The majority of patients presenting with flashes and/or floaters will not have a retinal detachment. If you do not feel competent to manage a patient presenting with flashes and/or floaters, you should refer them to an appropriate colleague. Emergency referrals include: 

1. retinal detachment
2. pigment in the anterior vitreous (tobacco dust)
3. vitreous, retinal or pre-retinal haemorrhage
4. lattice degeneration or retinal break, with symptoms.

A retinal hole or tear does not always lead to retinal detachment. However, you should refer the patient if they are having relevant symptoms and any of the signs in section Principles of examining a patient with symptoms of flashes and floaters are present.