Hemophthalmos
The content of the article:
- Causes of hemophthalmos
- Forms
- Symptoms of hemophthalmos
- Features of the course of hemofalm in children
- Diagnostics
- Hemophthalmos treatment
- Prevention
- Consequences and complications
Hemophthalmus is a hemorrhage in the vitreous body of the eyeball and its surrounding structures, caused by damage to the vessels of the retina and subretinal space. With a large amount of hemorrhagic contents, there is a sharp decrease in visual acuity due to clouding of vitreum, and in the absence of adequate treatment, hemophthalmos can lead to severe complications and irreversible changes in the internal structures of the eye, which can cause blindness.
Source: retinacenter.ru
Causes of hemophthalmos
Hemophthalmus is the result of bleeding in the retina and subretinal space. On the second or third day after the release of blood into the vitreous, the formation of hematomas begins. On the tenth day after the hemorrhage, the blood clots begin to gradually break down.
Most often, more fragile newly formed vessels are damaged, therefore, patients with proliferative retinopathies, in whom the number of abnormal newly formed vessels is higher than the average, are at risk: patients with diabetes mellitus and sickle cell anemia, premature babies and persons who have undergone retinal vein thrombosis. The listed conditions are often accompanied by chronic retinal ischemia, which leads to increased production of vascular formation factors. There are also known cases of inheritance of excess production of endothelial growth factor (familial exudative vitreoretinopathy).
Intraocular hemorrhages are observed with mechanical damage to blood vessels with penetrating and blunt trauma to the eyeball, complications after ophthalmic surgery, retinal rupture or detachment of the posterior hyaloid membrane. The risk of retinal rupture increases significantly with high myopia, accompanied by degenerative changes in the fundus.
Rupture of unchanged retinal vessels can also occur with traumatic brain injury, accompanied by hemorrhage into the subarachnoid space and a sharp rise in intracranial pressure (Terson's syndrome). Hemophthalmos can also appear as a result of a sudden increase in intrathoracic pressure during excessive physical exertion, severe vomiting and a tearful cough (Valsalva retinopathy).
Sometimes the occurrence of hemophthalmos is provoked by general diseases and anatomical abnormalities, accompanied by pathological changes in the vessels:
- vasculitis of various etiology;
- systemic lupus erythematosus;
- atherosclerosis;
- hypertonic disease;
- congenital precapillary loops of retinal vessels;
- oncohematological diseases.
It is extremely rare that the cause of hemophthalmos is subretinal hemorrhage caused by damage to the choroid in the wet form of age-related macular degeneration, polypoid choroidal angiopathy or choroidal melanoma.
Forms
Depending on the volume of hemorrhage, three forms of hemophthalmos are distinguished:
- total - more than 75% of the vitreous is affected;
- subtotal - from 1/3 to 3/4;
- partial - less than 1/3.
Partial hemophthalmos is characterized by a lighter course and is prone to self-resolution. Total and subtotal hemophthalmos often occur when the eye is injured, and partial hemophthalmia occurs when proliferative retinopathies, atherosclerosis and decompensated arterial hypertension occur.
The extent of hemorrhage is of great prognostic value. The most favorable prognosis for a partial form of hemophthalmos is when less than 1/8 of the vitreous volume is filled with blood. An increase in hemorrhage volume from 1/8 to 1/4 vitreum increases the likelihood of retinal detachment. With subtotal hemophthalmos, the prognosis for restoration of visual function is dubious, and total hemophthalmos almost always leads to irreversible loss of vision.
Source: ophthalmocenter.ru
Symptoms of hemophthalmos
Typical manifestations of hemophthalmos are visual aberrations, blurred vision, photophobia. Starting from the second or third day, from the moment the hematomas appear, there is a flickering of shadows from the side of the damaged eye. With fresh hemophthalmia, the eye turns red; the bloody spot is noticeable for several weeks. Due to large volumes and slow resorption of hemorrhagic contents, a sharp deterioration in object vision is observed. A patient with total hemophthalmos can only distinguish between light and darkness and loses the ability to orientate in space. With subtotal hemophthalmos, the field of vision is partially covered by massive dark spots, but the ability to recognize silhouettes of people and outlines of massive objects remains. In the case of partial hemophthalmos, severe visual impairment may not be observed. Patients complain of foghaze or cobwebs in front of the eyes, flickering black dots, red or black stripes in the field of view. At the stage of hemolysis, symptoms of hemophthalmos may be accompanied by signs of general intoxication - nausea, weakness, headaches. Painful sensations for hemophthalmos are uncommon; discomfort appears only with traumatic and iatrogenic damage to the retina, neovascular glaucoma and the formation of massive hematomas.
