Tag Archives: posterior vitreous detachment

Vitreous Hemorrhage

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Eye
Vitreous is the gel that fills the eye (click on image to enlarge)

What is vitreous hemorrhage?

Vitreous hemorrhage means blood has leaked into the vitreous gel of the eye. The vitreous is a clear gel that fills the center of the eye and helps to hold the retina in place against the eye-wall like wallpaper in a room. The retina is a thin layer of delicate nerve tissue, which acts like film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. The retina has many fine blood vessels, which sometimes leak blood into the vitreous and cause a loss of vision.

What symptoms does vitreous hemorrhage cause?

Vitreous hemorrhage usually causes many new floaters in the vision. Floaters may appear as round specks, hair-like or bug-like debris, or clouds moving in your vision as though they were in front of your eye. They are more noticeable when looking at a blank surface and may interfere with the good vision in the fellow eye.

Flashes are brief streaks of light that are usually seen off to the side, especially at night when you turn your head or eyes. Flashes are caused by vitreous gel pulling on the retina with eye movement.

Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters with or without flashes is an important sign of abnormal pulling on the retina by the vitreous. In some people with these symptoms, the retina may tear and detach resulting in loss of vision.

What causes vitreous hemorrhage?

There are many causes of vitreous hemorrhage. Diabetes can cause vitreous hemorrhage by weakening the blood vessels in the retina and by causing the vitreous gel to shrink and pull on the retinal vessels. Hardening of the arteries in the eye can cause vitreous hemorrhage by blocking a retinal vein where the arteries cross over the veins in the retina. Ageing changes of the vitreous gel can cause it to pull on the retina and tear it. The tearing of the retina may result in bleeding into the vitreous. Less common causes of vitreous hemorrhage include birthmarks inside the eye, inflammation, trauma, tumor, surgery, blood disorders, and macular degeneration.

How is vitreous hemorrhage treated?

The most important step is to have a thorough eye examination with ultrasonography. The ultrasound machine uses sound waves to safely and effectively “look through” the blood in the vitreous to see if the retina is attached. If a retinal detachment is found, surgery (scleral buckle, pneumatic retinopexy, and/or vitrectomy) is required in an attempt to repair it. If no retinal detachment is found on ultrasound exam, your doctor may allow the vitreous hemorrhage to clear on its own with time. The ultrasound exam may be repeated periodically to assure the retina remains attached. In many cases the cause of the vitreous hemorrhage cannot be determined until the hemorrhage has cleared. If the hemorrhage does not clear on its own, vitrectomy surgery as a one-day surgery in the hospital operating room may be considered. The amount of visual return depends on several factors including the health of the underlying retina.

What should I be on the lookout for?

After examination or treatment for a vitreous hemorrhage, you should notify your doctor if you have a burst of new floaters, a loss of side vision, or pain. Sometimes, retinal tears or a retinal detachment occur at a later date after the examination.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright 2016-2022 Designs Unlimited of Florida. All Rights Reserved.

Retinal Detachment

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is the retina?

The retina is a “tissue-paper” thin layer of nerve tissue, which lines the inside of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain.

What is retinal detachment?

When the retina detaches, it is no longer in proper position inside the eye. Instead, it is like film that has unrolled inside a camera. When this occurs, a camera cannot take a picture.  Similarly, when the retina detaches the eye loses vision.

Retinal break
Horseshoe-shaped retinal tear as seen in an eye with retinal detachment (Click on image for enlargement)

What causes retinal detachment?

Retinal breaks (holes and tears in the retina) cause retinal detachment. These retinal breaks are usually caused by a degeneration of the vitreous (the clear gel that fills the eye and normally helps to hold the retina in place). Vitreous degeneration is common in aging and near-sightedness, but may also follow a direct blow to the eye, hemorrhage, infection, or inflammation inside the eye. When the vitreous degenerates and condenses, it pulls on the retina and may cause retinal tears, which often lead to retinal detachment.

What are the symptoms of retinal detachment?

