Treatment of hemophthalmia and prevention of the development of eye disease

Hemophthalmos is a condition in which blood enters the vitreous body of the eye. The vitreum or vitreous humor is 99% water. The remaining percentage includes collagen, hyaluronic acid, ions and proteins. More than 80% of the eyeball, namely 4 ml, is vitreum. Thanks to it, the eye retains its shape and light reaches the retina.

What is hemophthalmos

There are hyaloid membranes in front and behind the vitreous body. The vitreum is limited posteriorly and laterally by the retinal membrane, and anteriorly and laterally by the epithelium of the ciliary body. Anteriorly, the structure is in contact with the ligaments of Zinn and the lens capsule.

Due to such close anatomical and functional interaction, the health of the retina largely depends on the condition of the vitreous body.

Vitreum is firmly attached to the retina along the dentate line and around the optic nerve, where the fixation can weaken as the body ages, causing posterior vitreous detachment.

Types of hemophthalmos:

1. Partial. Hemophthalmos occupies a third of the volume of the vitreous body. Occurs after mild eye injuries, against the background of diabetic retinopathy, atherosclerosis, arterial hypertension, retinal dystrophy and vascular pathologies.
2. Subtotal (from 1/3 to ¾) and total (more than 3/4 of the volume). They develop as a result of severe injury to the eyeball (penetrating or non-penetrating).

Hemophthalmos causes structural changes in the vitreous body, which can be dangerous for vision. Along with the blood, red blood cells enter the vitreum. Gradually they begin to break down, releasing hemoglobin, which settles in the form of grains. In the vitreous body, the hemoglobin shell dissolves, the substance turns into hemosiderin, which has a negative effect on the retina.

Danger of subconjunctival hemorrhage.

With hemophthalmia, strands can form in the vitreous body, attaching to the retina and increasing the risk of retinal detachment. This condition causes a sharp deterioration in vision. Depending on the severity of hemophthalmos, the patient may see dots and threads before his eyes, or become completely blind. Partial hemophthalmos is characterized by an improvement in visual function in the morning, since the blood settles overnight.

Hemophthalmos often develops when the retina is ruptured or detached. Sometimes the condition is diagnosed after abdominal surgery. Any signs of hemophthalmos are a reason to urgently seek help. Self-medication is not recommended due to the large number of severe complications.

How is hemophthalmos formed?

Under the influence of damaging factors, the integrity of the vessels of the eye is disrupted, as a result of which blood accumulates in the vitreous body. Red blood cells begin to break down, deposited in grains. Such processes harm all adjacent structures, but more so the retina.

Stages of hemophthalmos:

1. Bleeding (first day after injury). Blood enters the vitreous cavity and reduces its transparency.
2. Fresh hematoma (two days). Blood clots form.
3. Toxic-hemolytic (3-10 days). The process of clot destruction begins. Decay products enter other elements of the eyeball through diffusion. Complete opacification of the vitreous body occurs.
4. Proliferative-dystrophic (10-180 days). Dystrophy of the retina, lens and other structures develops. The hematoma fills with connective tissue and becomes denser.
5. Intraocular fibrosis (after six months from injury). The vitreous thickens, being replaced by connective tissue. The risk of retinal detachment increases. As a result, the eyeball atrophies and blindness occurs.

Causes of intraocular hemorrhage

Most often, the cause of hemophthalmos is a defect in the formation of blood vessels, in which they quickly rupture. This condition is typical for severe retinal damage in patients with diabetes mellitus.

This problem occurs when blood flow in the retina is disrupted during postthrombotic retinopathy.

The growth of defective vessels is also observed with dystrophy of the center of the retina and tumors of the choroid of the eyeball.

Causes of hemophthalmia:

• glaucoma;
• macular degeneration;
• damage to the eyeball;
• retinal or vitreous detachment;
• diabetic retinopathy;
• vascular thrombosis;
• hypertensive crisis (sudden increase in blood pressure);
• eye surgeries;
• neoplasm in the eyeball;
• autoimmune pathologies that cause vascular inflammation;
• abnormal development of eye vessels.

The cause of hemophthalmos can be injuries of a different nature: penetrating with destruction of membranes and blood vessels, as well as contusions and blunt trauma. Hemorrhages are often diagnosed when the retina is ruptured or detached when the retinal vessels are damaged. The most pronounced symptoms will be detachment of the posterior hyaloid membrane in those places where the vitreum is tightly attached to the vessels.

Hemophthalmos may indicate a disease of the circulatory system. Hemorrhages in the eye are often observed with hypertension, sickle cell anemia, vasculitis, vascular inflammation and oncological blood diseases.

Sometimes blood enters the vitreum from the subretinal space. This happens with the development of uveal melanoma or age-related macular degeneration. Hemophthalmos is possible with Treson syndrome, when subarachnoid hemorrhage occurs. In this case, the retinal vessels rupture due to a sharp jump in intracranial pressure.

It is extremely rare that hemophthalmos is caused by uveitis, Eales' disease, sarcoidosis, chronic leukemia, Crohn's disease, and retinopathy in prematurity. Bleeding disorders and long-term anticoagulant therapy do not usually lead to hemophthalmos.

