Hemophthalmus - Causes, symptoms and treatment. MF.

Hemophthalmus is the ingress of blood into the vitreous. Distinguish between partial, subtotal and total hemophthalmos. Total and subtotal hemophthalmus occurs more often with severe non-penetrating or penetrating injuries of the eye. Partial hemophthalmia mainly occurs as a result of light eye injuries, diabetic retinopathy, arterial hypertension, atherosclerosis, retinal dystrophy and other diseases in which the vessels become very brittle. Hemophthalmus can also occur due to rupture or detachment of the retina, as well as due to cavitary operations on the eyeballs.

Hemophthalm is total if the hemorrhage occupies more than ¾ of the vitreous volume, if the hemorrhage takes from 1/3 to ¾ volume, then the hemophthalm is called subtotal, if the hemophthalmus occupies less than 1/3 the volume of the vitreous, it is called partial.

When hemophthalmus enters the vitreous body, red blood cells, which in a few days begin to break down. From them comes hemoglobin, which settles in the form of grains, and the cell membrane itself dissolves. Hemoglobin, in turn, turns into a special substance - hemosiderin, which adversely affects the retina. In addition, in the vitreous body, strands are formed that attach to the retina, which in the future can lead to its detachment. Thus, when the hemophthalmus changes in the structure of the vitreous, which, if untreated, can lead to serious consequences.

As a result of hemophthalmia, visual acuity sharply decreases, starting from dots or threads floating before the eye, and down to complete blindness. As a rule, visual acuity in patients with partial hemophthalmus is better in the morning, when blood settles in the lower parts of the eyeball for a night.

With the above symptomatology should immediately call an ophthalmologist, not doing self-medication, because of the serious consequences of this pathology. The doctor needs to talk about when complaints have appeared, how they have changed over time, what treatment was administered, whether there were any injuries, whether there are any other diseases. The doctor necessarily conducts an external examination of the eye, draws attention to external eye injuries, if any;examines the eye with a slit lamp, which more closely examines the structure of the eye( there may be hemorrhages under the conjunctiva, there may be a hyphema( hemorrhage into the anterior chamber of the eye - the space between the iris and the cornea), etc. Then the doctor proceeds to an ophthalmoscopy. Hemophthalmos in the structure of the vitreous can be found floating when moving the eyeball blood clots, but the details of the fundus can be examined, and with complete hemophthalmia, the fundus is not at all visible,there is no red reflex from the fundus

Inspection of the patient with hemophthalmos

The state of the retina and vitreous humor, as well as the nature of the hemophthalmus can be determined by ultrasound, and the function of the retina can be assessed by the method of chromatic electroretinography

Treatment of hemophthalmia

With total andSubtotal hemophthalmia is mandatory for inpatient hospitalization, and partial hemophthalmia can be treated in a polyclinic. Treatment of hemophthalmus depends on the causes of its occurrence. It should be noted that the treatment of partial hemophthalmia is the same as total and subtotal, but less in intensity. Treatment, as a rule, long. For partial hemophthalmia, surgical treatment is practically not applied.

When "fresh" hemophthalmia is mandatory, bed rest with a bandage and cold( for 2-3 hours) on both eyes. To prevent the emergence of new hemorrhages, the patient is prescribed calcium inwards, as intramuscular injections( 10% of the calcium gluconate solution) and topically as eye drops 3% of calcium chloride solution. Also, vitamins C, B2 and PP are prescribed for this purpose;vicasol and dicinone. One to two days after the onset of the disease, rasasyaschie drugs are prescribed. Assign eye drops of potassium iodide, 0.1% of r-lidase or ronidase( enzyme preparations).To prevent the formation of strands prescribed hormonal drugs( 0.1% rr dexamethasone or 0.3% of rn prednisolone) in the form of eye drops and subconjunctival injections( ie injections under conjunctiva).Also for this purpose, parabulbar( ie, "ophthalmic") injections of collagen( an enzyme preparation that dissolves collagen) are administered, which are administered every other day in an amount of 10 injections per course;injections of fibrinolysin, lekosima( enzyme preparations).We also recommend the administration of the conjunctiva of r-heparin( anticoagulant - prevents blood coagulation) and streptodeases( an enzyme drug dissolving fibrin).In addition, with this pathology, intravenous administration of 10% of sodium iodide solution( has a resolving effect) is indicated. Well-proven autohemotherapy: intramuscular injection of 2-4-6-8 ml of blood taken from the patient's vein. Also, a positive effect is observed from the use of an extract of aloe, a vitreous in the form of injections;subcutaneous injection of lidase, electrophoresis of fibrinolysin( enzyme preparation, has a resorption effect), potassium iodide, lidase, vitreous body, at the same time, lidase electrophoresis is prescribed for 15-20 procedures for 15 minutes, and a month later - vitreous and potassium iodide electrophoresis15 procedures lasting 15 minutes each. Ultrasonic procedures are also shown: phonophoresis of potassium iodide, aloe, heparin, and laser treatment. Among folk methods of treatment in this pathology, the hydra therapy( i.e., treatment with leeches) is applicable.

If the therapeutic treatment is ineffective for the first 7-10 days, surgical treatment is prescribed to remove blood from the cavity of the eyeball.

Self-medication in this pathology is not allowed to be engaged! In the absence of proper treatment, spilled blood forms rough cords in the vitreous that can lead to retinal detachment and atrophic changes in the eyeball, which is certainly accompanied by loss of vision on the affected eye.

The prognosis for vision with partial hemorrhage is usually favorable, the hemorrhage resolves and the vision is restored, with a subtotal and total hemorrhage the forecast is unfavorable.

Prevention of hemophthalmia

To prevent the onset of hemophthalmia, it is necessary to treat the underlying diseases in a timely manner and also to observe safety measures when performing any manipulations that can lead to eye injury( for example, the use of goggles).

Voach ophthalmologist Odinochko EA