Eye is important, but at the same time a very fragile body, which is often subjected to injuries and diseases. One of the common ophthalmological pathologies is bleeding into the front chamber of the eye, or the gifem.

What is a gifema

The gifema is a condition that is characterized by bleeding into the front chamber of the eye.

The front camera of the eye is a space that is limited in front of the cornea and rear - iris.

The hyphem is characterized by hemorrhage into the front chamber of the eye

The source of bleeding (hemorrhage) is the iris - this is an anterior vascular, which is actively branched. Also, the hyphem is formed due to the breaking of the vessels of the ciliary body, the function of which consists in the implementation of accommodation using muscle fibers, as well as the production of water and moisture.

Accommodation is the ability of the eye well to see objects located at different distances.

The amount of blood that flies into the front chamber of the eye can be different: from the microhydham, which can be seen only during microscopy, to the total hyphem, when the entire cavity is filled. Depending on this, the following severity of the condition is distinguished:

• 1 degree - blood volume in the front chamber less than 1/3;
• 2 degree - blood fills the front chamber by more than 1/3, but less than half;
• 3 Degree - blood is most of the volume of the front chamber;
• 4 Degree (total) - the front camera is completely filled with blood, the eye has the appearance of "black".

Hemorrhage into the front chamber of the eye has a horizontal level, since blood, having a greater proportion, rather than a water-bearing moisture, under the force of gravity settles at the bottom eyeball.

When making a person horizontal position Blood seems to be "shaking", and the vision deteriorates, since weighted red blood cells and blood clot prevent the normal light in the light.

In addition, there is a coagulation (blood folding) with the formation of clots. The latter can block the outflow of water and moisture, which leads to an increase intraocular pressure and secondary glaucoma.

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The reasons

The main reasons for the hyphemus include:

1. Injuries:
   • penetrating - the integrity of the shells of the eye is disturbed, which is accompanied by bleeding into the front chamber;
   • imperformant - characterized by changing intraocular pressure and damage to the vessels of the iris.
2. Complications of operations. If the hyphem has developed during surgery, it does not carry such a state, since the bleeding can be successfully stopped. Serious consequences are fraught with recurrence (repetition) of hemorrhage during the recovery period.
3. Tomb of vessels in the vascular shell (with decomposed diabetes, the thrombosis of the eye veins, the oncological processes in the shells of the eye, etc.) new vessels are very thin, because with the smallest pressure change, they are destroyed and, as a result, bleeding.
4. Blood diseases. With such pathologies as hemophilia, thrombocytopenia, blood cancer, which are characterized by a disruption of the resulting blood function, are possible hemorrhages to the front chamber of the eye.

Symptoms

Depending on the volume of blood released into the front chamber, the symptoms of the hyphem may differ. However, there are a number of signs that help to diagnose this state:

The main manifestations of the gifem:

• worsening vision. In case of hemorrhage, the transparency of the shells of the eye changes, which interferes with unimpeded light rays;
• pellena before his eyes, clogging;
• nausea, vomiting (with an increase in intraocular pressure).

Diagnostics

Basically, the diagnosis of the gifem does not cause difficulties, the injuries in the history (illness history) and the presence of blood in the front chamber of the eye are directly indicated. However, in some cases, for example, with an estate clinical picture, a specialist will need to hold a number of additional studies, such as:

1. Victims. The acuity of sight is determined.
2. Bomicroscopy. Used in order to detect red blood cells, blood clots in the front chamber of the eye.
3. Gonoscopy. It is carried out after the risk of recurrence of bleeding in order to diagnose the change in intraocular pressure.
4. Computer tomography orbit. The integrity or degree of damage to bone structures during eye injuries is checked.

Treatment

Therapy of the gifema directly depends on the cause of the development of the state, the volume of bleeding, the presence of complications and related pathologies. The most favorable outcome is considered to be absorbing blood, which is observed several days after the injury gained. At the same time, auxiliary drug therapy is assigned. In more severe cases, they resort to surgical intervention.

Medical therapy - Table

Preparations appointed during hemorrhage - Gallery

Eye drops Dexatobropt
Actovegin - vessel reducing agent
Eye drops Icifrin
Aminocaproic acid - hemostatic drug

Surgical intervention

Indications K. operational treatment Gifema:

• extensive, not resolved after drug treatment of the gifema;
• uncontrolled eye pressure;
• the presence of sickle cell anemia in history (in the history of the disease).