Symptoms of hemophthalmos

With severe hemorrhage, visual acuity is critically reduced, even to the point of blindness. The degree of decrease in visual acuity depends on the amount of blood in the vitreum. In severe cases, only light perception is preserved. If the hemorrhage is caused by retinal detachment, patients see flashes of light of different types (lights, lightning, sparks). This is the phenomenon of photopsia.

An eye examination reveals the presence of a granular mass of blood behind the lens. The structure of the vitreous body is not determined. Resorption of blood clots leads to destruction of the vitreous body, it becomes liquefied. Fibrils (protein structures in tissues) thicken and swell, becoming covered with blood grains, red blood cells and other decay products.

With hemophthalmia, patients complain of cobweb-like and rounded shadows appearing in the field of vision. The effect of blurred vision appears. Shadows are usually dark red or black in color. When the eyes move, the blood clots move, causing the shadows to shift.

Diagnosis of hemophthalmos

The patient can help the doctor make a diagnosis by providing details about how and when the symptoms began. It is very important to mention all injuries that occurred, as well as associated pathologies.

An ophthalmologist should conduct an initial examination. Methods for diagnosing hemophthalmos include biomicroscopy using a slit lamp, when the doctor examines the structures of the eyeball and the fundus. With hemophthalmos, you can notice hemorrhages under the conjunctiva and in the anterior chamber of the eye, between the cornea and iris.

Ophthalmoscopy allows a more detailed examination of the fundus of the eye, which is fundamentally important for determining the cause of hemorrhage and choosing treatment. In case of partial hemophthalmos, floating blood clots are detected in the vitreum, which do not interfere with examination of the fundus. Complete hemophthalmos covers the bottom of the eye, there is no red reflex (reflection of light from the retina through the transparent media of the eye).

The condition of the retina and vitreous body can be analyzed using ultrasound scanning. Ultrasound helps determine the nature of hemophthalmos, and during chromatic electroretinography the functionality of the retina is checked.

Conservative treatment of hemophthalmos

Small foci of hemophthalmos tend to resolve, but this is a very slow process. In some cases, complete resorption does not occur.

Total and subtotal hemophthalmos is an indication for hospitalization of the patient. Treatment of partial hemophthalmos can be carried out on an outpatient basis.

Therapy for hemophthalmos is always the same, but partial hemorrhage, as a rule, does not require great intensity and surgical intervention. You should prepare in advance for the fact that the treatment will be long, and it must be completed.

Principles of treatment

1. If the hemorrhage has occurred recently, the patient is advised to rest in bed and wear a cold bandage.
2. To avoid new hemorrhages, calcium supplements are prescribed (calcium gluconate 10% intramuscularly and calcium chloride drops 3% locally).

3. Additionally, you can take vitamins B2, C and PP, as well as Dicinone and Vikasol.
4. After 1-2 days from the start of treatment, enzyme preparations are prescribed to resolve clots. These are eye drops with potassium iodide, lidase or ronidase solution (0.1%).

5. To prevent the formation of strands, hormonal therapy (eye drops or injections under the conjunctiva) is prescribed. For these purposes, use a solution of Dexamethasone (0.1%) or Prednisolone (0.3%). Parabulbar injections of collalysin, an enzyme preparation that dissolves collagen, are effective.

   You need to make 10 injections every other day. Additionally, injections of enzymes (Lecozim, Fibrinolysin) are prescribed.

6. Anticoagulant therapy is recommended to prevent blood clotting. Solutions of heparin and streptodecase are injected under the conjunctiva.

7. To enhance the resorption effect, sodium iodide solution (10%) is administered intravenously.
8. It is possible to use autohematotherapy. 2, 4, 6, and then 8 ml of blood from a vein are injected intramuscularly.
9. Sometimes medications with aloe extract are prescribed.
10. We must not forget about physical therapy.

    For hemophthalmia, lidase electrophoresis is indicated (15 procedures, 15 minutes each). A month later, potassium iodide electrophoresis is performed with the same frequency.

11. Additionally, phonophoresis of heparin and potassium iodide is prescribed.
12. Laser treatment of hemophthalmos is possible.
13. The effectiveness of hirudatherapy cannot be denied.

In cases where drug treatment is ineffective within 7-10 days, surgical treatment of hemophthalmos is required. Without treatment, strands begin to form in the eye, which provoke retinal detachment and atrophy the eyeball. Lack of therapy or its ineffectiveness is a sure path to complete blindness.

With complete and timely treatment of partial hemophthalmos, the prognosis is favorable in most cases. Conservative therapy promotes resorption of hemorrhage areas and restoration of vision. Subtotal and total hemophthalmos require urgent and powerful treatment, otherwise the risk of complications reaches one hundred percent.

Surgical treatment of hemophthalmos

Since complications of hemophthalmia are extremely dangerous, only 10 days are allocated for conservative therapy. If treatment does not help during this period, surgical removal of blood from the vitreous body is prescribed.

One of the main methods of treating hemophthalmos is vitrectomy. The operation involves removing the vitreous and replacing it with a gel-like substance. This procedure helps prevent retinal detachment.

Removing the vitreous and filling the cavity with a special solution eliminates the problem of retinal tension. The solution presses the retina against the walls of the eye, maintaining its normal position.