Source: oftalmika.com
Features of the course of hemofalm in children
Preterm infants often have hemophthalmos due to atrophic changes and neovascularization of the retina, which can further lead to myopic refractive error and amblyopia. For the prevention of complications of recurrent hemophthalmos in proliferative retinopathy of prematurity and in diabetic children with suspected traction syndrome, vitrectomy is indicated. In order to prevent recurrence of intraocular hemorrhage in infants, parents are advised to rock the child gently, avoiding shaking.
In rare cases, hemophthalmos in a child can be a manifestation of congenital pathologies, such as Ills disease (primary idiopathic retinovasculitis) or Norrie's disease linked to the X chromosome - a pseudoglioma of the retina of both eyes.
Diagnostics
The detection of blood in the vitreous body and the spaces formed by it is considered a sufficient basis for the diagnosis of hemophthalmos, however, with extensive hemorrhage, it is not always possible to examine the fundus using biomicroscopy methods. In such cases, the patient is referred for eye ultrasound. To clarify the source of hemorrhage, fluorescent angiography of the retina and choroid may be prescribed. To identify concomitant diseases that affect the dynamics of the pathological process, laboratory tests are carried out - general and biochemical blood tests, coagulogram, determination of blood glucose levels.
Hemophthalmos treatment
The therapeutic strategy for hemophthalmos depends on the cause and extent of the hemorrhage. With partial hemophthalmos, treatment is reduced to taking hemostatics, enzyme and hormonal agents for the rapid resorption of hematomas, as well as ascorbic acid and B vitamins to strengthen the vascular walls. In case of relapse, the vitreous body is washed. Until the hemorrhage is completely resolved, the patient is recommended to stay in bed with the head of the bed raised by 35-40 °, and put a cold compress on the area of both eyes. Total and subtotal hemophthalmos are treated in stationary conditions.
In parallel, an in-depth examination of the patient is carried out to identify concomitant pathologies and an ophthalmological examination, including visiometry, tonometry and instrumental studies of the fundus. In case of revealing proliferative retinopathy, inhibitors of vascular growth are injected into the vitreous body. In case of retinal rupture, laser coagulation of ischemic areas on the retina is indicated; in the absence of the necessary equipment, cryocoagulation is possible.
Vitrectomy - radical treatment of hemophthalmos with removal of the vitreous body or part of it is carried out in the following cases:
- bilateral hemophthalmos;
- retinal detachment;
- proliferative retinopathy of prematurity;
- proliferative diabetic retinopathy in children with suspected traction syndrome;
- intraocular hemorrhage that does not resolve within 2-3 months;
- the presence of cataracts, glaucoma, or rubeosis.
The substitute for the vitreous body after vitrectomy is saline, silicone oil, or an air-gas mixture.
Prevention
To prevent hemophthalmos in the absence of atrophic changes in the retina and other associated pathologies, it is sufficient to avoid eye injuries. After 40 years, it is important to monitor blood pressure and blood sugar levels and measure intraocular pressure once a year. Patients at risk for proliferative retinopathies are required to undergo preventive examinations with an ophthalmologist twice a year with visometry, tonometry and biomicroscopy, while simultaneously monitoring the underlying diseases. In case of revealing atrophic areas on the retina, prophylactic laser coagulation is recommended, which reduces the likelihood of hemophthalmos by 80-85%.
Consequences and complications
The most common complication of hemophthalmos is hemosiderosis of the eyeball - toxic damage to the photoreceptors of the retina, vitreous body and lens by the decay products of erythrocytes. With a prolonged course of hemophthalmos and frequent relapses, there is a possibility of developing secondary glaucoma.
With a complicated course of hemophthalmos, the eyes may atrophy. With extensive hemorrhage, the risk of replacing vitreum cells with connective tissue increases. The final stage of vitreous degeneration is intraocular fibrosis, followed by retinal detachment and atrophy of the eyeball, which leads to blindness.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
