This is often bilateral but characterized by the involvement of only one eye at a time, in most cases. More problematic when in a bright-light situation, or when reading.
Some patients develop mechanisms for relieving the scum such as:
- Eye drops
- Splashing water into the eyes
- Forceful blinks
- Quick eye movements.
Almost always the cause is a media problem involving the tear film, or vitreous. Perform careful evaluation of corneal wetting and tear quality using the slit-lamp, keratometry and retinoscopy.
Perform careful assessment, looking for vitreous membranes and floaters using:
- Direct ophthalmoscopy
- Slit-lamp biomicroscopy
- Binocular indirect ophthalmoscopy
Management if a wetting problem:
- Lubrication and lavage
- Lid hygiene.
Management if a vitreous problem:
- Reassurance and patient education
- Laser photodisruption of larger condensates (controversial)
- Vitrectomy (controversial)
- Teach the patient to ‘chin tuck and rhythmically self-indent’ the eye to move the floaters out of their line of sight.