Surgical intervention includes washing the front chamber, removal of blood clots. The postoperative period is characterized by the control of intraocular pressure for 5-7 days.

Prediction of treatment and possible complications

Basically, with timely handling for medical help It is possible to completely stop the bleeding and eliminate the consequences of the gifem. However, in some cases, especially during launched states, such complications are possible:

• blood leakage through the cornea;
• secondary glaucoma;
• worsening vision.

Preventive measures

In order to avoid complications and relapses, it is necessary to adhere to the following recommendations:

• regularly undergo inspections from an ophthalmologist;
• for a month to sleep with a raised head end;
• to avoid physical Loads, sharp shifts of the position of the body;
• if surgery was performed, wearing a protective bandage for the eyes within 2-3 weeks.

Thus, in the manifestation of similar symptoms, especially if there is an eye injury in history, you should immediately contact a specialist. It is important to remember that in the absence of adequate treatment of the hyphem, temporary impairment of vision can contact constant, up to full loss.

The gifema is a condition in which in the front chamber of the eye (the area of \u200b\u200bthe eyeball, limited in front of the cornea, and behind the iris and crystal) appears blood.

The amount of the washing blood may be different, from the hardly noticeable strip of blood visible only under the microscope, to pronounced when the blood fills the entire space of the front chamber of the eye. Due to the fact that blood is heavier than intraocular fluid, it always caution in the lower part of the front chamber.

When blood appears in the front chamber, visual acuity may decrease, which depends on the amount of blood, so with a pronounced gifem, the patient distinguishes only light in front of the eye.

Causes of gifema

There are three main reasons for the occurrence of the hyphem:

• Eye injury. Injury can be both with full damage to the shells of the eye (penetrating), and without damage - not penetrating, the so-called stupid injury.
  With penetrating injury, the shells of the eye with blood vessels occur and blood is poured into the front chamber.
  With imperimentant injury, bleeding occurs due to a sharp pressure drop inside the eyeball, in which either break blood vesselsor inner shells of the eye (Rainbow shell - the front of the vascular eye shell performing the function of the protective membrane; the cylinder body is part of the vascular shell of the eye, consisting of several muscles governing the change in the crystal shape; vascular sheath - choroid, provides power to the outer layers of the eye-sensitive eye sheath that is, the retina).
  Eye injury is the most common cause of the occurrence of the gifem.

• Operations on the eyeball. As a result of stripes and laser Operations On the eyeball, in the form of complication of the emerging during the operation, a hyphem may occur. In this case, the cause is damage to the vessels of the iris and ciliary body resulting in bleeding. As a rule, with this bleeding well coped during the operation. But after the operation, the hyphem can be observed until several months - due to the opening of bleeding again from the same vessel as on the operation, as well as the growth of newly formed vessels at the operating point.


• Eye diseasesunder which there is an increase in newly formed vessels on a rainbow shell, such as heavy, noncompensated diabetes, the consequence of severe thrombosis central Vienna retina, intraocular tumors and some others. At the same time, growing newly formed blood vessels has defective walls, and with the slightest vibration arterial pressure, intraocular pressure their wall is broken and bleeding occurs.


• General diseases of the body, for example, hemophilia, anemia, blood cancer, as well as alcohol abuse, which leads to a violation of blood coagulation, due to which bleeding without visible causes may occur.

Complications

The blood flowing into the front chamber can cause a number of complications. Most often, they are observed with the full filling of the front chamber with blood: the bladeing of the cornea with blood, it increases with time and leads to a decrease in vision, even if the gifema passes, since the proceeding of the cornea is very long cleaned. An increase in intraocular pressure or secondary glaucoma may be observed with different blood quantities, but more often with full filling the camera.

Diagnostics

If there is a gifem, it is necessary to establish its cause. If there is a mention of a recent injury, eye operation, then it may be the most probable reason.

If this was not, it is necessary to exclude all sorts of causes of the gifem. Both intraocular and systemic causes, the reception of drugs that dilute blood. All patients need to make blood test for coagulation.