Prior to retinal detachment, most people notice warning signs such as new floating spots or “cobwebs” in the vision. Sometimes, brief lightning-like flashes of light are seen in the side vision. These are the symptoms of vitreous degeneration and retinal breaks. The retinal detachment that follows usually causes a dark “curtain” or “shadow” to form in the side-vision. The “shadow” often comes from below and on the side near the nose.  If it is not treated, the shadow gradually covers all of the vision resulting in blindness. There is generally no pain with retinal detachment.

How is retinal detachment treated?

The treatment of most retinal detachments requires surgery. Your doctor is skilled in a number of techniques to prevent blindness. Which type of surgery is recommended depends on the precise findings on examination. Surgery is not usually aimed at eliminating flashes and floaters. Flashes usually disappear in a few weeks or months. The floaters gradually fade over many months, but rarely disappear completely.  Some retinal detachments that do not cause symptoms may be observed without initial surgery.

Laser/Cryopexy demarcation:  Small areas of the retinal detachment (especially before any side vision has been lost) can sometimes be treated with laser or cryopexy to “seal down” the retinal along the edges of the detachment in an effort to prevent it from extending further.  This surgery is performed in the office. If it is not successful in stopping the detachment, more extensive surgery is required.

Pneumatic retinopexy:  Many retinal detachments can be repaired by this surgery performed in the office by anesthetizing the eye, sealing the break(s) with laser or a freezing probe (cryopexy), and pushing the retina into proper position with a gas bubble which is injected into the eye. Although this procedure is successful most of the time, it requires the strict cooperation of the patient to remain in proper head position for about five days. If this procedure fails, more extensive surgery in the hospital operating room is sometimes needed.

Scleral buckle surgery:  Some retinal detachments require the placement of a permanent plastic supporting belt around the eye to create a “ledge of support” for the retina. This is a major surgery in which a belt is placed around the eye in the hospital operating room. The eye is often rendered more near sighted by this procedure. Rarely, permanent side effects include double vision. If this surgery is not successful, vitrectomy surgery may be recommended. Scleral buckle surgery is preferred over other methods of surgery if the retinal breaks are located in the inferior (bottom portion) of the retina, where gas bubbles may not be effective in holding the retinal in position. Scleral buckle is also preferred over vitrectomy in eyes with a clear lens, because vitrectomy surgery usually results in cataract formation. Scleral buckle surgery is often used when other attempts at surgery have failed.

The video below demonstrates scleral buckle surgery. If you are uncomfortable watching surgery, please do not click on this video:

Vitrectomy surgery:  Performed in the hospital operating room as a major eye surgery, vitrectomy surgery involves making small incisions into the eye to remove floaters, dissect scar tissue, remove fluid from under the retina, apply laser, and place a gas bubble or silicone oil into the eye to hold the retina in place. Specific head positioning is sometimes needed. Sometimes a cataract or lens implant must be removed to adequately repair the retina. This surgery may be repeated if necessary to prevent blindness.

The video below demonstrates vitrectomy surgery. If you are uncomfortable watching surgery, please do not click on this video:

With one or more surgeries most retinal detachments can be repaired keeping useful vision. Vision may not return to normal, as there may be some permanent damage from the retinal detachment resulting in blurred or distorted vision. In some cases additional surgery is needed to removed scar tissue that forms after retinal reattachment surgery.  There are always risks to surgery including hemorrhage, infection, scarring, glaucoma, cataract, double vision, deformity, loss of vision/loss of the eye. Sometimes despite all efforts with surgery, all vision may be lost. Surgery is recommended for retinal detachments because blindness usually results if treatment is withheld. If you have questions, please do not hesitate to ask your doctor.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2014-2023 Designs Unlimited of Florida.  All Rights Reserved.

Posterior Vitreous Detachment (PVD)

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What is posterior vitreous detachment?

