Hyphema and glaucoma
Introduction
Introduction to anterior chamber hemorrhage and glaucoma Hemorrhagic-related glaucoma includes anterior chamber hemorrhage, ghosting glaucoma, hemolytic glaucoma, and hemorrhagic glaucoma, with pre-clinical blood being the most common. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: iridocyclitis, vitreous hemorrhage, retinal detachment, amblyopia
Cause
Anterior chamber hemorrhage and glaucoma cause
(1) Causes of the disease
1. The contusion of anterior chamber blood in the anterior chamber is an important manifestation of eye contusion. The wounds include slingshots, throws, balls, and elbow injuries.
2. Internal eye surgery combined with anterior chamber blood With the popularity of microsurgery, the improvement of surgical techniques, the incidence of intraocular hemorrhage in intraocular surgery is getting lower and lower, and the cause of bleeding during glaucoma surgery is mostly due to posterior incision injury. The ciliary body, or due to excessive traction of the iris, damage the iris blood vessels, such as the position of the filter does not exceed the posterior edge of the limbus, generally does not damage the ciliary body, under the operating microscope, the ciliary body tone Deep, and not as easy to get out of the wound as the iris, if the pigmented membrane is found to bulge and the pupil is not displaced, it should not be easily cut. A small amount of anterior chamber blood after trabeculectomy may come from the sclera. In the middle of the sclera, the majority of the blood vessels are small and can be absorbed by themselves. Clinically, a small amount of anterior chamber blood is not absorbed for many days. It is associated with strong postoperative filtration and low intraocular pressure. Wound healing, elevated intraocular pressure, can be quickly absorbed, only a small amount of bleeding, elevated intraocular pressure, should consider anterior chamber irrigation, other intraoperative, postoperative anterior chamber hemorrhage surgery and ciliary body Separation, external trabeculectomy In the cataract surgery, the anterior chamber blood is often caused by blood infiltration at the incision and the rupture of the iris when the iris is broken or enlarged. At this time, the balanced saline solution or Healon is injected into the anterior chamber, and the bleeding can be stopped by a moment, and the bleeding is low. The concentration of adrenaline rinses the anterior chamber.
Postoperative cataract bleeding usually occurs 3 to 7 days after surgery, which may be due to defects in wound healing; UGH syndrome; secondary trauma and abnormal blood vessels in the anterior chamber (iris redness), resulting in a small amount Bleeding can be absorbed within a few days. The best treatment is observation. If the bleeding does not absorb or cause long-term high intraocular pressure and the risk of corneal blood staining, anterior chamber irrigation can be performed, and large bubbles are injected at the end to prevent further bleeding.
Another common complication is sputtering hyphema syndrome, which is a recurrent anterior chamber hemorrhage that occurs months to years after surgery and is associated with new blood vessels in the wound, which can be associated with eye pain. Vision loss, photophobia, iritis and elevated intraocular pressure require active treatment. The anterior chamber gonioscopic examination should be performed to determine the source and location of the bleeding. Abnormal blood vessels require argon laser photocoagulation, and Nd-YAG is performed through the sclera. Laser treatment is effective, the wound can be reopened, and the blood vessels can be stopped to stop bleeding or suture.
3. Spontaneous anterior chamber blood is less common in spontaneous anterior chamber blood, which can be caused by the following reasons.
(1) intraocular tumors: common in retinoblastoma, young yellow granuloma, other iris tumors including malignant melanoma, leiomyoma, hemangioma, neurofibromatosis, etc.
(2) blood diseases and vascular diseases: seen in hemophilia, leukemia, purpura, vitamin C deficiency, iris vascular plexus, etc., can cause spontaneous anterior chamber blood in a single eye.
(3) Hemorrhagic iritis: such as herpetic and diabetic iridoinopathy.
(4) iris reddening: seen in diabetes, central retinal vein occlusion.
(5) Fibrous vascular membrane hemorrhage after the lens or in the suspensory ligament region: found in the posterior lens fibrosis, residual primary vitreous proliferation, and the like.
