Hemophthalmic eyes: what is and how to treat?

Hemophthalmic eye is one of the most common causes of sudden loss of vision. By this term physicians call hemorrhage into the vitreous of the eye. The formed clots of blood interfere with the passage of light to the retina, which leads to a decrease in visual acuity and even loss of visual functions of the eye.Why does hemorrhage occur? What diseases are caused by this pathology? About this - later in our material.

Definition of disease

Hemophthalmus is the ingress of blood into the vitreous body or into the space surrounding it.

Vitreous body (vitreum) consists of 99% of water; one percent are ions, proteins, collagen and hyaluronic acid. The vitreous humor is firmly attached to the retina near the dentate line and to the zone around the optic disc. With age or for other reasons fixation weakens and the posterior halide membrane of the vitreous humor easily separates.

The prevalence of hemophthalmia is 7 per 100 000 people.The risk group includes:

• Persons with diabetes mellitus;
• Hypertension with disease in the stage of decompensation;
• Patients who have suffered a myocardial infarction or stroke;
• People with high cholesterol in the blood.

Hemophthalmia often develops in individuals older than 40 years. The most prone to this disease women. In children, pathology can develop with the syndrome of "baby shaking".

Hemophthalmia:

• Partial (affects up to a quarter of the eyeball);
• Subtotal (up to 3/4 of the eyeball);
• Total (over 3/4 of the eye).

Causes

The main cause of hemophthalmia is rupture, damage to retinal vessels and the formation of new vessels, more fragile than normal ones.

Most often, hemophthalmia is found in patients with type 1 diabetes, since a prolonged increase in blood sugar adversely affects the vessels.

In addition, damage to the vessels and hemorrhage leads to a violation of blood flow in the veins of the retina in pathologies such as:

• Post-thrombotic retinopathy;
• Dystrophy of the central area of ​​the retina;
• Tumors of the choroid of the eye;
• Retinal disinsertion;
• Rupture of the retina without its detachment.

Hemophthalmos may occur because of trauma to the eye.Penetrating wounds, contusions of the eye, trauma blunt object destroy the shell of the eye and blood vessels. The result is hemophthalmia.

Sometimes a hemorrhage becomes a consequence of abdominal operations on the eyeball.

Hemophthalmia may also result in common vascular disease or hematopoietic system, for example:

• Hypertonic disease;
• Inflammatory vascular disease;
• Vasculitis;
• Oncological diseases of the blood;
• Sickle-cell anemia.

Hemorrhage in the retina of the eye or the vitreous can occur even in the baby with the syndrome of "hard shaking infants." That's why doctors categorically do not recommend strongly to rock the newborn, trying so to calm him with crying.

Symptoms

Patients with hemophthalmia present the following complaints:

• Occurrence of opacities floating in the field of vision;
• Blurred vision;
• Photophobia;
• The appearance of shadows, cobwebs before the eye.

The rupture of small vessels is perceived by the patient as "flies" before the eyes.Hemorrhages of medium degree appear as dark bands; pronounced hemophthalmia sharply reduces vision up to the level of perception of light.

Hemophthalmia, as a rule, is not accompanied by painful sensations.Exceptions are cases of neovascular glaucoma or trauma.

If there is a concomitant pathology, then the clinical picture will be supplemented by symptoms characteristic of its course and stage.

Possible complications

Hemorrhage into the cavity of the eye is already a complication in itself, however, this pathology also has its own consequences associated with the toxic effect of substances that are formed as a result of the destruction of cells blood.In the initial stages of hemophthalmus, damage to the retina can occur.At later stages, scars appear in the cavity of the eye and tight adhesions between the reticular membrane and the vitreous body, the result of which sooner or later becomes a retinal detachment.

Damage to the retina due to hemophthalmia

Diagnostics

Instrumental diagnostics of hemophthalmia is based on conducting such examinations as:

• Indirect binocular ophthalmoscopy (allows you to carefully inspect the peripheral parts of the retina and to detect a retinal rupture);
• Visometry (definition of visual acuity);
• Biomicroscopy (detection of melanocytes and foci of hemorrhage);
• Tonometry;
• Ultrasound of the eyeball;
• Ultrasound B-scan.