A posterior vitreous detachment (PVD) occurs when the vitreous gel inside the eye condenses and pulls away from the retina.  The vitreous is a thick, clear gel with invisible fibers that fills the inside of the eye.  From birth the vitreous gel is attached to the retina and helps to support it.  The retina is a thin layer of tissue that lines the inside of the eye like film in a camera.  Just like film, the retina serves to “take the picture” of objects you look at.  The primary cause of PVD is a degeneration of the vitreous, in which the tiny fibers clump together causing the vitreous to pull away from the retina.

vitreous gel
Clear vitreous gel fills the eye (click on image to enlarge)

 

PVD
A. Vitreous gel fills the eye at birth. B. Vitreous fibers begin to pull away from retina. C. Further separation of vitreous fibers that remain attached to the optic disc. D. Complete separation of vitreous fibers from the posterior retina.

 

What symptoms does posterior vitreous detachment cause?

The most common symptoms of PVD are floaters and flashes.   Floaters are specks, fibers, or veils that appear to move in front of your eye.  Floaters are actually tiny clumps of gel or cellular debris within the vitreous.  PVD sometimes causes bleeding inside the eye.  Blood in the vitreous appears as floaters described as hair-like strands or tiny round dots.  Over time floaters may appear like a cloud or veil that moves across the vision.  Flashes are brief streaks of light that are usually seen off to the side, especially at night, when you turn your head or eyes.  Flashes are caused by vitreous gel tugging on the retina with eye movement.  Although the sudden onset of new floaters is reported by almost everyone with PVD, flashes are only seen by half of all people with PVD.

Why is it important to be seen for these symptoms?

Although many people have occasional floaters or flashes of light, the sudden onset of many new floaters, with or without flashes, is an important symptom to report to your eye doctor.  In about 10-20% of people with these symptoms, the vitreous pulls on and tears the retina.  A retinal tear by itself causes no pain or visual problems.  However, if a retinal tear is not detected and treated, it may go on to cause blindness from retinal detachment.  A retinal detachment is when the retina stops functioning because it is pulled away from the inner eye wall and floats freely inside the eye.  A retinal detachment causes a progressive loss of vision appearing like a curtain or shadow that slowly moves across the vision from the side.

What causes posterior vitreous detachment?

PVD is usually due to degeneration of the vitreous gel from aging.  Over time, the thick vitreous gel tends to become liquefied and the microscopic fibers in the gel tend to condense together becoming visible and causing traction on the retina.  The following conditions tend to accelerate the degeneration and cause PVD to occur earlier in life:  trauma, inflammation, diabetes, and myopia (near-sightedness).

How is posterior vitreous detachment managed?

The most important step is to have a thorough, dilated eye examination.  The eye doctor will check for the presence of a tear in the retina.  If a tear is found, laser or cryopexy is usually recommended to decrease the chances of blindness from retinal detachment.  If a retinal detachment is found, more extensive surgery is required in an attempt to repair it.  If there is no retinal tear or retinal detachment found at the initial exam, another exam several weeks later may be performed to be certain that a delayed tear has not occurred.  Generally, there are no restrictions to your activities.

What happens to the floaters and flashes?

There is no treatment to make the floaters and flashes go away even though they may be quite annoying.  The flashes gradually subside and disappear over days to weeks without treatment.  However, the floaters rarely completely disappear.  They will gradually fade and become less obvious over weeks to many months.  For the first few days or weeks, many people find that the floaters are less annoying if they wear sunglasses when out of doors and turn the lights down when indoors.

What to be on the lookout for?

After examination or treatment, any new floaters or loss of side vision should be reported to the doctor without delay.  Sometimes, new tears or a retinal detachment can occur after the eye examination.  In fact, 7% of eyes with PVD will develop a retinal break sometime after the initial eye exam; about half occur more than one year after PVD.  This is more likely to occur in near-sighted eyes and eyes with lattice degeneration.

PVD may stimulate the formation of macular pucker, which may cause symptoms of distortion of vision. Treatment of a retinal tear does not prevent macular pucker.

When one eye develops a PVD, the fellow eye will usually do so at a future date.  Whether the floaters and flashes are more or less severe in the second eye, they should be promptly reported to the eye doctor.  If the first eye develops a torn retina, the second eye runs about a 20% chance of developing a tear as well.  But even if the first eye does not have a torn retina, the second eye may still develop a tear when a PVD occurs.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright 2014-2023 Designs Unlimited of Florida. All Rights Reserved.