Photopsia

Photopsia
This is an approximation of the zig-zag visual of a scintillating scotoma as a migraine aura. It moves and vibrates, expanding and slowly fading away over the course of about 20 minutes.
Specialty	Ophthalmology, Neurology
Symptoms	Flickering lights or flashes in the field of vision, along with pain, loss of colour perception, and eventual vision loss are also part of the damage to the optic nerve during optic neuritis[1]
Usual onset	During pregnancy
Duration	Migraine with aura, which includes photopsia 39% of the time, typically lasts 10 to 20 minutes and often is followed by a headache.[2]
Causes	Peripheral (Posterior) vitreous detachment, retinal detachment, age-related macular degeneration, ocular (retinal) migraine / migraine aura, vertebrobasilar insufficiency, optic neuritis, occipital lobe infarction (similar to occipital stroke), sensory deprivation (ophthalmopathic hallucinations)
Risk factors	Above age 50 (risk of retinal detachment)[3]
Treatment	In most cases, photopsia is a symptom of a preexisting condition. The underlying condition must be identified and treated to resolve the symptoms.

Photopsia is the presence of perceived flashes of light in the field of vision.

It is most commonly associated with:^[4]

• posterior vitreous detachment
• migraine aura (ocular migraine / retinal migraine)
• migraine aura without headache
• scintillating scotoma
• retinal break or detachment
• occipital lobe infarction (similar to occipital stroke)
• sensory deprivation (ophthalmopathic hallucinations)
• age-related macular degeneration
• vertebrobasilar insufficiency
• optic neuritis
• visual snow syndrome

Vitreous shrinkage or liquefaction, which is the most common cause of photopsia, causes a pull in vitreoretinal attachments, irritating the retina and causing it to discharge electrical impulses. These impulses are interpreted by the brain as flashes.

This condition has also been identified as a common initial symptom of punctate inner choroiditis (PIC),^[5] a rare retinal autoimmune disease believed to be caused by the immune system mistakenly attacking and destroying the retina. During pregnancy, new-onset photopsia is a concern for severe preeclampsia.

Photopsia can present as retinal detachment when examined by an optometrist or ophthalmologist. However, it can also be a sign of uveal melanoma. This condition is extremely rare (affecting 5–7 per 1 million people, typically fair-skinned, blue-eyed northern Europeans). Photopsia should be investigated immediately.