(6) Delayed bleeding caused by blood dyscrasia and recessive trauma.
(7) Drugs such as aspirin cause platelet aggregation damage and prolonged bleeding time, causing anterior chamber hemorrhage.
(two) pathogenesis
The blunt external force acts on the cornea, causing the pressure in the anterior chamber to rise sharply, which in turn transmits pressure to the lens-iris compartment and the iris cornea angle, causing the lens-iris to move back and the sclera of the equator to expand, causing the iris aortic ring. A small artery ring of the iris, a branch of the ciliary body or a choroidal recurrent small artery or a rupture of the vein between the ciliary body and the superior scleral venous plexus, resulting in anterior chamber hemorrhage.
The outcome of anterior chamber hemorrhage: the most important discharge path of anterior chamber hemorrhage is through the aqueous drainage channel. Under the condition that the aqueous humor discharge system is complete, blood cells can be quickly discharged through the trabecular system, and all of them have been seen clinically. The case of anterior chamber hemorrhage disappeared completely within 24 hours, showing an astonishing speed. The earliest red blood cells marked with radioactive phosphorus were injected into the anterior chamber. It was found that the phosphorus-labeled red blood cells entered the blood circulation in the form of whole cells. Experiments also showed that Schlemm The cell wall of the wall is 5 ~ 6m, can pass the normal 6 ~ 8m size, elastic, deformable red blood cells, another secondary mechanism for clearing red blood cells is near the iris ring, the crypt near the iris The aqueous humor and red blood cells can enter the capillaries through the crypt. In some of the mechanisms for clearing red blood cells, the phagocytic function of the trabecular endothelial cells (the reticular endothelium of the anterior ocular system), the phagocytic cells phagocytose the broken red blood cells by phagocytosis of foreign bodies, hemolysis The role may be another unimportant mechanism of red blood cell loss, which can explain that most of the anterior chamber blood can disappear in a short time, if the anterior chamber Hemorrhage does not occur repeated bleeding, elevated intraocular pressure, corneal blood staining and optic atrophy, prognosis is good, most cases of anterior hemorrhage are absorbed within a few days, when the absorption begins, the blood clot shrinks and dissolves away from the corner, aqueous drainage Return to normal, otherwise it will cause elevated intraocular pressure, repeated bleeding, often accompanied by iritis, large pupil and obvious angle structure, lens, posterior segment and eyelid damage.
Prevention
Anterior chamber hemorrhage and glaucoma prevention
Pay attention to self-protection.
Complication
Anterior chamber hemorrhage and glaucoma complications Complications, iridocyclitis, vitreous, retinal detachment, amblyopia
1. Recurrent anterior chamber hemorrhage is a serious complication, referring to rebleeding after primary hemorrhage, the incidence rate is 6% to 38%, any degree of anterior chamber hemorrhage can occur recurrent bleeding, recurrence Bleeding often occurs 2 to 7 days after injury, which may be related to the release of fibrinolytic enzyme and clot constriction at this time. The amount of recurrent bleeding is often greater than the amount of primary bleeding, and recurrent bleeding may be heavier than that of the iris. In particular, arterial damage, bleeding is difficult to stop, may also be the damage of the ciliary body, bleeding from the posterior chamber and vitreous, so that the blood in the process of absorption and re-bleeding, from the vitreous, the posterior chamber to the anterior chamber, recurrence More than 1/2 of the patients with bleeding will have secondary glaucoma, the prognosis is poor, recurrent bleeding sometimes does not affect the visual prognosis, the real greater impact is the injury of the posterior segment of the eye, recurrent anterior hemorrhage often and more The damage of one organization coexists.