In this way, it is possible to prevent repeated hemorrhage and stop the growth of pathological vessels. Vitrectomy does not require hospitalization of the patient, despite the fact that it is a complex microsurgical operation.

The procedure takes 1-2 hours.

Complications of hemophthalmos

A frequent complication of hemorrhage in the eye is severe destruction of the vitreous body. It happens that hemophthalmos becomes recurrent, provoking the formation of connective scar tissue in the vitreum. With prolonged intraocular hemorrhage, children often develop amblyopia and myopic shift.

Hemophthalmos can be complicated by hyphema. This is a hemorrhage in the anterior segment of the eyeball, which is localized between the iris and cornea. Even if prolonged hemophthalmos has not led to significant damage to the retina, and normal vision is preserved, the risk of developing secondary glaucoma increases.

Hemorrhage into the vitreous body can be prevented by timely treatment of pathologies that can cause hemophthalmos. It is very important to follow safety precautions and protect your eyes from damage.

Source: https://BeregiZrenie.ru/vospaleniya/gemoftalm/

Hemophthalmos of the eye

Content

• Classification of hemophthalmos
• Causes
• Treatment
• Summary
• Video on the topic

Hemophthalmos of the eye is a common cause of vision loss. The basis of the disease is the effusion of blood into or around the vitreous body.

The disease causes a decrease in visual acuity down to the level of light perception. The most common source of hemorrhage is the blood vessels of the retina.

As a result of the pathological process, the vitreous body loses its transparency, which causes vision impairment.

Hemophthalmos tends to gradually resolve, but this does not always happen. The disease causes not only visual difficulties. In the presence of hemorrhage, the ophthalmologist simply cannot examine the blood vessels of the fundus.

There are no nerve endings in this area, which is why patients do not experience pain.

Classification of hemophthalmos

Depending on the volume of hemorrhage, experts classify hemophthalmos as follows:

• total. Most often occurs against the background of trauma. Hemorrhage accounts for seventy-five percent of the total volume of the vitreous. Characterized by complete loss of objective vision. A person sees only at the level of light perception; he cannot independently navigate in space;
• subtotal. The volume of blood shed is 35–75 percent. Most often occurs against the background of retinopathy in diabetes mellitus. Massive dark spots appear that cover a significant part of the field of view. As the disease progresses, the patient can only see the outline and silhouettes of objects;
• partial hemophthalmos. Hemorrhage accounts for less than thirty percent of the total volume. Occurs against the background of arterial hypertension, diabetes mellitus, retinal rupture or detachment. Partial hemophthalmos of the eye is mild and has a favorable prognosis. The disorder manifests itself as the appearance of black dots or stripes in the field of vision, as well as fogginess and general haze before the eyes. Patients complain of the appearance of shadows or cobwebs before the eyes.

With hemophthalmia of the left or right eye, a significant decrease in the fundus reflex is noted, in some cases its complete absence is diagnosed. During examination, the ophthalmologist may notice a red spot located at the bottom of the eye. Additional symptoms of the disease may include swelling of the upper and lower eyelids, as well as pain in the eye area.

With hemophthalmia, as a rule, one eye is affected. A symmetrical process is very rare

Recurrent hemophthalmos is a periodically recurring hemorrhage. In young people, pathology is often the result of injury, while in older people it is a physiological process in the body. Often, age-related hemophthalmos develops against the background of endocrine and cardiovascular diseases.

Causes

Let us highlight the main causes of hemorrhage:

Retinal vascular angiopathy

• vascular diseases of the retina: diabetic retinopathy, proliferative retinopathy, retinal vein thrombosis. Such disorders cause insufficient oxygen consumption and ischemia. As a result, the vessels of the retina and optic nerve head become fragile and vulnerable to spontaneous rupture;
• vascular abnormalities of the retina that are not associated with ischemia;
• rupture of blood vessels due to contusion or penetrating injury;
• diabetes;
• ophthalmological operations;
• arterial hypertension;
• blood diseases;
• myopia;
• hereditary predisposition.

Experts say that diseases of the coagulation system and long-term use of anticoagulants do not cause the development of hemophthalmos.

Diabetes mellitus is a provoking factor in the occurrence of the disease

Treatment

Taking an anamnesis is of great importance when making a diagnosis. The specialist is interested in the presence of injuries, concomitant disorders, and ophthalmological diseases. If examination of the fundus is difficult, an ultrasound examination of the fundus is prescribed.

If alarming symptoms appear, you should immediately contact an ophthalmologist. In the absence of timely adequate therapy, irreversible blindness may develop. At the initial visit for hemorrhage, expectant management is prescribed. Patients often note that their hemophthalmos resolved within a few weeks.

Along with this, the ophthalmologist should exclude retinal detachment and the development of other complications. Treatment of hemophthalmos of the right or left eye mainly comes down to symptomatic therapy. During the treatment process, patients are contraindicated in excessive physical activity. Changes in blood pressure can trigger a relapse.

Patients are advised to remain in bed, with the head in an elevated position. Drug therapy is aimed at resolving the effusion of blood.

Doctors prescribe hemostatic agents, and vitamin complexes are used to strengthen the vascular wall. For a complete cure, it is extremely important to get rid of the underlying disease.

