No red light reflection in the fundus

Introduction Grade IV of blood volume of glass volume refers to no red light reflection at the fundus. Vitreous hemorrhage is a common complication of visual impairment caused by ocular trauma or fundus vascular disease.

Cause

The cause of no red light reflection at the fundus:

(1) Causes of the disease:

For any reason, the retinal vascular blood vessels or new blood vessels are ruptured, and blood flows out and accumulates in the vitreous cavity to form vitreous hemorrhage. Normal human vitreous is avascular, but retinal neovascularization can grow into the vitreous, or vitreous vascular tissue proliferation. Ocular trauma and fundus vascular disease are common causes of vitreous hemorrhage in the clinic.

1. Vitreous volume caused by ocular trauma or surgery: eyeball penetrating injury or blunt contusion can cause traumatic vitreous hemorrhage. In the corneoscleral penetrating injury, scleral perforation and foreign body injury in the posterior segment of the eye, the incidence of vitreous hemorrhage is very high. The instantaneous deformation of the eye caused by eyeball contusion can cause rupture of the choroid of the retina and hemorrhage; the anterior vitreous hemorrhage can be caused by damage to the ciliary body.

Surgical vitreous hemorrhage can be seen in cataract surgery, retinal detachment repair surgery, vitreous surgery, and the like.

2. Spontaneous vitreous hemorrhage: more diseases are involved. There are mainly retinal vascular diseases, such as diabetic retinopathy, retinal vein occlusion, Eales disease, retinal aortic aneurysm, etc.; posterior vitreous detachment or retinal tear formation; wet age-related macular degeneration; inflammation, degeneration or tumor of the choroid of the retina. Clinical analysis of 151 cases of monocular vitreous hemorrhage except for two causes of diabetes and ocular trauma found that the main cause of bleeding was retinal tear formation (42%) and retinal vein branch obstruction (37%). Some blood system diseases such as leukemia and retinoschisis can also cause vitreous hemorrhage, but it is rare. In diabetic patients, retinal neovascularization is a precursor to vitreous hemorrhage. If no treatment is done, about 27% of the vitreous hemorrhage occurs within 5 years. The loss of vision due to bleeding, accounting for 60% of patients who cannot recover by blood self-absorption.

(2) Pathogenesis:

Vitreous blood can come from the posterior retina, optic disc and choroid, but also from the iris and ciliary body in the anterior segment of the eye. For aphakic eyes, bleeding is more likely to enter the vitreous. A small amount of bleeding is easy to absorb, and there are no sequelae. More bleeding is difficult to absorb, and there may be cholesterol deposition, hemoglobin deposition, partial liquefaction of the vitreous, partial concentration and detachment. A large amount of bleeding can also cause red blood cell degeneration to form a ghost cell, which occurs in blood cell or hemolytic glaucoma. Repeated massive bleeding can stimulate the proliferative response of the eye to form a dense fibrous proliferative membrane with neovascularization. The neovascularization of this membrane is easily ruptured and causes repeated bleeding, and it can contract to produce retinal tears and traction retinal detachment, and form a complicated cataract or even atrophy of the eye.

an examination

Related inspection

Fundus examination, ophthalmologic examination, slit lamp, visual acuity, and CT examination of the temporal region

Examination and diagnosis of no red light reflection at the fundus:

The symptoms, signs, course of disease, prognosis and complications of vitreous hemorrhage mainly depend on the primary disease and the amount of bleeding caused by bleeding, and the number of bleeding.

Spontaneous hemorrhage often occurs suddenly, can be a small amount of bleeding, and many form a dense blood clot. When a small amount of bleeding occurs, the patient may not be aware of it, or only "floating mosquitoes"; when more bleeding occurs, the patient may notice that the shadows in front of the eyes are fluttering, or there may be obscuration of red glass sheets, and patients with repeated bleeding may consciously "smoke". Visual acuity decreased significantly. Ophthalmic examination can show that red blood cells accumulate in the scaffold of the vitreous gel when there is less bleeding and does not affect the observation of the slit lamp. A moderate amount of fresh bleeding can be a dense black strip of turbidity. A large amount of bleeding caused no red light reflection at the fundus, and the vision decreased to the light.

As time goes by, the blood in the vitreous is dispersed, the color becomes lighter, and the vitreous body gradually becomes transparent. More blood absorption takes 6 months or more than 1 year. In the absence of significant fundus lesions, vision may be completely or largely restored. In the posterior segment of the eye with a large amount of vitreous hemorrhage, half of the patients may lose useful vision.

1. Determining the primary disease: According to the cause of the hemorrhage and clinical diagnosis, it is of great value to check the contralateral eye. The diagnosis should include the primary disease, or traumatic and comorbidities.

2. Definition of bleeding volume: According to the degree of vitreous opacity, it can be divided into 4 grades, grade I, which means that a small amount of bleeding does not affect the fundus observation; level II refers to the red light reflection of the fundus, or the upper peripheral part. Retinal blood vessels can be seen; Grade III means that some of the fundus has red light reflection, and the lower half has no red light reflection; Grade IV refers to no red light reflection at the fundus.

Differential diagnosis

There are no red light reflections on the fundus that are confusing:

Posterior vitreous detachment caused by vitreous hemorrhage should be distinguished from retinal detachment in the diagnosis of ultrasound images. The detached retina often has a high-amplitude echo, and the retinal echo does not change much when the sensitivity is changed. The detached retina can often be traced to the attachment or optic disc, and the traction retinal detachment will exhibit a pulled configuration. After the simple vitreous detachment, the posterior vitreous interface has obvious post-movement when the eyeball rotates, and the echo amplitude is weakened when the sensitivity of the machine is lowered. Therefore, the ultrasound examination can determine the degree of posterior segmental trauma and vitreous hemorrhage, whether or not there are lesions such as retinal detachment, can determine the visual prognosis, and can be repeated if necessary.

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