Retinal hemorrhage

Introduction Retinal hemorrhage is not an independent eye disease, but a condition common to many eye diseases and certain systemic diseases. Clinically, it is generally known as fundus hemorrhage. Retinal hemorrhage is most common with capillary lesions, mainly capillary endometrial damage, increased permeability, blood exudation; followed by bleeding from the vein, mostly in local or systemic lesions, venous blood flow or retention, blood Viscosity changes, venous thrombosis, inflammation of the vein wall, etc.; bleeding from the arteries is relatively rare, mainly in the vascular wall local atherosclerosis or vascular embolism. Chinese medicine believes that: blood temperature is blood, blood stasis is blood coagulation, clinical qi deficiency or qi deficiency is delayed, or qi stagnation is blocked, it is easy to cause upper fundus hemorrhage, blood stasis block the eye, often leading to floating clouds in front of the eye, such as The flag is shaken, and the black spot is not seen. Repeated attacks can cause eye pain and so on until blindness.

Cause

There are many eye diseases that cause retinal hemorrhage. The causes are:

(1) Mechanical obstruction, such as a blood clot.

(2) Inflammatory diseases or immune complexes invade the blood vessel wall, such as inflammation around the retinal vein, optic disc vasculitis.

(3) Systemic vascular disease and blood diseases such as hypertension, diabetes and other retinopathy.

(4) Retinal vascular abnormalities, the same pathological damage caused by various causes, such as retinal hemorrhage, exudation, microangioma, neovascularization and the like.

an examination

Related inspection

Ultrasound examination of the eyeball and eyelids for ophthalmoscopy and CT examination of the eye

Eye and sacral area CT examination --

CT examination of the eye and temporal region is a method of examining the eye and temporal region by CT.

The CT scan provides a high-resolution, cut-off image and gray-scale eye image that displays the human-level image with X-rays as an energy source. At present, CT has become very popular, providing a superior examination method for the diagnosis of ophthalmic diseases. However, for various reasons, there are still many problems in CT analysis and diagnosis of ocular lesions. Diagnostic ultrasound for intraocular disease is superior to CT, and CT is superior to ultrasound in the diagnosis of orbital lesions. This article discusses some of the problems in CT diagnosis of orbital lesions, and introduces the basic knowledge of CT related to diagnosis, which is very important for comprehensive analysis of ocular CT films.

Eye CT scanning method

1. Transverse scan: The patient is placed on the supine examination bed for continuous scanning from the top side of the 1cm skull below the ear line. The level of the 5mm thick layer of the straight axis requires 6-8 layers. For thin layer scanning (1 mm layer thickness), nearly 40 layers are required for all eyelids.

2. Coronal scan: The patient is supine or prone on the examination table, the head is over-extended, so that the sagittal line of the head is consistent with the bed surface. The ear lines on both sides are perpendicular to the scanning baseline, and the front ear canal is continuously scanned 4 cm in front of the ear canal. ~5mm). For CT scan of intraocular lesions, the eyeball begins to scan backwards.

3. Contrast enhancement method: The method of intravenous administration of contrast agent is to inject the contrast agent within a few minutes, and then start scanning after the full amount of injection is completed.

4. Pressing neck examination: When the internal CT scan of the internal iliac vein is not developed, or only a small part of the lesion is displayed, it is feasible to observe the whole range of the lesion and the neck pressure examination. Wrap the sphygmomanometer bag around the patient's neck, position it, pressurize it to 5.33 kPa (higher than the venous pressure), and then scan it. The balloon will be relaxed immediately after the scan.

5. Optic nerve and optic nerve scanning methods

Sometimes a detailed CT examination is required for detailed observation of optic neuropathy (tumor, trauma, etc.). First, a 1mm thin layer is needed, because the normal optic nerve is about 4mm thick, and the thicker layer is not conducive to analysis. The second special scanning angle is to make a scan line with a negative 15° to the ear line, and then let the patient's eye look upwards. At this time, the optic nerve is straight and parallel with the scan line. CT can observe the optic nerve on one level. The length of the inner section or even the inner section of the tube.

2. CT scan thickness of the eye

The thickness of the conventional ocular CT scan is 5 mm, and the normal height of the normal eyelid is about 40 mm. Therefore, the general horizontal scanning of 8 layers can include all the intraocular structures. The lesion in the iliac crest is large in size and is suitable for a scanning surface of 5 mm thickness. However, in some special cases or lesions requiring thinner thickness scanning, such as intrabulbar lesions, extraocular muscle lesions, optic neuropathy, or estimated lesion diameter less than 5mm, 3mm or 1mm layer thickness scan is required, otherwise the thickness is thick. Small, and only one level shows lesions, which is not conducive to diagnosis and analysis, and may even miss the display of lesions. Since the thin section is less affected by the volume average, the image resolution is improved, and the lesion is more clearly displayed.

intraocular pressure--

Diagnosis of glaucoma detection methods.

Ophthalmoscopy -

Fundus examination should be performed in a dark room. The patient takes a seat and the doctor can take a seat or stand. The right hand held ophthalmoscope is located on the right side of the patient.

Eye drops should be moderately used. Don't read newspapers and TV for a long time. It is recommended to take a rest for 2 to 3 minutes after 40 minutes. Don't be overly excited, tired, excited or angry, and maintain good and adequate sleep. At the same time, there is less smoking, less alcohol, less irritating food, and no tea or coffee.

Differential diagnosis

1. Suddenly the front of the eyes is dark, only manual or only light.

2. Suddenly there is a round black shadow in front of the eyes, not floating with the eyes turning, the object in the middle direction is completely missing, and the objects on both sides are blurred.

3. Suddenly, there is a line of black shadows in a certain direction, and the progress is rapid, and gradually increase, and finally, to cover the eyes, the object is blurred and cannot be distinguished.

4. Suddenly there was a red glow in front of him, and gradually increased, so that the red light was full and the object was unknown.

5. Aura of the disease, most of them have eye swelling, eyeball beating and other feelings.

6. Most recurrent episodes, each episode, there are some of the above symptoms, even if the blood does not retreat, when continuing to bleed, there may be some of the above feelings.

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