Untreated disease can lead to the development of secondary glaucoma.

Conservative treatment includes the use of the following techniques:

• during the first day, applying cold to the eyes;
• injections and drops with calcium, vitamins and hemostatic agents;
• absorbable drugs and steroid hormones on the second day of treatment;
• injections of heparin and fibrinolysin;
• electrophoresis;
• hirudotherapy.

Hemostatic drops are used to treat hemophthalmos

Laser treatment

If conservative therapy is ineffective within one to two weeks, laser treatment is indicated. The laser does not violate the integrity of the eyeball and at the same time selectively removes inclusions from the vitreous body. The laser beam acts exclusively on blood hemoglobin.

The use of laser technology can prevent relapse in the next five years in eighty percent of cases.

Antivasoproliferative treatment

To stop the pathological process, drugs such as Bevacizumab or Ranibizumab are administered intravitreally. These drugs are used both as monotherapy and in combination with surgery and laser therapy.

Vitrectomy

Surgery can restore vision, regardless of the volume and duration of the hemorrhage, as well as the provoking causes. The operation does not require stitches and can be performed on an outpatient basis using local anesthesia.

Surgical removal is prescribed in the following cases:

• within several months the hemorrhage does not resolve, but there is no retinal detachment;
• in the case of advanced retinopathy, which was treated with laser therapy, but the hemorrhage persists for six to eight weeks;
• total form, combined with retinal detachment or rupture;
• risks of complications;
• the reasons for the bleeding have not been established and it is impossible to visualize the retina;
• bilateral lesion;
• hemophthalmos, which developed against the background of increased intraocular pressure;
• a history of blunt eye trauma in the absence of dynamics.

Treatment with folk remedies

Hemophthalmos can also be treated using non-traditional methods. The use of folk remedies is an auxiliary aid, but does not replace the main treatment.

The most common method is human urine. Adherents of this method recommend boiling freshly collected urine in a copper vessel, adding a spoonful of honey to it.

Next, the resulting mixture is soaked in the fabric and applied to the eye as a compress.

Aloe is used as a treatment for hemorrhage

In addition, it is recommended to take a decoction of chicory roots internally. Chicory is poured with water and boiled for fifteen minutes. Should be taken twice a day, half a glass. And it is recommended to apply a frozen piece of any meat to a bruised eyeball. This will stop the bleeding and speed up the resorption process.

Let's consider other recipes for traditional treatment of hemophthalmia:

• take one and a half tablespoons of ginger root, pour a glass of boiling water and boil for twenty minutes. Take half a glass twice a day. The resulting solution is also used in the form of lotions;
• Use aloe juice as eye drops. The juice should be instilled two drops twice a day. Aloe can be used in the form of compresses. To do this, add a tablespoon of goat's milk and a teaspoon of honey to aloe juice;
• Lotions based on strong black tea, which are applied for twenty minutes, are also considered effective. It is also recommended to drink natural green tea;
• Ginger tincture will also help cope with the problem. Fill twenty grams of the product with one hundred grams of vodka. The product should be infused overnight. You need to take twenty-five grams twice a day;
• mix blueberry juice with water in a 1:3 ratio. Use the product in the form of drops, instill them once a day in the morning.

Summary

So, hemophthalmos of the eye is a serious disease that threatens complications, including loss of vision. Under no circumstances should the symptoms of the disease be ignored. Timely, qualified assistance will help preserve vision and eye health for many years.

Source: https://gsproekt.ru/bolezni/gemoftalm-glaza

Hemophthalmos

Hemophthalmos is a polyetiological disease of the organ of vision, which develops as a result of rupture of blood vessels and hemorrhage into the vitreous body. Clinically manifested by the presence of shadows, “fog,” black or red floating cloudiness before the eyes, decreased visual acuity and the development of photopsia. To make a diagnosis, ophthalmoscopy, visometry, biomicroscopy, tonometry, and ultrasound are recommended. Treatment tactics depend on the extent of the lesion. For partial hemophthalmia, treatment is not indicated. Subtotal hemorrhages require laser coagulation and drug therapy, total hemorrhages require vitrhemectomy.

Hemophthalmos (intravitreal hemorrhage) is an urgent condition in ophthalmology, in which the vitreous cavity fills with blood or blood clots. The prevalence of hemophthalmos is 7:100,000.

The risk group includes people with diabetes mellitus and hypertension in the stage of decompensation, myocardial infarction or stroke in history. A relationship has been established between this pathology and elevated blood cholesterol levels. The disease most often develops in people over 40 years of age. In children, hemophthalmos can occur with shaken baby syndrome.

Women are more prone to this disease than men. The total form in 95% of cases leads to complete loss of vision and disability of the patient.

Hemophthalmos

A common cause of vitreous hemorrhage is proliferative diabetic retinopathy, which develops primarily in patients with type 1 diabetes. Insulin deficiency is accompanied by impaired blood supply to the posterior segment of the eye.

This, in turn, stimulates the synthesis of angiogenic factors. The most intense neovascularization is observed in the area of ​​vitreoretinal fusion. As a consequence, vitreous detachment or eye movements lead to rupture of the vessels with further hemorrhage.

Somewhat less frequently, the pathology occurs against the background of occlusion of the central retinal vein (CRV) or its branches.