Treatment

Options for treating patients with hypheth depends on the cause that caused hemorrhage, the amount of blood, which is in the front chamber, the presence of complications and the duration of the existence of hemorrhage.

To accelerate the absorption of the hypham, patients cancel the drugs diluting blood (anticoagulants, disagrements), if they were used. It is prescribed a hemostatic, vasculating, absorbing treatment. In the presence of systemic blood coagulation disorders - they are also treated.

In some cases, there are indications for the operation - blood removal or blood clot from the front chamber: if the cornea began to score with blood; If in the front chamber the blood curled and the blood clot was formed; If the front camera is completely filled with blood and it is not resolved in treatment for more than 5-10 days; If intraocular pressure and inefficient use of local and common drugs that reduce intraocular pressure have increased.

Gifema - blood clot formation in the eyeball as a result of injury or medical manipulations. Such a state leads to an increase in intraocular pressure and impaired light to the retina of the eye. For diagnostics use laboratory and instrumental methods of survey, according to the results of which the doctor will determine the most effective tactics of treatment.

The gifema eyes can be eliminated both conservative and radical methods. The question of hospitalization is solved individually, but perhaps treatment and outpatient, depending on the severity of the pathological process. Independently use any drugs, including eye drops (Lidase or Emoxipin) is not recommended.

The gifema in an easy degree does not represent a threat to health, but if the treatment is not started in a timely manner, it is possible to a significant reduction in the quality of vision. There are no clear restrictions on age and gender, but according to statistics, most often the hyphem is diagnosed in young people (18-20 years old) and in elderly people.

According to international Classification Diseases, the gifema refers to the section "Other diseases of the iris". Code of the ICD-10 - H21.0.

Etiology

The gifema of the organ of view may be due to the following etiological factors:

• mechanical damage to the eyeball as a result of blunt impact or medical manipulations;
• blood diseases under which are observed bad coatability;
• systemic diseases in which vascular walls are affected.

More than 70% of cases of gifema combined with.

Classification

According to the nature of the prevalence of the pathological process, these degrees allocate:

• microhyfehem - the presence of blood can be diagnosed only with the help of an ophthalmic microscope;
• limited - blood level is no more than 2 mm, there are blood smears on the iris;
• the average eye gifema is blood level from 2 to 5 mm;
• total hyphem - more than 5 mm of blood in the front eye chamber.

The severity of the pathological process is determined by the doctor through the necessary diagnostic measures.

Symptomatics

The gifema is clearly (with the exception of the microhydhem) is visible externally. In general, the clinical picture of such pathology is characterized as follows:

• reduction of visual acuity;
• flashing "Flies" before your eyes;
• increased sensitivity to light stimuli;
• feeling of the foreign body in the affected organ of vision;
• eye apple soreness;
• pellena or fog before your eyes.

Intensity of manifestation clinical picture It will depend on the severity of the pathological process, as well as on whether the patient has other ophthalmological diseases.

Diagnostics

In the presence of the above-described clinical picture, it is necessary to immediately seek medical care to an ophthalmologist. In most cases, the diagnosis does not cause complexity due to the specificity of the clinical picture, however, in order to determine the severity of the disease, as well as the likelihood of the development of complications, the following laboratory and instrumental diagnostic measures are carried out:

• measurement of intraocular pressure;
• CT eye orbit and brain;
• two-dimensional ultrasound examination of the organ of vision;
• inspection of the retina using a special microscope;
• biomicroscopy;
• inspection of the eye dna and adjacent soft tissues.

Standard laboratory tests do not represent diagnostic value, and therefore are carried out only with particular need.

Treatment

The issue of hospitalization is solved individually, but, as a rule, a patient is hospitalized with such a diagnosis. With microscopic form of the gifem, therapeutic measures are carried out outpatient.

The eye gifema treatment implies both conservative and radical.

Conservative therapeutic measures include:

• bed regime with raised headboard;
• imposing a bandage for an affected organ of vision;
• local processing glucocorticosteroids;
• receiving medication.

The doctor may prescribe the following drug drugs:

• analgesics;
• hemostatic;
• eye drops - lidase or emoxipin;
• M-cholinoblocators.

As a rule, such therapeutic measures lead to full recovery on the 2nd and 5th day.

