Photopsias: underdiagnosed symptom and help of electroretinography

Background Photopsias are unformed luminous spontaneous visual hallucinations, often described as flickering or wiggling lights, sometimes like a glare. Phosphenes are more intense and of shorter duration whereas migraine fortifications have a specific time course and succesion of events. Recognition of this symptom is often poor, hence patients are wrongly investigated. Purpose To describe the clinical presentation and electroretinographic characteristics of patients with photopsias. Methods 4 patients were worked-up with clinical, psychophysical, angiographic and electroretinographic examinations. Results Despite normal fundus and angiographic examinations, full-field electroretinogram was diagnostic in all cases. Retinal dysfunction involved either inner or outer retina. Paraneoplastic, and probable autoimmune/inflammatory retinopathies were found in our cases. Conclusion Photopsias are often secondary to sick retinal cells. In the presence of photopsias, investigations should be directed towards the retina and electroretinography is the gold standard. Recognition of the symptom should prevent useless and potentially harmful investigations for the patient.