Inflammatory or degenerative changes in the vascular wall are predictors of retinal tears or rhegmatogenous retinal detachment. These pathological conditions occur among patients with vasculitis, sickle cell anemia and Eales disease.

In some cases, the etiological factor of hemophthalmos is blunt trauma or penetrating injury to the eye, which are similar to the manifestations of subarachnoid hemorrhage (Terson syndrome) in ophthalmology.

In false Terson syndrome, retinal neovascularization is observed after parsplanitis.

An increase in intraocular pressure, arterial hypertension, or a change in the rheological properties of blood provokes a rupture in the area of ​​the aneurysm.

Clinical manifestations of intravitreal hemorrhage are characteristic of posterior detachment of the scleral body, which may be accompanied by a retinal rupture.

It has been proven that autoimmune processes that develop with systemic lupus erythematosus can also affect the vascular wall. In this case, increased vascular permeability leads to the accumulation of hemorrhagic exudate in the vitreous body. This mechanism is also characteristic of the exudative form of age-related macular degeneration, which can also cause hemophthalmos.

The progression of malignant choroidal melanoma or Norrie disease (congenital bilateral retinal pseudoglioma) leads to disruption of the structure of the microvasculature, which in the later stages is manifested by frequent retinal breaks and bleeding. Most oncological diseases lead to neovascularization, but the vessels that provide tumor trophism are poorly differentiated. A low degree of differentiation causes frequent ruptures and hemorrhage into the vitreous.

Clinical manifestations of intravitreal hemorrhage depend on the volume of blood, its rheological properties and stage of development.

During the bleeding stage, which lasts from a few seconds to 24 hours, patients notice the appearance of a “fog” before their eyes, which gradually gives way to cloud-like or cobweb-like shadows. Cloudiness develops suddenly, against the background of complete well-being.

A distinctive symptom of hemophthalmos is the black or red color of the shadows that appear. The degree of decrease in visual acuity directly depends on the volume of blood in the vitreous cavity. With massive hemorrhages, patients do not respond to light. With small hematomas, visual acuity decreases slightly.

At the stage of fresh hematoma (up to 2-3 days), the first manifestations of phagocytosis are observed. During this period, the patient notices the migration of shadows in his field of vision, which is associated with the formation of blood clots. From days 3 to 10, hemolysis of red blood cells occurs. Hemoglobin and its breakdown products spread to other structures of the eyeball. Visual acuity progressively decreases.

The release of toxins can lead to hemodynamic instability, headache and general weakness. Starting from day 10, irreversible hemosiderotic dystrophy of the vitreous body, retina and lens develops.

In turn, the hematoma is replaced by connective tissue, which is accompanied by increased synthesis of pigment epithelial melanocytes and proliferation of retinal neuroglia. Within six months from the onset of the first symptoms of hemophthalmos, total loss of vision occurs.

After six months, intraocular fibrosis develops, which is accompanied by intravitreal mooring, retinal hemosiderosis with further detachment and phthisis. The final stage of massive hemophthalmos is atrophy of the eyeball.

Instrumental diagnosis of hemophthalmos is based on indirect binocular ophthalmoscopy with scleral suppression, visometry, biomicroscopy, tonometry, and ultrasound B-scanning.

The method of indirect binocular ophthalmoscopy with scleral punching allows you to examine the peripheral parts of the retina and verify the retinal tear, in which melanocytes are visualized.

For greater reliability, ophthalmoscopy with a three-mirror Goldmann lens is recommended. Using visometry, it is possible to measure visual acuity, which in patients with hemophthalmos varies from a slight decrease to a complete absence of light perception.

The indication for an ultrasound of the eyeball is a decrease in the transparency of the optical system of the eye caused by clouding of the cornea or cataracts.

This technique allows you to visualize ruptures or a foreign body of the eye during the traumatic genesis of hemophthalmos and assess the degree of retinal attachment and vitreous detachment.

In B-scan mode, in addition to the above changes, it is possible to identify intraocular melanoma, foci of neovascularization and study the condition of the posterior part of the vitreous. Ultrasound examinations should be performed serially for early diagnosis of retinal detachment. It is repeated until the hemophthalmos clears.

All patients are recommended to undergo laboratory tests: CBC, coagulogram and blood glucose test. Suspicion of CVS occlusion is an indication for performing an OAC, which reveals an increase in ESR. A coagulogram may indicate blood thickening phenomena. In patients with diabetic retinopathy, increased glucose levels are detected.

If you suspect the development of hemophthalmos, consultation with an ophthalmologist is necessary. Treatment tactics depend on the etiology of the disease. If a small hemorrhage is detected, specific treatment is not required. In case of relapse, vitreous lavage is recommended.

Conservative therapy consists of oral administration of tissue plasminogen activators (alteplase). From days 3 to 28 it is advisable to take prourokinase. Subtotal and total hemophthalmos require surgical treatment (vitrhemectomy). Proliferative retinopathy, accompanied by retinal rupture, is corrected using laser coagulation.

In case of obvious opacification of the vitreous body against the background of conservative therapy, vitrectomy is indicated.

Specific measures to prevent hemophthalmos have not been developed. Patients are recommended to monitor their blood pressure levels, and after 40 years of age, measure intraocular pressure once a year.