The testimony for surgical intervention are the following factors:

• full filling in the blood of the front eye chamber;
• significant reduction in vision;
• impression of cornea with blood.

Also, the operation is assigned in cases where medicia treatment Does not give proper result.

In most cases, if the treatment is started in a timely manner, then significant complications can be avoided. Therefore, at the very first symptoms, it is necessary to contact the doctor, and not carry out treatment by independently specific drugs, such as emoxipin or lidase.

Possible complications

If this violation is not fixed in a timely manner, then the development of such complications is possible:

• reducing visual acuity or complete loss.

Prevention

The only effective method of prophylaxis with such a disease is to prevent injury to the eyeball. In the event that there are pathologies that lead to a violation of blood coagulation, then during injury, it is necessary to take appropriate drugs, and urgently seek medical help.

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Diseases with similar symptoms:

Sclerit is a serious illness of the visual apparatus, in which the inflammatory process affects the protein sheath of the eye (SCLEAR). The disease can be expressed as small reddish nodules and occupy the entire scler. Almost always affects only one eye, but depending on the species, it may be distributed immediately to two or alternately arise in both eyes. It occurs in women several times more often than in men. IN childhood It is expressed quite rare, most often appears because of the other inflammatory process in organism. It is complicated by what proceeds very painfully and can lead to impairment of vision.

- This is the pathological condition of the organ of vision, in which the blood is determined in the anterior chamber of the eyes. Clinical manifestations are "fog" or "paddy" before your eyes, a decrease in visual acuity, photophobia. The diagnosis of the gifem is based on the inspection of the front departments of the eye, biomicroscopy, gonoscopy, visometry, tonometry, ultrasound-scanning. Depending on the stage of the disease, the combined conservative treatment Corticosteroids and mydriatics. Operational intervention in the hyphem is reduced to washing the front chamber of the eye and carrying the trabeculectomy.

MKB-10

H21.0.

General

The gifema is a cluster of blood and blood clots in the front chamber of the eye as a result of injury, breaking of newly formed vessels or against the background of hematological diseases. The traumatic origin of the disease among male representatives is three times more often than in female. Other etiological options are distributed in ophthalmology in equal ratio. Patients after 40 years are more prone to the development of the hyphem. In infants, pathology develops very rarely against the background of the "Shaking" syndrome or congenital blood diseases. For the disease, a complicated course with a tendency to progression is characterized. In the absence of adequate treatment, the hyphem leads to full blindness. More than 35% of cases are recurrent to 2-5 days.

Causes of gifema

The key role in the development of the hyphemus is given by traumatic damage to the eyeball. With penetrating injury, the shells and vascular damage occurs, which leads to hemorrhage into the front chamber of the eye. Imperforming injuries due to stupid injuries are accompanied by an increase in intraocular pressure. The sharp rise in ISD provokes the rupture of blood vessels and the inner shells of the eyeball. The most often occurs damage to the iris, ciliary body and choroid. Hemorrhage can develop during surgical intervention during a strip or laser operation. The etiological factor is the damage to the vascular plexus of the iris or the ciliary body. The cause of hemorrhage B. postoperative period is the instability of hemodynamics and thrombus.

In some cases, the hypham is a consequence of the discontinuity of the newly formed vessels of the eyeball. The low degree of differentiation leads to the formation of a thin and fragile vascular wall, which is unstable to an increase in intraocular or systemic blood pressure. The process of neovascularization is characteristic of diabetes in the stage of decompensation, malignant choroidal melanoma, rosetosis of iris, pseudoglyoma and tombmeter of central veins of retina. Patients with oncohematological diseases in history (hemophilia, sickle cell anemia, thrombocytopenic purpura, vasculitis, acute or chronic leukemia) are most susceptible to the hemorrhages in the front chamber of the eye.

