Flashing Lights in the Eyes (Photopsia): Causes & Treatment

Photopsias are visual flashes of light that come in many forms. 

The primary causes of photopsias are posterior vitreous detachment, retinal tears, and neovascular age-related macular degeneration. Treatment will depend on the particular conditions causing photopsia. 

What Do Photopsias Look Like?

Photopsias are visual flashes, but this covers a wide range of similar yet distinct visual phenomena. Common photopsia experiences include those described as the following:

• Lightning streaks
• Zig zags
• Camera flashes
• Flickers
• Sparkles
• Spinning, pinwheel, or circular flashes
• Bars or spots

Usually, this light is the white typically associated with bright flashes, but it is sometimes colored. 

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Types of Flashes

The type of flashes experienced can help a doctor diagnose the potential cause of the condition. Important factors include where the flash is occurring and in what light conditions. 

For example, the most common causes of photopsias cause flashes in one eye (unilateral photopsia). More rarely, a condition may cause flashing in both eyes (bilateral photopsia). 

The area of your vision can also help a doctor diagnose you. Peripheral flashes are those that occur in the periphery (edges) of your vision. Central flashes occur in the center of your vision. 

The areas of your vision where flashes occur usually aren’t random. Instead, they occur because a related part of the eye (or sometimes the brain, which processes visual information) important to that part of vision is being affected.

The frequency and severity of your flashing also matter. Generally, the more frequently you experience flashes and the more the flashing affects your vision, the more serious your condition.

Finally, pay attention to whether the flashing occurs in particular lightning conditions. Some conditions that cause photopsias cause flashing even in dark and low-light conditions. Others require light in order for a person to experience them.

Common Causes of Photopsias

Most often, photopsias are due to three causes:

Posterior Vitreous Detachment

According to one study, the most common cause of photopsias is posterior vitreous detachment (PVD), causing photopsias in 39.7 percent of the eyes observed in the study. 

This is a condition where the vitreous of the eye, the substance that fills it, pulls away from the retina. It is a relatively common condition among older patients. A person with PVD may also experience floaters, tiny specks that move around in a person’s field of vision. 

While it usually isn’t a major concern, it is a good idea to confirm your overall eye health with an ophthalmologist if you haven’t been diagnosed yet, as it can sometimes develop into something more serious.

Retinal Tear

In that same study, 8.9 percent of eyes experiencing photopsias had retinal tears. This is a condition in which the light-sensitive retinal tissue of your eye tears, usually because the vitreous of the eye pulls it abnormally. 

A retinal tear is often caused by what begins as a PVD and has similar visual symptoms. However, it is much more serious if left untreated.

Neovascular Age-Related Macular Degeneration

The third most common cause of photopsias, according to that study, was neovascular age-related macular degeneration (AMD), seen in 7.9 percent of eyes experiencing photopsia.

This is a condition that is extremely common among older adults, as it is caused by the way the eye naturally deteriorates as we age. Visual symptoms occur because the macula, the part of the eye responsible for straight-ahead vision, begins to wear. 

AMD is usually not an emergency, but an ophthalmologist can help you monitor progression and provide appropriate treatment.

Other Causes of Photopsias

Other causes of photopsias identified in the study include the following:

• Rhegmatogenous retinal detachment (RRD)
• Classic and ophthalmic migraine
• Hypoglycemia
• Vertebrobasilar insufficiency
• Non-AMD choroidal neovascularization

Risk Factors

One of the biggest risk factors for photopsias is age, as it is a major contributing factor to several of the most common causes of the visual phenomenon. Other common risk factors include the following:

• Trauma to the eye
• Diabetes and other cardiovascular problems
• Eye surgery, especially cataract surgery
• Nearsightedness
• Family history of relevant eye health problems

It is important to note that photopsia is a symptom rather than an eye condition in itself. Something causes flashes, and it is important to identify what it is. 