Patients with diabetes should monitor blood glucose levels, follow basic treatment and undergo a preventive examination by an ophthalmologist twice a year, which should include ophthalmoscopy, tonometry and visometry.

The prognosis for hemophthalmia depends on the volume of hemorrhage. Early diagnosis and timely treatment allow for complete restoration of eye function.

If the vitreous is 1/8 filled with blood, the prognosis is favorable; 1/8 – 1/4 – there is a high risk of retinal detachment; at 1/4 – 3/4 – the prognosis for the restoration of visual functions is doubtful.

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

Source: https://www.KrasotaiMedicina.ru/diseases/ophthalmology/hemophthalmos

Hemophthalmos (partial and total): causes and treatment

Hemophthalmos is an eye disease that develops as a result of vascular ruptures and hemorrhage into the vitreous , in which it and the area around the vitreous are filled with blood and blood clots. This disease occurs in 7 cases per 100,000.

The main risk group includes people with diabetes, hypertension, myocardial infarction, stroke survivors, and high blood cholesterol. The disease is often diagnosed after 40 years of age, but it also occurs in children.

It is important to know what it is, hemophthalmos, in order to pay attention to the first symptoms in time and carry out treatment.

Causes

There are a large number of different factors that contribute to the occurrence of hemorrhages.

The main causes of hemophthalmos are as follows:

• eye injury as a result of injury resulting in rupture of the eye membranes and blood vessels;
• complication after eye surgery;
• rupture of newly formed vessels that occurs in patients with decompensated diabetes mellitus, in people with circulatory disorders in the retinal vessels;
• retinal detachment, accompanied by rupture of blood vessels;
• vasculitis;
• persistent increase in blood pressure;
• sickle cell anemia.

The disease often causes spontaneous vision loss, as blood clots prevent the light ray from passing to the retina. Whether vision is lost completely or partially depends on the volume of blood accumulated in the vitreous.

After a few days, the hemoglobin in the blood cells is destroyed, the red blood cells become discolored, and therefore vision is completely restored.

But without appropriate treatment, the process will be repeated again and again until the breakdown products of red blood cells and constant hemorrhages lead to atrophy of the eyeball.

Kinds

The process of hemophthalmos goes through several stages, differing in their characteristic features. The main stages of the disease are shown in the following table.

Stage name.	Peculiarities.
Bleeding stage.	During its course (about 24 hours), blood enters the vitreous body, reducing its transparency.
Fresh hematoma.	Lasts about 48 hours. Blood clots form in and around the vitreous body.
Toxic-hemolytic stage.	Has a duration of 10 days. During this period of time, hemoglobin in blood clots is destroyed, and the breakdown products begin to negatively affect the eye structures. The vitreous body becomes cloudy.
Proliferative-dystrophic.	During the stage, the connective tissue hematoma is replaced.
Retinal detachment.	The vitreous body thickens and fills with fibrous tissue. At this stage, refusal to visit a doctor entails the most dire consequences; there is a high risk of atrophy of the eyeball, followed by complete loss of vision.

Hemophthalmos has varieties depending on the reasons that caused the hemorrhage and the volume of blood:

1. Partial. Partial hemophthalmos of the right or left eye is caused by minor eye injuries, diseases, due to which the vessels become brittle and fragile. With partial hemophthalmos, the hemorrhage makes up no more than a third of the surface of the vitreous body.
2. Total. The surface of the hemorrhage occupies more than 75% of the eye. Caused by severe eye trauma.
3. Subtotal. The area of ​​hemorrhage occupies almost the entire surface of the vitreous body. Occurs as a result of severe injuries to the ocular structures.

Symptoms

The clinical picture of hemophthalmos depends on the stage of development of the disease and the volume of blood accumulated in the vitreous area.

Patients with hemophthalmia experience the following unpleasant symptoms:

• sensation of cobwebs in the eyes;
• floating black spots before the eyes;
• blurred vision;
• fear of bright light.

Symptoms vary depending on the stage of ophthalmological pathology. At the bleeding stage, patients note the appearance of fog before the eyes, which is gradually replaced by cobweb-like or cloud-like shadows (red or black).

Numerous black spots in front of the gases indicate minor hemorrhages, dark stripes in front of the eyes indicate a moderate hemorrhage.

Hemophthalmos does not cause pain, the only exception being cases when it is caused by glaucoma or injury to the organs of vision.

Diagnostics

To identify partial, total, subtotal hemophthalmos of the eye, you need to undergo a thorough examination by an ophthalmologist. Initially, the doctor will ask about the presence of diseases that contribute to the appearance of hemophthalmos and eye injuries. Using various studies, the presence of blood clots in the vitreous body and the area that surrounds it is established.

Instrumental diagnostics include:

• indirect binocular ophthalmoscopy with scleral punching, which is used to examine the peripheral parts of the retina for retinal breaks;
• ophthalmoscopy with a Goldmann lens;
• visometry to determine visual acuity;
• biomicroscopy to identify foci of hemorrhage and condensation in the anterior parts of the vitreous;
• B-scan, which helps to study the condition of the posterior vitreous;
• Ultrasound of the eye. Helps to see ruptures of the ocular vessels during the traumatic genesis of hemophthalmos, to assess the degree of vitreous detachment, and the retinal fit. It is prescribed if it is impossible to examine the retina due to clouding of the cornea, cataracts, or severe hemorrhage.

