Hemophthalmus of the vitreous: features of the disease and methods of treatment

Hemophthalmus is a pathological condition of the vitreous and nearby areas caused by the ingress of blood there. Usually this is due to rupture of blood vessels or hemorrhage of any type. Depending on the degree of hemorrhage, a partial and total hemophthalma is distinguished, differing not only in the clinical picture, but in the risk of developing possible complications. That is why it is so important to turn in time to the ophthalmologist who will tell in detail what it is hemophthalmus and help to avoid irreversible atrophic processes.

Definition of disease

In its structure, the vitreous humor consists of 99% of a gel-like liquid, as well as hyaluronic acid, collagen and positively charged particles to maintain innervation.Despite the simple structure, this is the most important part of the eye system, since it is the vitreous body that provides the shape and tone of the eyeball. In addition, it is a kind of contour through which the nerve endings of the optic nerve and small blood vessels pass.

During the life of a person, the fixation zone begins to weaken, and the posterior membrane gradually moves away from the vitreous, blood clots and capillary ruptures arise, which is why hemophthalmia is formed.

Depending on the severity, and sometimes on the stage of the disease, there are three forms of this pathology:

• Partial. Typically, it occurs because of jumps in blood pressure, diabetes mellitus of various types, or dystrophy of the retina. Blood fills up to a third of the vitreous volume. Therapy of this form usually has a positive prognosis;
• Subtotal. Blood fills from 1/3 to 3/4 of the volume of the cavity of the eyeball. This most often occurs during consequences with diabetic retinopathy, less often with Terson's syndrome;
• Total. More than 34 volumes of vitreous body is filled with blood, in the structure of the eye fall red blood cells, which eventually form clots. Plus, the blood cells release hemoglobin, which is transformed into hemosiderin and leads to dysfunction of the retina and other components of the visual apparatus. In most cases, total hemophthalmus develops on the background of severe injuries or mechanical damage to the eye.

The disease is infrequent, only 7 people out of 100 thousand.Typically, the pathology is formed against a background of systemic diseases or against the background of the onset of detachment of the retina, so more often hemophthalmia is diagnosed in persons older than 40 years. According to statistics, women are more prone to this ailment than men.

There is a risk of development of pathology with careless treatment of the newborn. In most cases, this occurs with the syndrome of "shaking the baby."

Causes

The most common cause of the development of pathology is diabetic retinopathy, which often occurs with type 1 diabetes.This is due to a violation of the blood supply to the posterior segment of the eye due to insulin deficiency. The second most common cause is a complication against the background of the vitreous humor, which often occurs in old age. In addition, there are several other factors that provoke a partial or total hemophthalmus:

• Operations on the visual organs:
• Injury and damage to the eyeball;
• Diseases of the circulatory system;
• Chronic hypertension;
• Avascular therosclerosis;
• Oncological diseases of the hematopoietic organs;
• Acquired glaucoma;
• Vasculitis and Illza disease.

Fact: There is a hypothesis that hemophthalmus can develop as a hereditary disease and an example of this is one of the causes of the emergence of pathology - family exudative vitreoretinopathy. But today it remains only at the level of theory - there is no evidence of a genetic predisposition to the disease.

Symptoms

The only visual indication of hemophthalmus is the penetration of the vitreous with blood and ophthalmic disorders in the form of loss of visual acuity. On this structure there are no direct nerve endings, which means that the appearance of pain sensations or a feeling of squeezing is simply impossible. External manifestations of the disease completely depend on the amount of hemorrhage. All forms of hemophthalmia take place in several stages:

1. Internal bleeding. Lasts no more than a day. The blood cells penetrate the vitreous body and its nearby structures, settle on the surface and dissolve in a liquid medium;
2. The appearance of a hematoma. It is associated with the appearance of blood clots on the structural elements of the visual apparatus. The process lasts no more than 2 days;
3. Toxic-hemolytic stage. Lasts from 1 to 2 weeks. Blood clots begin to spontaneously break down, so that the products of their decay begin to affect the visual apparatus. It is from this that the turbidity of the vitreous body arises;
4. Proliferative-dystrophic period. Can last up to six months. On the site of the destroyed blood clot, connective tissue is formed, which starts dystrophic and atrophic processes in the eyeball and retina;
5. Intraocular fibrosis. The most severe stage of hemophthalmia development. There is a detachment of the retina, the fluid inside the vitreous body changes to the connective tissue, the organ itself becomes heavily compacted. Often there is a complete atrophy of the eyeball or irreversible blindness.

