Retinal edema

Introduction Macular capillary lesions caused by trauma and various pathological changes in the brain and the fundus cause abnormalities in the local retinal microcircles, resulting in damage to the blood-retinal barrier. A type of symptom that causes blood circulation disorders.

Cause

Renal-angiotensin-aldosterone plays an important role in local optic disc ischemia. The anterior ischemic visual lesion is caused by the interference of the blood supply to the optic disc and the slow and slow phase of the axial flow. Increased intracranial pressure caused by various causes; intracranial tumor, intracranial inflammation, brain abscess, cerebral parasitic disease, intracranial hematoma, venous sinus thrombosis and benign intracranial hypertension.

an examination

Related inspection

Ultrasound examination of the eyeball and eyelid and CT examination of the temporal region

Clinical manifestations include optic disc congestion, redness, unclear borders, disappearance of physiological cup depression, optic disc bulge, retinal vein filling, thickening, venous pulsation disappeared, physiological blind spots enlarged, optic disc and retinal hemorrhage, retinal edema and exudation, In the later stage, the optic disc was pale.

There are two types of pathologically:

Intracellular edema: refers to the accumulation of liquid inside the cell, causing the turbid swelling of the cell itself. Due to sudden circulatory blockage, acute hypoxia or poisoning, retinal lining cells and nerve fibers are hypoxic edema. At this time, the protein in the cell disintegrates, the permeability of the cell membrane changes, and the cell body absorbs water, making the retina grayish white. turbid. The extent of edema depends on the blocked blood vessels. If the central artery is obstructed, the entire retinal edema; when the branch artery is obstructed, there is edema only in the range of supply of the artery; when the anterior capillaries are blocked, the edema is smaller, and irregular cotton-like edema is called Soft exudation or cell-like body.

Extracellular edema: accumulates in the extracellular space of the fluid, mostly due to the blood-retinal barrier, that is, the retinal vascular endothelial cells rupture, and the capillary permeability changes, resulting in an increase in extracellular matrix fluid. The location of fluid accumulation can be divided into superficial retinal edema and deep retinal edema. The surface edema of the retina comes from the superficial capillary network of the retina, and the fundus is in the shape of a cloud-like scorpion, which loses normal reflection, and the optic nerve fiber bundle around the optic disc is separated by edema and becomes conspicuous. After the edema subsides, the lipids are left behind, distributed in the posterior part of the fundus, or scattered or fused. In the macular area, the Henle fibers are arranged in a radial shape, which is called star exudation. Surface retinal edema and lipids do not show fluorescence during fluoroscopy. Deep retinal edema originates from the deep capillary network, and the liquid mainly accumulates in the outer reticular layer. It is characterized by thickening of the posterior pole of the fundus, retinal folds, and foveal reflexes. It is different from superficial edema, mainly in the macular area, which damages central vision and can also show petal-like edema in the process of fluorescein.

Differential diagnosis

Retinal Roth plaque: Retinopathy has the most bleeding, fan-shaped or round, may have a white center, and sometimes only a round white spot on the fundus is called the Roth point.

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.

Retinal vein occlusion is a common fundus vascular disease. Its incidence is higher than arterial obstruction. Most cases occur in middle-aged and older, males are slightly more than females, often with monocular onset.

Retinal detachment is the separation of the neuroepithelial layer of the retina from the pigment epithelial layer. There is a potential gap between the two layers, and the liquid retained in the gap after separation is called subretinal fluid. According to the cause, it can be divided into rhegmatogenous, traction and exudative retinal detachment. The part of the retinal detachment does not work properly, and the brain accepts incomplete or total loss of images from the eye.

The cause of retinal vascular occlusion is mostly caused by arterial spasm, but it can also be caused by embolism (such as endocarditis, embolus formed by cardiac surgery) or thrombosis (such as endarteritis). Because the central retinal artery is a peripheral blood vessel, there is no collateral connection. Once the obstruction occurs, the retina of the blood supply area will be hypoxic, hypoxic, edematous, degeneration, necrosis and even atrophy, thus causing severe damage to vision.

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