If you are unable to carry out an adequate examination when you examine a patient who presents with flashes and/or floaters, you must refer the patient to a practitioner who is competent to do this.

You should ensure that front line or support staff are trained to deal with such a patient who contacts the practice. Patients should be told a diagnosis cannot be reached without an examination.

If you carry out an examination, you should continue until you detect a problem and can make a diagnosis or have sufficient evidence to decide what action to take.

If you suspect a retinal break or tear, you should, as a minimum: 

1. take a detailed history and symptoms, looking for particular risk factors
2. examine the anterior vitreous to look for pigment cells
3. perform a dilated fundal examination, using an indirect viewing technique
4. give appropriate advice to the patient, which you back up with written information.

You should follow local protocols for the management and referral of these patients.

You should keep full and accurate records of all patient contact.