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
• Retinoscopy.

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.