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Vitreous haemorrhage is not uncommon for daily eye examination with complaints of flies, soot rain, seeing bright pink or seeing a lot of black covering in front of the eyes.
The composition of the vitreous is 99% water, the remaining 1% is hyaluronic acid, which gives the vitreous transparency and viscosity. The vitreous at the back is covered by the inner limiting membrane, in front there is a non-pigmented membrane that adheres to the back of the vitreous and the zinnia. The vitreous cavity occupies 80% of the volume of the eyeball (about 4 ml). Vitreous adheres firmly to the retina in 3 areas: vitreous base, optic disc and retinal blood vessels.
– Bleeding due to abnormal blood vessels – Bleeding due to trauma on normal vascular site – Bleeding from nearby lesions
Vascular abnormalities can include: neovascularization that produces weak blood vessels such as in diabetic retinopathy, retinal ischemia, sickle cell disease, retinopathy of prematurity (ROP). ). Chronic anemia increases vascular endothelial proliferative factor (VEGF) and other neovascular proliferative factors, and the new endothelial form is loosely bound or ruptured causing hemorrhage. Fibrogenic factors, pathological vitreous also cause contraction and pull on the already weak blood vessels, causing vitreous hemorrhage.
Disruption of normal blood vessels: a blood vessel is ruptured by physical contractions strong enough to disrupt its normal structure. Posterior vitreous detachment, vitreous contractions on blood vessel walls, especially on tightly bound areas, can cause bleeding. In addition to the ruptured blood vessel, the vitreous may or may not detach. Vitreous hemorrhage associated with posterior vitreous detachment is a precursor of retinal tear (accounting for 50-70% of total posterior vitreous detachment). Injury to the eyeball is also the cause of vitreous hemorrhage (CHD) in the group of people younger than 40 years old.
A few other rare syndromes such as Terson syndrome, caused by blood in the subarachnoid space spreading into the vitreous space, Valsava syndrome due to sudden increase in pressure on the retinal vessel wall can also be the cause of DVT.
Bleeding from the spaces adjacent to the vitreous: pathology of the adjacent tissues can cause DVT: from micro aneurysms, tumors, neovascularization of the choroid… The blood breaks through the inner limiting membrane and spills into the fluid compartment. glasses.
2. Symptoms of vitreous hemorrhage
Symptoms of DVT are varied: painless, usually unilateral: sensation of floating objects, decreased vision. A low degree of DVT is often described by patients as flying flies, like a spider’s web, feeling like fog, like having a barrier or seeing a red halo… More severe will be the feeling of losing central vision right away. get up. When taking history, doctors will pay attention to tracing trauma history, eye surgery history, diabetes, sickle cell disease, leukemia, carotid artery disease, high myopia.
The patient must have a complete ophthalmologic examination: direct and indirect ophthalmoscopy with scleral compression, anterior chamber angle for neovascularization, intraocular pressure measurement, and full posterior segment B ultrasonography. Sometimes ophthalmoscopy helps to find the cause, as in diabetic retinopathy.
Detecting STDs is not difficult. With high-intensity light, red blood cells, vitreous Tyndal can be seen, in the clear areas of the vitreous can be seen retina and damaged blood vessels. Sometimes the hemorrhage will be in the form of a pool because it is localized under the hyaloids – anterior retinal hemorrhage.
Sailboat hemorrhages are seen when blood is localized between the posterior limit membrane space and the posterior vitreous membrane. Bleeding is also associated with anterior chamber hemorrhage. The degree of severity, the spread of KID can range from very mild: few red blood cells in the vitreous or anterior chamber to very severe: nothing can be seen in the back.
3. Matters needing attention about vitreous hemorrhage
Progression of KID: the blood in the vitreous is cleared at a rate of about 1% per day. Blood outside the vitreous cavity is dissipated more quickly. In young people, blood also dissolves faster because the vitreous structure is still loose, similar to eyes that have been vitrectomy or have been in the stage of blood clot formation. Hemolysis depends on the disease that caused it, with diabetic retinopathy and age-related macular degeneration (AMD) being the most difficult. Proliferative vitreous disease usually occurs about 1 year after IUD.
Possible complications include ocular iron infection: retinal toxicity, vitreous and corneal iron contamination. Proliferative disease of the retina – vitreous after DVT causes fibrovascular proliferation, leading to fibrous scars, later can be retinal detachment, phantom cell glaucoma
Treatment method: Before that, an ultrasound of the eye must be performed if the retina cannot be seen. Vitrectomy should be performed immediately if retinal detachment is present. Outpatient treatment if retinal detachment is not present. Sleeping with the head elevated can also help the blood settle down, allowing the doctor to see the upper retina. Areas of retina that are torn or detached are treated with cryotherapy, laser, or embolization. Diseases that are the cause of DVT will be treated with localized or global lasers
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