Symptoms of the gifema

The clinical picture of the gifem depends on the blood volume in the front chamber of the eye. With a microhydhem, the disease wears latent current. Sometimes patients note minor discomfort, hyperemia is not characteristic. For the first stage, the appearance of "fog" before the eyes. Patients can observe a narrow strip of red-brown when independent inspection. Under traumatic origin, the development of photophobia and painful syndrome is possible. In the second and third stage increase clinical manifestations: The blood level is noticeable at a distance, the paddle appears in front of the eyes, the vision decreases slightly. Neurological symptoms are joined: "Flies" before your eyes, headache, dizziness. Total, or "black", the gifema is accompanied by a complete loss of vision. A number of patients remain only light percement. Even after the treatment, the cornea is determined by the track number of uniform elements, which changes its painting and adversely affects visual functions.

Blood accumulation in the front chamber of the eye provokes an increase in intraocular pressure, which is a predictor for the development of secondary glaucoma. The remote complications of the hyphemus include the formation of the front synechs along the periphery of the eyeball. The combination of increasing ing, occlusion of blood vessels and contusion during traumatic hemorrhage leads to atrophy of the optic nerve. This pathology causes the splitting of the ciliary muscle and the offset of the iris and lens by the stop, as a result, the canal helmets narrows up to it full blockade. These circumstances, as well as the mechanical pressure of the accumulated volume of blood leads to the deepening of the angle, limited in front of the cornea and the scler, rear-cylinder body and iris, which underlies the recession of the angle of the anterior eye chamber.

Diagnosis of the gifema

The hyphemium diagnosis is based on an anamnesis data, an objective inspection, the results of the biomicroscopy of the eye, gonoscopy, visometry, toneometry, ultrasound-scanning. In history, most patients have traumatic damage to the eyeball, operational interventions, blood diseases or eye pathology, accompanied by an increase in angiogenesis processes. With objective inspection, the microhydhem is not determined. To verify it, you need to carry out microscopy intraocular fluidin which traces of blood shaped blood elements will be determined. At the I stage of the disease, the front camera of the eye is filled with blood on 1/3; at 1/2; at III - on 3/4. The stage of the stage is characterized by filling the entire volume of the front chamber with a red-brown hemorrhagic fluid.

The method of biomicroscopy using a slit lamp is determined by the pool of circulating erythrocytes in the fluid of the front chamber of the eye or solid blood. Other organic changes are detected as a result of injury (subconjunctive hemorrhages, refinement, sphincter gap iris, foreign bodies, etc.). Ultrasonic B-scanning allows you to visualize signs of traumatic damage even with a total hyphem and determine the source of bleeding.

The study of the anterior chamber of the eye by the method of gonoscopy is carried out no earlier than in 21 days after the relief of the hyphem. This study is necessary as screening for early detection of complications (front synechs, angle recession). The visometry is shown to monitor the view function after the treatment. At the I, stage II and the microhydhem, visual acuity is measured after the end of the course of therapy, on III, IV stage - 1 time per month. The method of tonometry is determined by the level of BGD, which increases with the development of glaucoma. All patients are recommended general analysis Blood (UAC) and coagulogram to eliminate the hyphem on the background of hematological diseases.

Treatment of gifema

Microhyfehema does not require special treatment. Conservative therapy At the I, II stage of the disease implies local application Drops of corticosteroids (prednisone) and midriats (atropine). The coal processes of fibrinolysis, corticosteroids prevent recurrence development. Aminocapronic acid has antifibrinolytic activity, which is used systemically. Atropine prevents the formation of anterior synechism, reduces the manifestation of photophobia, reduces the severity of the accommodation spasm. Upon increasing inhibitors, the oral intake of carboanhydrase inhibitors (acetazolamide, dorzolamide) is recommended.

The surgical treatment of the gifem is carried out on the III, IV stage of the disease. For washing the front chamber of the eye, two parallel paraventions are performed. In one of the holes, a balanced crystal-shaped solution is poured, blood and formed blood clots are removed through the second. Trabeculectomy improves blood outflows, leads to a decrease in WGD and eliminates the pupil unit. Obtaining postoperative fistula occurs independently.

Treatment of patients with sickle-cell anemia in history eliminates the use of carboanhydrase inhibitors. Preparations of this group reduce the partial oxygen pressure in the fluid of the front chamber, which leads to the deformation of the erythrocytes. The deformed shaped elements lead to the blockade of the outflow of intraocular fluid, which provokes an increase in BGD.

