Flashes of Light in Your Eye: What They Mean and When to Be Seen the Same Day

Flashes of light in your eye are almost always a sign that something is tugging on your retina. The retina has no pain receptors, so it can't hurt. The only way it can tell your brain something is going on is with light. Most of the time, the tugging comes from the vitreous gel inside your eye pulling away as it ages, which is called a posterior vitreous detachment, or PVD. In my experience, a small minority turn out to be a retinal hole, tear, or detachment. That small minority is why new flashes get a same-day dilated exam, every time.

I'm Dr. Jordan Jin, an optometrist in Bellevue. Flashes come up in my office every week, and the search results most people land on go straight to the scariest answer. Here's what's actually going on, how I sort the urgent cases from the common ones, and what to say when you call.

What do eye flashes look like?

Patients describe them the same way almost every time: camera flashes or lightning bolts that come from nowhere. They can be brief or last a couple of seconds. They can be small or take up a big part of your vision. They usually show up in one eye, oftentimes off to the side, and they're easiest to notice in a dim room.

If you're seeing them with your eyes closed, that's a clue. A light in the room can't do that. Flashes you see with your eyes shut are coming from inside the eye, which points to the retina.

What causes flashes of light in the eye?

Physical traction on the retina. That's the short list. Here's where the traction usually comes from:

• A posterior vitreous detachment (PVD). The vitreous is the gel that fills the back of the eye. With age it shrinks and pulls away from the retina. As it peels off, it tugs, and you see flashes. This is the most common cause by far.
• New floaters forming. Sometimes it isn't a full PVD. A clump of collagen forming in the vitreous can tug on the retina enough to set off a flash.
• A retinal hole, tear, or detachment. The vitreous pulls hard enough to tear the retina, or the retina starts to lift off the back wall of the eye. This is the one we're ruling out.
• A migraine aura. Not retinal traction at all, but it gets mistaken for it. More on that below.

What doesn't cause flashes: high blood pressure, stress, eye strain, or screen time. I get asked about all four often. Flashes are mechanical. Something is pulling on the retina.

Posterior vitreous detachment: the usual reason, and why it still needs a look

If I had to bet on the cause of your new flashes, I'd bet PVD. It's a normal part of aging, and it's more common if you're nearsighted, because a myopic eye is elongated and the vitreous has more room to shift.

The reason it still needs a same-day exam is simple: a PVD and a retinal tear feel identical from the inside. Both produce flashes. Both can produce new floaters. The only way to know which one you have is for someone to dilate your eyes and look at your retina. I can't tell over the phone, and neither can a search engine.

One more thing I tell every PVD patient: if one eye has gone through it, the other eye generally will too, eventually. Same rules apply when it does.

Flashes with new floaters or a curtain: the retinal-tear signs

Flashes alone are a reason to call today. These three make it non-negotiable:

• A sudden shower of new floaters along with the flashes.
• Flashes that keep going or get stronger instead of tapering off.
• A shadow or curtain coming across any part of your vision. That's the classic sign of a retinal detachment.

If you have any of these, don't wait to see if it resolves. Call, say "new flashes and floaters," and we'll fit you in.

Migraine aura vs. retinal flashes

A migraine aura can also put light in your vision, and plenty of people have had one without knowing that's what it was. Here's how I separate the two in the chair:

• Retinal flashes look like a camera flash or a lightning streak. Usually one eye. No headache.
• Migraine aura looks more like a kaleidoscope: shimmering, shifting patterns that move across your vision. It's typically accompanied by a headache.

Here's the honest part: I don't ask patients to figure this out themselves. If you call with flashes, you get the same workup either way, the same day. If it turns out to be a migraine, good. We've confirmed your retina is fine.

Why do I see flashes with my eyes closed, or in a dark room?