Checking visual acuity (visometry)

The ultrasound of the eyeball allows us to identify gaps or reveal a foreign body in case of trauma to the eye, assess the level of the retina and the degree of detachment of the vitreous.Ultrasound B scan will help to detect intraocular melanoma, foci of new vessel formation and assess the condition of the posterior part of the vitreous. The ultrasound investigation is carried out in several stages for the early diagnosis of retinal detachment and is repeated until the moment of resolution of the hemophthalmus.

Conduction of ultrasound examination of the eyes

In addition, all patients are assigned laboratory tests, such as:

• UAC (with suspected occlusion of the CVC);
• Coagulogram (reveals blood clots);
• Research of blood glucose level (in diabetics).

Treatment

The tactics of treatment are always selected individually and depends on many factors.During initial treatment, the patient is often examined and examined, and then expectant management is used. The hematoma resolves, as a rule, for 3-4 weeks. At this time the patient is under constant medical supervision, passes various additional examinations to monitor the dynamics of the status of the fundus.

The expectant approach to treatment is acceptable in the absence of detachment of the retina and also after revealing the main cause of hemorrhage into the vitreous cavity.

During the resolution of the hematoma, the patient should be at rest, limit movement, avoid stress and lie with his head raised.At this stage, prescribe vitamins and drugs that improve blood clotting and strengthen the vascular wall.

Laser coagulation in this disease is used after partial resorption of blood clots. To stop proliferative processes and reduce the risk of recurrence of hemorrhage (eg, with diabetic retinopathy), photocoagulation is performed. An effective method of inhibiting the processes of angiogenesis is considered to be the intravitreal administration of antiproliferative drugs, (Avastin, Lucentis).

Laser Coagulation Procedure

If there are indications for the rapid removal of the vitreous, then appoint - vitrectomy.Treatment by surgical intervention is indicated in the following clinical situations:

• Subtotal or total hemophthalmus, lasting for 2-3 months;
• Volumetric hemorrhage in combination with exfoliation, retinal ruptures or open trauma to the eye;
• Cases when it is impossible to identify the etiology of hemophthalmia.

The operation is a minimally invasive removal of the vitreous body and filling the free cavity with sterile silicone, saline or air / gas mixture.A parallel application of laser photocoagulation is possible. This intervention is almost painless, performed under local anesthesia. After a brief observation, the patient is usually released home for further outpatient treatment and follow-up.

The prognosis for hemophthalmia is caused by the volume of hemorrhage.Early diagnosis and timely therapy allow you to fully restore visual functions. If the vitreous body is filled with 1/8 of a part of the blood - the prognosis is more than favorable; 1/7 - 1/4 - available high risk of retinal detachment; on 1/4 - 3/4 - the forecast doubtful and to restore visual functions is unlikely it will turn out.

With total eye hemorrhage, it is not possible to restore vision. In 95% of patients, atrophy of the eyeball is observed, which leads to complete blindness.

Prevention

No specific measures aimed at the prevention of hemophthalmia have yet been developed.Patients are recommended:

• Monitor blood pressure;
• Persons after 40 years of age to measure intraocular pressure;
• Patients with diabetes mellitus should regularly monitor blood glucose levels, perform all doctor appointments and 2 times a year to undergo an examination with an ophthalmologist, including the conduct of visometry, ophthalmoscopy, tonometry.

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conclusions

So, hemophthalmus is a rather dangerous pathology.Treatment of vitreous hemorrhage requires an integrated approach and careful attention to the underlying disease both from the physician and the patient. Lack of careful observation and untimely treatment can lead to a serious deterioration in visual acuity or to a complete loss of vision. Do not ignore even minor symptoms, since timely therapy allows you to keep your eyesight for the rest of your life.