2. Corneal hemorrhage duration > 6 days, high intraocular pressure associated with large amount of anterior chamber blood and blood toxin directly attached to the corneal endothelium, degeneration of corneal endothelial function, permeability of corneal endothelium to blood cells Changes, red blood cells infiltrated into the corneal parenchyma, causing corneal blood staining. When the blood is attached to the corneal endothelial cells, blood staining is not easy to be found. When examined with a slit lamp, early blood staining shows a yellow granular change in the posterior corneal stroma. Or translucent red, corneal transparency decreased, this process can develop rapidly, sometimes the entire cornea is infiltrated by blood cells within 24h, with the degradation of platelets, the cornea appears bright, opaque green, can last for several years, and then corneal blood Dyeing starts from the periphery and gradually becomes transparent in a centripetal manner. In children, deprivation amblyopia can be caused by blood staining. It is worth noting that when there is corneal endothelium damage, normal intraocular pressure can also cause corneal blood staining.
3. Other comorbidities contusion of anterior chamber blood, in addition to complications caused by anterior chamber hemorrhage, may also cause combined damage of the eye and other tissues due to trauma, and other lens opacity (4% to 10%), Dislocation of the lens (6% to 7.3%), pupillary change (8%), iris damage (4%), anterior chamber angle retreat (60%, 10% of which is complicated by glaucoma), iridocyclitis (33% to 47%) , vitreous hemorrhage (4% to 13%), low intraocular pressure (13%), retinal concussion (33% to 74.34%), retinal hemorrhage (13%), retinal detachment (3%), scattered retinal pigmentation ( 18%), retinal serrated dissociation (4%), followed by eyelid and conjunctival laceration, corneal injury, orbital fractures are rare, some fundus complications, often found only 1 month after injury, severe Intraocular hemorrhage can lead to hemorrhagic ophthalmia (hemophthamitis), often ending with eyeball atrophy.
Symptom
Anterior chamber hemorrhage and glaucoma symptoms Common symptoms Increased intraocular pressure in the anterior chamber swelling...
The typical feature of anterior chamber hemorrhage is that there are red blood cells in the anterior chamber. The amount of bleeding often varies depending on the size, type, direction of action, and impact point of the wound. A small amount of anterior chamber blood is only in the slit lamp examination. There are a few floating red blood cells in the aqueous humor. It is called the anterior chamber of the microscope. When there is a considerable amount of blood in the anterior chamber, you can see that there is a layer of blood under the anterior chamber with the flashlight. How much, can be divided into 3 degrees: 1 degree anterior chamber blood (blood volume less than 1/3 anterior chamber), 2 degrees anterior chamber blood (1/3 ~ 1/2 anterior chamber), 3 degrees anterior chamber blood (greater than 1/2 to the whole anterior chamber), more than 50% of patients, the amount of bleeding in the anterior chamber 1/3 or less, 10% or less of patients, bleeding filled the anterior chamber, when the bleeding filled the anterior chamber became a blood clot before the occupation The room, or the blood clot machine embedded in the pupil collar into a figure-shaped double-leaf shape, when it is crossed before and after the pupil, it is called black globular or 8-spherical hemorrhage. At this time, the probability of secondary glaucoma is high, and the intraocular pressure after ocular occlusion of the anterior chamber is contused. Elevation is often temporary, and a few days after the bleeding, compared with the contralateral eye, can also show a lower level, the incidence of elevated intraocular pressure and the amount of bleeding Some people reported 235 cases of anterior chamber hemorrhage, the whole anterior chamber blood pressure increased by 52%, recurrent bleeding is prone to increase intraocular pressure, and another author reported 113 cases of anterior chamber hemorrhage, including recurrent bleeding glaucoma The incidence rate was 33%, recurrent bleeding was black globular, and 100% of glaucoma occurred.
Examine
Examination of anterior chamber hemorrhage and glaucoma
Blood-related bleeding, blood coagulation indicators and blood tests, such as the number of platelets, excluding bleeding disorders, blood biochemical tests, exclusion of diabetes and complications caused by diabetes.
B-ultrasound is very useful when the amount of blood in the anterior chamber is large. It can be used to determine the degree of damage in the structure of the eyeball, and it is also possible to detect tumors in the ball.
Diagnosis
Diagnosis of anterior chamber hemorrhage and glaucoma
Have a clear history of trauma, and according to the patient's clinical manifestations and auxiliary examinations can be glaucoma.
This disease is generally not confused with other diseases.