Treatment for Photopsia

The appropriate treatment for photopsia depends on the cause.

PVD

For posterior vitreous detachment, a doctor may decide that treatment is not necessary. 

While occasional flashes and small floaters may be inconvenient, PVD often doesn’t seriously impact a person’s quality of life and doesn’t usually worsen with time.

However, it does increase your risk of retinal tears. You should see a doctor right away if you experience a sudden increase in the severity of your symptoms or experience any new visual symptoms not associated with PVD.

Retinal Tears

A retinal tear requires prompt treatment, as it can sometimes lead to retinal detachment, which is a serious eye condition that can cause permanent vision loss.

If caught early, retinal tears are usually easy to treat, with the tear sealed via a laser or a freezing treatment called cryotherapy. This treatment is both easy and safe, generally only causing a person mild discomfort.

Some retinal tears don’t require any treatment. This is a decision a doctor, not a patient, should make after observing the tear.

AMD

Age-related macular degeneration has no cure, but a doctor can help monitor progression and give advice on how to slow down that progression and better handle symptoms. 

Several different treatments exist to help slow progression, and more are being studied to check their efficacy. One of the most straightforward treatments is taking certain micronutrients, such as vitamin C and vitamin E, which has been linked to helping slow the progression of AMD.

When Are Flashes Normal?

It is normal to experience flashes when a bright light, such as from a car headlight or lightning flash, occurs. Rubbing your eyes can also cause photopsia. 

While you should be careful in these cases for other reasons, as bright lights can be temporarily blinding and rubbing your eyes has the potential to do damage, the flashes themselves are usually not a sign of serious concern unless they occur for more than a few seconds after the inciting event is over.

Note that in the case of extremely focused light, such as some lasers, you should close your eyes immediately if you believe your eye is being exposed to the beam. Powerful lasers have the potential to cause permanent vision damage very quickly, sometimes almost instantaneously. 

Signs of an Emergency

Photopsias can signal an emergency if you suddenly experience them without any obvious cause or experience them in much greater severity than normal. 

Other visual symptoms linked to conditions that cause photopsias that signal an emergency include a shifting gray-like veil over your vision and/or a blurring or shadowing effect on your vision. This could mean you’re experiencing a retinal tear or retinal detachment, which requires prompt treatment or you may experience permanent vision loss. 

If you’re experiencing photopsias or other visual symptoms that you believe are an emergency, get someone else to drive you to a medical facility. It is not always possible to predict if your vision may deteriorate further, and that could be extremely dangerous if it were to happen while driving.

A good rule in eye health is to treat any visual symptom as serious unless you know its cause through a diagnosis given to you by a doctor and they told you it was normal. Many eye health conditions can worsen quickly if untreated, as the eye is one of the most sensitive exposed organs on the body.

When to See a Doctor for Photopsia

If you experience photopsia without any obvious cause, see a doctor as soon as possible. While many causes of photopsia are not concerning, photopsia can also sometimes signal health conditions that may cause permanent vision damage if left untreated. 

In either scenario, a doctor can diagnose the issue and help you understand why you’re experiencing the symptoms. They can then provide an appropriate treatment plan.

References

1. Age-Related Macular Degeneration. (November 2021). American Academy of Ophthalmology.

2. Photopsias. (June 2019). The University of Iowa.

3. Photopsias: A Key to Diagnosis. (October 2015). American Academy of Ophthalmology.

4. Retinal Tears. (2016). American Society of Retina Specialists.

5. What Is a Posterior Vitreous Detachment? (February 2022). American Academy of Ophthalmology.

6. Spontaneous Posterior Vitreous Detachment: A Glance at the Current Literature. (May 2021). World Journal of Experimental Medicine.

7. Management of Retinal Detachment: A Guide for Non-Ophthalmologists. (May 2008). The BMJ.

8. Ocular Causes of Visual Distortions. (August 2019). Australian Journal of General Practice.