The treatment of the hyphem in most cases is carried out outpatient. Inpatient treatment is subject to a group of patients with high values BGD, non-drug correction, patients with blood pathologies and under 3 years old. Bed regime recommended with the highest possible restriction of motor activity. In bed, lie with a headboard raised by 40-50 degrees. Throughout the day, it is necessary to wear a protective flap on the affected eye.

Forecast and hyphemus prevention

Specific measures for the prevention of the hyphemus are not developed. Patients with a burdened history of blood disease must be carried out timely monitoring of hematological indicators. Dispensary observation Ophthalmologist 2 times a year are subject to all patients with diabetes and arterial hypertension. Persons with oncological diseases of the eye are subject to a detailed examination from the ophthalmologol, 1 time in 3 months. Timely treatment Provides a favorable forecast for life and health. The total reduction in visual acuity with further disability is possible in patients on the III, IV stage with inadequate or delayed operational intervention.

As a rule, three main reasons lead to the state of the hypheth:

Eye injuries.Such injuries are with damage to the shells of the eye (penetrating) and without damage - not penetrating, called stupid.

Penetrating injuries are characterized by breaking the shells of the eye and damage to the blood vessels, which is why blood is poured into the front chamber area.

With imperimental injuries, bleeding occurs due to a sharp drop of intraocular pressure, due to which blood vessels or inner shells of the eye (including the iris - the front wall of the vascular eye shell, which performs a protective function;, which is part of the vascular shell and consists of several muscles, Clarifying the form of the lens; the vascular shell - providing power to the outer layers). Eye injury - most frequent cause The occurrence of the gifema.

Operators. When carrying out stripe or laser operations in front of the eyes, the bleeding may occur as one of the complications of surgical intervention. In this case, the reason is the damage to the vessels of the iris and the ciliary body. As a rule, with such bleeding, surgeons cope in the process of operation. However, hefhams may be observed after surgery for several months. What is due to the bleeding of the affected vessel or the growth of the newly formed vessels, which takes place in the area of \u200b\u200bthe operational cut.

Diseases of the eyewhich are accompanied by the growth of newly formed vessels in the rainbow shell. Such diseases include: noncompensated diabetes, intraocular tumors, central veins thrombosis and some others. Growing newly formed vessels at the same time, have fragile walls that are broken at the slightest blood pressure, causing bleeding.

Common diseases of the body. Diseases provoking intraocular bleeding are considered: hemophilia, anemia, blood cancer, as well as alcoholism, leading to a decrease in blood coagulation, as a result of which bleeding and occur without obvious reasons.

Symptoms

Diagnosis of the gifema

The establishment of the gifem begins with the collection of anamnesis, including information about recent injuries and operations in the eyes, because these are the most likely reasons.

If nothing like this happened, it is necessary to eliminate the remaining causes of the occurrence of the gifema: systemic diseases, taking drugs for blood dilution. At the same time, the study of blood coagulation for all patients is required.

Complications of gifema

The blood flowing into the front chamber of the eye is able to cause a number of complications. Especially often such complications are observed with a significant fill in the blood of the anterior chamber.

These include:

Blood staining, which leads to a decrease in visual acuity due to the fact that it is absorbed very long, even if the bleeding itself has already been stopped;

An increase in intraocular pressure, called, often observed with different quantities of the blood.

Treatment of gifema

The treatment options are somewhat and the choice of one of them depends on the reasons that caused this condition, the amount of spectacular blood, the presence of complications, as well as the duration of the existence of hemorrhage.

Conducts are prescribed by hemostatic, vesselsfactory, absorbent agents. When the systemic disorders of blood clotting is detected, appropriate treatment is prescribed. To accelerate the resorption of hemorrhage, drugs diluted blood (disaggregants, anticoagulants) are canceled if they were used.

Sometimes there are indications for operational intervention - the removal of blood or its clots from the front chamber. The operation is necessary if the cornea began to be painted with blood; If blood has already rolled and formed a clutch; If the front camera is filled with blood completely and it is not resolved for 5-10 days when appropriate treatment; If an increase in intraocular pressure is observed, and the use of local or common preparations to reduce intraocular pressure is inefficient.

Having found suspicious symptoms, you need to show a sick doctor as soon as possible in order to put the correct diagnosis, assign adequate treatment and avoid the development of complications, to treat which will be much more expensive.