Treatment of hemophthalmos

Therapy for hemophthalmos will depend on the causes of the disease. Total and subtotal forms are treated exclusively in a hospital. For partial hemophthalmia of the eye, treatment is carried out conservatively, without surgery.

As soon as the patient begins to bleed from the eye, he is immediately advised to stop all physical activity, lie down and raise his upper body 30 degrees. Under no circumstances should you take blood thinning medications.

Immediately after the injury, hemostatic drugs are used (Dition, also known as Etamzilat, calcium chloride). To remove hemoglobin breakdown products, infusions of glucose and sodium chloride solutions are used.

To prevent repeated hemorrhages, vitamin preparations with calcium (Vikasol, Dicion) are prescribed.

A couple of days after the appearance of hemorrhages, enzyme medications (prourokinase, collalysin, alteplase) that dissolve blood clots are prescribed, which are administered through the lower eyelid under the eye.

It is possible to use enzyme tablets (Flogenzym, Wobenzym). The choice of drugs depends on each specific case.

For the treatment of hemophthalmos of the eye (partial, total), retinoprotectors are also prescribed, that is, drugs that protect the retina of the eye (Emoxipin). To strengthen the vascular walls, Pyridoxine, Riboflavin, and Ascorbic acid are prescribed.

To prevent new hemorrhages, calcium preparations are prescribed in the form of instillations and injections for intramuscular administration. Lidase eye drops, Ronidase solution, and potassium iodide work effectively.

To eliminate hemophthalmos, cryo and laser coagulation are prescribed. The drugs Lucentis, Eylea, and Avastin are also injected into the vitreous body. These are inhibitors that prevent the formation of new abnormal vessels.

Surgical intervention

A radical surgical option to eliminate hemorrhage into the vitreous body is vitrectomy - an operation during which the entire vitreous body or only part of it is removed. The free space is filled with a gel-like substance (saline solution, silicone oil, air-gas mixture).

Vitrectomy is used in the following cases:

• retinal detachment;
• hemorrhage occurred against the background of rubeosis, glaucoma;
• bilateral hemophthalmos or suspected traction complex in children with diabetes;
• hemorrhage lasting more than 2-3 months.

After surgery, phonophoresis with heparin and potassium iodide is prescribed to improve eye healing.

Traditional treatment

Folk remedies for partial, and especially for total and subtotal hemophthalmia, cannot cure them, but will help strengthen the blood vessels of the eye. To do this, you need to include blueberries, carrot and apple juice, and chicory in your diet.

Complications

If you do not consult a doctor in a timely manner or if hemorrhage in the vitreous body of the eye is treated incorrectly, the following complications may occur:

• development of secondary glaucoma;
• hemosiderosis of the eyeball (toxic damage to the photoreceptors of the retina);
• in children under two years of age, the development of amblyopia and myopic shift.

Prognosis and prevention

At present, methods for preventing hemophthalmos have not yet been developed. There are only recommendations.

They boil down to the following:

1. Blood pressure control;
2. Regular examination by an ophthalmologist (persons over 40 years of age are recommended to undergo it twice a year);
3. Controlling blood sugar in diabetic patients.

The prognosis largely depends on the volume of hemorrhage. With partial hemophthalmia, if the filling of the vitreous body with blood is an eighth, then the prognosis for complete recovery is quite favorable.

When the vitreous body becomes full of blood, the risk of retinal detachment increases by a quarter.

With total hemophthalmia, when more than 3/4 of the vitreous is filled with blood clots, the prognosis is very doubtful; in 90% of cases the patient faces atrophy of the eyeball and blindness.

Video

Bakhareva Elena Sergeevna, specialist for the website glazalik.ru
Share your experience and opinion in x.

Source: https://GlazaLik.ru/bolezni-glaz/drugie-bolezni/gemoftalm/

Modern approaches to the treatment of hemophthalmos

Currently, the treatment of vitreal hemophthalmos is represented by three main directions: medication, enzyme therapy and surgery (intravitreal enzyme treatment - IPF, vitrectomy).

Drug therapy

Conservative therapy is aimed at eliminating or weakening the causes that cause or aggravate pathological processes in the microvasculature in patients with vitreal hemorrhages of various etiologies.

Therefore, among the many currently known medications used for this purpose, the use of drugs whose action is aimed at improving rheological properties and reducing blood viscosity, normalizing the functional activity of formed elements - platelets, erythrocytes, as well as drugs with pronounced fibrinolytic activity.

For this purpose, patients in the treatment of hemophthalmia are prescribed drugs with antiplatelet and angioprotective effects.

• An angioprotective drug is Doxium (calcium dobesilate), which affects the permeability and elasticity of the vascular wall. Other angioprotectors have also found their use - Parmidine, sodium ethamsylate (Dicinone).
• Antiplatelet drugs include pentoxifylline (Trental, Agapurin, Pentilin), which has a dilating effect on the microvasculature, affecting the elasticity of erythrocyte membranes and the rheological properties of blood.

