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
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A new shadow after vitreous separation
A retinal tear or detachment can develop during an evolving posterior vitreous detachment, including after an initially reassuring examination.
Action: Arrange emergency same-day retinal assessment for a new field shadow, sudden increase in floaters, reduced vision or evidence of vitreous haemorrhage. A previous diagnosis of uncomplicated PVD does not justify waiting for a scheduled review.
Synopsis
Understand vitreous separation, distinguish uncomplicated symptoms from retinal injury, and arrange examination, follow-up and safety advice that protects vision during an evolving posterior vitreous detachment.
Posterior vitreous detachment is separation of the posterior vitreous surface from the retina, usually as the vitreous changes with age.
Moving spots, cobwebs or a ring-shaped floater and brief peripheral flashes are typical symptoms, but cannot establish a benign diagnosis by history alone.
Retinal traction during separation can tear the retina or disrupt a vessel, producing a sight-threatening complication.
Key red flags
A dark curtain, missing peripheral vision or newly reduced acuity requires immediate contact with the emergency eye service.
Investigation priorities
01
History and monocular acuityFirst step
Identify the onset, functional impact and factors increasing retinal risk.
Management branches
New symptomsArrange an adequate examination promptly
A patient develops new flashes or floaters without an established assessment of the current episode.
Identify visual decline, a field shadow, trauma and previous retinal problems, and arrange the appropriate urgent eye assessment.
Seek same-day emergency retinal review for a curtain, a sudden shower, haemorrhage or other signs of a possible break or detachment.
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.