Dark spots in vision may represent scotomata or large floaters casting shadows. They can be fixed or moving.
Fixed and Mobile Spots
Fixed dark areas usually reflect retinal or optic nerve damage from macular disease, vascular occlusions, or scars. Moving spots are often due to vitreous floaters, blood, or inflammatory debris within the eye.
- Sudden onset of numerous dark spots can indicate retinal tear or haemorrhage
- Macular lesions cause central dark patches affecting reading and face recognition
- Optic nerve disorders may create paracentral dark zones
- Migraine aura can produce transient dark or shimmering areas
Clinical Approach
Any new dark spot, especially with flashes or field loss, needs prompt dilated examination. Persistent defects may need imaging and visual field analysis.
- Benign floaters are monitored, but symptomatic retinal tears require urgent treatment
- Systemic conditions such as diabetes and hypertension are key risk factors
- Patients should be counselled about warning signs of retinal detachment
- Low‑vision aids can help where central dark areas persist