Some authors note the positive effect of Divertin, an antagonist of induced platelet aggregation, which is prescribed at 120 mg per day for 2-3 months. The drug helps to increase the concentration of NO in the blood and affects the functional activity of the microvasculature.

Good clinical results were obtained with treatment with Peritol, which reduces platelet aggregation and relieves retinal vascular spasm, suppressing the effect of histamine; The drug Divascan is similar in pharmacological action.

In order to improve microcirculation and disaggregation, it is recommended to use heparin in small doses. Reduces platelet and erythrocyte aggregation, reduces the permeability of the vascular wall, improves metabolism and increases resistance to hypoxia with the drug Sulodexide (Wessel-Due F).

The treatment also uses a combination of laser treatment of the vitreous body with the use of the systemic fibrinolytic thrombusazim.

In the pathogenesis of vitreoretinal hemorrhages (intravitreal hemophthalmos, retrovitreal hemophthalmos), a large role is played by damage to the retina by peroxidants - free radicals and reactive oxygen species, which predetermines the widespread use of antioxidants.

For this purpose, Emoxipin is prescribed, which improves metabolism by inhibiting lipid peroxidation, which is activated during retinopathy. Emoxipine is prescribed in the form of parabulbar and intramuscular injections. Galileeva V.V. and Kiseleva O.A.

tested the effectiveness of the antioxidant drug Mexidol, which was prescribed 100 mg once a day intramuscularly for 10 days. Its pronounced protective and membrane-stabilizing effect has been established.

Tocopherol acetate, serotonin, oxidized glutathione, catalase, hemase, emoxypine, tanakan are widely used as inhibitors of free radical processes. Polunin G.S.

et al. used the natural antioxidant Histochrome (from the group of polyhydroxynaphthaquinones) in the form of parabulbar injections in patients with hemophthalmos of various origins, thrombosis of the central retinal vein, and preretinal hemorrhages.

A pronounced therapeutic effect was observed in 63.2%, moderate in 29.6%, and no effect in 17.2% of cases. The authors consider Histochrome an effective drug for proliferative processes, degenerations and hemophthalmia of various origins.

The drug has a hemoresorption, retinoprotective effect, has antioxidant properties and can be widely used for diseases associated with metabolic disorders of the retina, choroid and cornea, to improve trophism, reduce edema and accelerate epithelization. It has been proven that the use of antioxidants accelerates resorption, reduces capillary permeability, and has a fibrinolytic effect

Enzyme therapy

Despite the variety of drugs and treatment methods considered, the leading role in the resolving therapy of hemophthalmos is given to the local (parabulbar) use of enzymes with proteolytic and hyaluronidase action.

It has been proven that fibrinolysin enhances the lytic activity of the vitreous body, promotes a longer stay of the spilled blood in a liquid state, preventing its organization into a clot, and accelerates the resorption of hemophthalmos.

Successful results were noted with its subconjunctival, parabulbar administration and in the form of medicinal films.

Currently, a promising direction is the search for substances that can influence the processes of phagocytosis. It is known that the vitreous body has weak fibrinolytic activity, and blood resorption in the case of hemophthalmos is slow.

The group of drugs of microbial origin includes the highly purified enzyme proteolysin. The use of proteolysin in ophthalmological practice is based on its specific ability to break down necrotic tissue and lyse blood clots when exposed locally.

However, the use of proteolysin in the form of an injection causes local reactions, and when it is administered by electrophoresis, an increase in the coagulation properties of blood is observed.

The drug Unitol has a positive effect on the course of hemophthalmos. These drugs are recommended to be administered in the form of instillations, injections under the conjunctiva, under the skin or intravenously.

Surgery

An analysis of the literature showed that significant changes have occurred in vitreal surgery over the past 30 years. The technique of endovitreal surgery continues to improve along with the improvement of equipment, instruments, optical systems and tamponing substances.

A new method has been developed for the treatment of proliferative diabetic retinopathy (PDR), complicated by hemophthalmia, with the combined use of an aqueous medium and a PFOS medium (perfluoroorganic compounds, the so-called “heavy water”). The vitreous is removed down to the epiretinal membranes. Membranes that are loosely fused to the retina are excised.

In areas of newly formed vessels and around retinal tears, endolaser coagulation is performed. At the next stage of treatment, the vitreous is replaced with silicone oil. In patients with PDR complicated by hemophthalmia, posterior closed vitrectomy is performed. The epiretinal membrane and posterior hyaloid membrane are excised en bloc.

According to the authors, the use of enzymatic collagenolysis reduces the retraction abilities of the remnants of the vitreous cortex and, thus, reduces the risk of retinal detachment.

Analysis of special literature on the problem of vitreal surgery for tractional retinal detachments involving the macular region, hemophthalmos, showed that achieving success in surgical treatment of the above pathology is possible only with the use of combined surgical techniques: transciliary closed vitrectomy, total removal of the posterior hyaloid membrane and epiretinal membranes, scleral interventions , prolonged vitreal tamponade, intraoperative laser coagulation of the retina and the use of laser treatment in the postoperative period. Taking into account all of the above, we can conclude that any of the methods is an option.

Source: https://eyesfor.me/home/eye-diseases/pathology-of-vitreous-humour/hemophthalmus-treatment.html