Because the signal is coming from your retina, not from the room. The retina can't feel pain. When something pulls on it, whether that's a new floater forming or a vitreous detachment in progress, its only way to say so is to fire off a light signal to the brain. You perceive that as a flash whether your eyes are open or shut, and you notice it most when the room is dark because nothing else is competing for your attention.

If you notice flashes with your eyes closed, that's an internal problem, and it's exactly the kind we want to look at.

Can high blood pressure, stress, or eye strain cause flashes?

No. I know that's a short answer to a question a lot of people ask, but the mechanism matters. Flashes come from physical traction on the retina. Blood pressure, a stressful week, a long day at a screen: none of those pull on the retina. If you're seeing flashes, the explanation is in the back of the eye, and that's where we look.

Who's at higher risk for a tear?

Everyone who gets flashes gets the same exam, but some patients make me look harder:

• High myopia. A longer eyeball means a more stretched retina. Bellevue has a lot of tech workers, which means a lot of nearsighted eyes in my chair.
• Age over 40. PVDs become common in the later years. Younger patients can get them too, especially with a high prescription.
• Prior cataract surgery.
• A strong family history of retinal detachment.
• Eye trauma, even years ago.

What happens at the exam

Plan on being dilated. I warn every flashes patient about that up front, because you'll be light-sensitive and blurry up close for a few hours afterward.

Here's what we do:

• Vision and eye pressure, the normal baseline checks.
• Dilation, every time. There is no version of this exam without it.
• Optos wide-field retinal imaging, every time. I like the Optos because I can turn the screen around and show you exactly what I'm seeing.

One practical note: this is a medical visit, not a routine vision exam, so it's billed to your medical insurance rather than your vision plan, which means it is subject to copay and deductible, just like any other doctor visit.

If I find a hole or a small tear, you get an urgent referral to a retina specialist, typically within the week, or as soon as possible just to be safe.

If I find a detachment, we try to get you seen as soon as possible, and how soon depends on whether the macula, the center of your retina, is still attached. If it is (a "mac-on" detachment), your central vision can still be saved, and that's the true emergency. If the macula has already detached ("mac-off"), it's still urgent, but the window for protecting central vision has largely passed, so it's handled urgently rather than as an emergency.

If it's a PVD with no tear, which is the most common outcome, you'll go home with instructions and a follow-up visit about a month later, dilated and imaged again, to make sure everything has stayed stable. In between, the flashes and floaters should settle down in frequency and intensity. You come back sooner if the floaters worsen, the flashes get stronger or won't stop, or a curtain appears.

Seeing flashes in Bellevue? What to say when you call

Yes, we see new flashes the same day. When you call Vision Care Center, say the words "new flashes" or "new floaters." Our front desk will ask a handful of questions: Which eye? When did it start? Are there floaters too? Any change in your vision? Are you still seeing them, how often, and how intense? Those answers tell us how fast you need to be in, and if we need to squeeze you in, we will.

The one thing I wish every patient knew

If you search "flashes in eye," the results will tell you it's a retinal detachment. That's possible, and it's exactly why we take flashes seriously. But most of the time it's a PVD or simply new floaters. Either way, it needs a professional looking at your retina promptly, not a week of watching and hoping.

FAQ

Are flashes of light in the eye serious? They can be. Flashes range from mildly annoying to a real threat to your vision, and they feel the same from the inside. Get them checked.

Can high blood pressure cause flashing lights in the eyes? No. Flashes come from physical traction on the retina.

Why do I see flashes when I close my eyes? Because the problem is inside the eye, at the retina. Closing your eyes doesn't shut off a signal that's coming from the retina itself.

How long do eye flashes last with a PVD? It varies wildly. Some people see one flash and never another. Some see them on and off while the vitreous finishes separating.

Can I be seen the same day for flashes? Yes.

Do flashes go away on their own? Oftentimes yes, if they're from a PVD or simple traction. If they keep coming, something is still pulling on the retina, and we need to look again.

Schedule your comprehensive eye exam today!

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