear.
Key red flags
New flashes or floaters accompanied by a fixed field defect or reduced vision require emergency retinal assessment.
Investigation priorities
01
Monocular acuity, pupils and confrontation fieldsFirst step
Document visual function and detect an obvious afferent or field abnormality.
Management branches
Triage at first contactIdentify the need for emergency assessment
The patient contacts a service because visual phenomena are new or have changed.
Ask immediately about a curtain, visual decline, a sudden shower, injury and the time of the most recent change.
Arrange emergency same-day ophthalmic assessment for threatened retinal function; staff should have a clear escalation route rather than attempting a telephone diagnosis.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 7 Sept 2026; clinical approval remains outstanding.