What is intraocular hemorrhage?
Intraocular hemorrhage is a bleeding condition that usually occurs in the back of the eye and can occur due to many different diseases. Intraocular hemorrhage needs to be treated quickly.
The thin nerve layer that surrounds the inner surface of the eye like a sheet and creates visual signals is called the retina. The transparent gel substance that fills the inside of the eye is called the vitreous.
In order for a clear vision to be formed, the rays must pass through the vitreous and reach the retina without scattering. When bleeding develops in the eye, the transparent structure of the vitreous is disrupted and the rays cannot reach the retina clearly. The result is vision loss.
What causes intraocular hemorrhage?
Intraocular hemorrhage can occur in any disease that may cause rupture of the vessels in the eye or blood leakage from these vessels. Intraocular hemorrhage is most commonly seen due to the following reasons:
- Diabetic retinopathy: In diabetic patients, the vessels in the back of the eyes are damaged and the new vessels that are formed bleed and cause intraocular hemorrhage. Approximately 50% of intraocular hemorrhages are due to diabetic retinopathy.
- Branch retinal vein occlusion: New vessel formations that occur after the occlusion of the veins in the retina may rupture and cause intraocular hemorrhage.
- About 20% of all intraocular hemorrhage occurs due to retinal detachment.
- All kinds of head and eye traumas can cause a detachment in the normal retinal vessels and cause intraocular hemorrhage.
- During Posterior vitreous detachment, as the gel layer decomposes, it may cause bleeding by tearing the retinal vessels.
- Cerebral hemorrhages can sometimes cause intraocular hemorrhages by tearing the eye vessels.
- Abnormal vessel formations that cause macular degeneration can rupture and cause intraocular hemorrhage.
Apart from these, the use of anticoagulants, high blood pressure, straining, heavy lifting, intraocular inflammatory diseases and eye tumors can also cause intraocular hemorrhage.
What are the symptoms of intraocular hemorrhage?
Intraocular hemorrhages occur as a result of rupture of retinal vessels.
The most common symptoms of intraocular hemorrhage are blurred vision and eye floaters (flying flies) or spider web-like spots. There is no pain in intraocular hemorrhage.
Sometimes photopsia can be seen. Depending on the underlying disease, there may have been a decrease in vision in the pre-bleeding period.
How is the diagnosis of intraocular hemorrhage made?
Before planning the treatment for intraocular hemorrhage, the cause of the hemorrhage should be determined. For this reason, taking a detailed history from all patients is very important in determining the cause of intraocular hemorrhage.
During the examination, your doctor will determine your vision level and will put drops in your eye and examine the back of the eye.
If necessary, eye ultrasonography examination can be performed. In this way, in cases where the back of the eye cannot be seen, causes such as retinal detachment or tumor can be distinguished.
If there is a history of trauma, eye tomography is examined to determine whether there is a problem in the surrounding tissues.
A referral to an internist can be made to determine whether there is an underlying disease. Additionally, drug history should be questioned and bleeding disorders should be examined.
How is the treatment planned for intraocular hemorrhage?
Eye ultrasonography examination
Treatment of intraocular hemorrhage is determined by the cause and severity of the bleeding and the needs of the patient. For example, even if the bleeding is not very severe but if the patients have vision loss preventing them from doing their daily works, surgery can be considered in the early period.
On the other hand, if there is no emergency in the eye that requires intervention, the bleeding can be expected to go away on its own. Before surgical treatment is planned, the cause of bleeding must be determined and the underlying disease must be corrected.
The waiting method is generally preferred if there is no emergency such as tear, detachment, etc., and if the patient can do his/her daily works with the other eye.
If the patient is to be waited for without surgery, this period is about 3 months and the condition of the bleeding is followed by monthly controls. If the bleeding has not gone away after 3 months, surgery is planned.
If the patient is one-eyed, if the situation that causes bleeding in the eye requires emergency intervention or if the patient does not want to wait, surgery can be planned without waiting.
Treatment of intraocular hemorrhage is vitrectomy surgery. Today, high success rates can be achieved in vitrectomy surgeries with the development of surgical techniques and technology.
In this way, patients are provided with a faster and more comfortable recovery. In vitrectomy surgery, very thin instruments are inserted into the eye and the gel substance of the eye and bleeding are cleaned. Additional problems such as tears and detachment are also treated.
If necessary, laser treatment can also be performed in patients with retinopathy, as in diabetic patients. In this way, the treatment of both bleeding and accompanying diseases is done in a single session.
What happens if a patient with intraocular hemorrhage is not treated?
In the case of intraocular hemorrhage, there is usually an underlying disease. Depending on what the disease is, it can be predicted how the disease will progress.
For example, in case of intraocular hemorrhage due to diabetes, if the hemorrhage is not treated, retinal damage will progress over time and the condition may become incurable and even blindness. Again, if the treatment is delayed in retinal detachment, blindness will be inevitable.
What should be the expectation after the treatment of intraocular hemorrhage?
The increase in vision after treatment in intraocular hemorrhage depends on the underlying disease, that is, the cause of the bleeding. In diseases such as diabetic retinopathy or retinal detachment, the condition of the retina is controlled after the bleeding is treated.
If the retina is healthy, the expectation of vision will be high. In simple hemorrhages, the expectation of visual improvement is generally high after the intraocular hemorrhage is treated.
As a result, intraocular hemorrhage is a condition that can develop due to many different diseases. The timing and success of treatment depend on the underlying disease.
In some diseases, emergency surgery is required, while in some diseases it can be waited for a while. All these are decided as a result of detailed examinations and tests.