In addition to visual examination of the eyeball, the development of hemophthalmia is assisted by subjective ophthalmic disorders, which may not occur in all cases. This is the appearance of flies or dark spots before your eyes, blurred vision, as well as photophobia.

Despite the fact that there are no nerve endings in the vitreous humor, pain in the eyeball area, as well as a feeling of pressure, may be due to the fact that hemorrhage affected nearby structures.

Possible complications

The greatest danger is total hemophthalmia, in which no treatment has been prescribed. Long and extensive hemorrhage can lead to serious irreversible consequences - severe retinal detachment, complete or partial blindness. In rare cases, atrophy of the nerve of the eyeball occurs, which leads to complete dysfunction of the eye. Plus to this,if you do not start therapy on time, your visual acuity may decrease or the acquired glaucoma develop.

Even with partial hemorrhage, there is a risk of toxic damage to retinal receptors due to iron and hemosiderosis of the eyeball released from hemoglobin.

Treatment

The strategy of therapy largely depends on the volume of the hemophthalmus.If less than one-third of the vitreous humor is affected, then no serious measures are recommended, since hemorrhage can self-resolve within a few weeks. During this period, bed rest and regular examination of the dynamics of the disease.In addition, anticoagulants are prescribed to prevent the formation of clots on the surface of the body and preparations for stabilizing blood pressure, since hypertension often leads to a relapse and causes complications. Important is the intake of vitamins B and C, helping to strengthen the walls of blood vessels.

Surgical methods

With subtotal and total bleeding, conservative therapy is almost useless, since medication is not can stop the spread of blood cells and prevent the formation of clots with a large volume bleeding. Therefore, in such a situation, almost always resort to surgical methods of treatment.

• Laser coagulation. It is used in the event that the disease does not manage to lead to detachment of the retina. The method consists in crushing blood cells to extremely fine particles, which subsequently cease to be a threat to the health of the vitreous. This operation is very difficult in terms of execution, so a certain skill of the surgeon and assistants is required. As a rule, it can help not only reduce the risk of complications, but also prevent relapse in the next five years;
• Antivazoproliferative therapy. This is a hybrid operation at the junction of surgery and conservative treatment. The procedure consists in the administration of medications (bevacizumab or ranibizumab) inside the vitreous, which helps reduce the risk of complications and prevent subsequent bleeding. Often the technique is used as a preparatory procedure before vitrectomy or after some ophthalmic operations;
• Vitrectomy. It is considered a traditional way of treating complex forms of hemophthalmia. It is an endoscopic procedure, with the help of it, the contents of the vitreous body are surgically removed, which subsequently flooded with an analogous chemical and physical property of artificial liquid, a mixture of gas or silicone oil. The technique and procedure of the procedure is very different, depending on the skills of the surgeon and the clinical picture of the disease. As a rule, the prognosis for recovery is almost always positive if all the prescriptions are observed during the postoperative period.

  Laser Coagulation Procedure

To prevent complications and the risk of relapse, it is extremely important to adhere to all medical recommendations in the first three weeks after the procedure. During this time, normalization of visual functions occurs, and the condition of the vitreous and retina should improve.

If there are even minor ophthalmic manifestations, it is necessary to immediately seek advice from a specialist.

Prevention

Today there are no reliable preventive measures for the development of hemophthalmia.Due to the fact that the disease often occurs against the background of systemic diseases, it is necessary to regularly undergo medical examinations in order to detect possible complications. In addition, it is extremely important to use personal protective equipment - glasses and masks when working with the risk of eye injury.

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conclusions

Hemophthalm is a complex ophthalmic disease that tends to recur. Therefore, it is important not only to consult a doctor on time in case of detection of characteristic signs, but also to comply with all the rules during recovery after treatment. Thanks to modern methods of surgery today, there is every chance of a full recovery, even with total hemophthalmia, which can significantly improve the quality of life after the disease.