What happens in the eye
The vitreous body does not have its own vessels, so blood enters it from the retina or choroid. Fresh hemorrhage is perceived as a reddish or dark veil. Gradually, the red blood cells settle and are destroyed, and the person no longer sees a complete darkness, but a multitude of floating threads and dots. Resorption occurs slowly, over weeks and months, because there is no blood flow in the gel. With large volumes of blood, dense strands are formed, which can stretch the retina and cause its detachment.
- Partial hemophthalmos - isolated opacities, vision is partially preserved
- Subtotal - most of the cavity is filled with blood
- Total - vision drops to light perception
- Blood is absorbed slowly, over weeks to months
- The consequence of a major hemorrhage is scar cords
Reasons
Diabetic retinopathy comes first in adults: newly formed vessels in the retina are fragile and bleed easily. The second most common mechanism is posterior vitreous detachment, in which the gel moves away from the retina and tears it along with the vessel; such a gap is dangerous due to subsequent retinal detachment. Hemorrhage is also caused by retinal vein thrombosis, age-related macular degeneration in the wet form, and eye and head injuries. Taking blood thinners and high blood pressure increase the risk.
- Diabetic retinopathy
- Retinal tear due to posterior vitreous detachment
- Retinal vein thrombosis
- Wet form of macular degeneration
- Trauma to the eye or skull
- Arterial hypertension, taking anticoagulants
Symptoms
Complaints appear suddenly and almost always in one eye. With a slight hemorrhage, a person notices new floating shadows, cobwebs, a “flock of midges” or a slight haze that moves when the eye moves. More voluminous blood gives a reddish veil, and with total hemophthalmia, vision drops to distinguishing light and shadow. A characteristic detail: in the morning after sleep you can see better, because during the night the blood has settled down. There is usually no pain, and the eye may look healthy on the outside.
- Sudden appearance of many floaters
- Reddish or dark veil before the eye
- A sharp decrease in visual acuity
- Flashes of light when the retina breaks
- Improved vision after sleeping in an upright position
- No pain or redness
Diagnostics
The doctor checks visual acuity and examines the fundus with a dilated pupil. If there is little blood, it is possible to see the source: a rupture, newly formed vessels, a thrombosed vein. With dense hemorrhage, the fundus of the eye is inaccessible for inspection, and the key method is ultrasound examination of the eye in B-mode: it shows the volume of blood and, most importantly, answers the question of whether there is retinal detachment. Be sure to check the second eye. At the same time, they are looking for a common cause: measuring blood pressure, assessing sugar levels and blood clotting indicators.
- Testing visual acuity and fundus examination
- Ultrasound of the eye in B-mode - mandatory for dense blood
- Repeated ultrasound in dynamics
- OCT of the retina after partial resorption
- Blood glucose and glycated hemoglobin
- Blood pressure control, coagulogram
Treatment
If the retina is not damaged, the doctor often chooses a wait-and-see approach: he recommends sleeping with the head of the bed elevated so that the blood settles down and does not interfere with central vision, limiting stress and bending, and adjusting blood pressure and sugar. Drugs that accelerate absorption have limited proven benefit. If a retinal tear is found, laser coagulation is performed; for diabetic retinopathy, laser treatment and injections of drugs that suppress the growth of new blood vessels are performed. If the blood does not resolve within several weeks or a retinal detachment is detected, a vitrectomy is performed - an operation to remove the vitreous humor along with the blood.
- Rest, sleep with the head of the bed raised, limit bending
- Monitoring blood pressure and sugar levels
- Laser coagulation for ruptures and retinopathy
- Injections of drugs into the eye cavity according to indications
- Vitrectomy for persistent hemophthalmos and retinal detachment
- Discuss your blood thinning medications with your doctor
