choroidal hemorrhage
Introduction
Introduction to choroidal hemorrhage Choroidal hemorrhage has important clinical implications. No matter how much bleeding is due to damage to the retina, it can cause permanent visual impairment, especially in the macula. Local choroidal hemorrhage is limited to the choroid, which is characterized by dark red, nodular or round masses of varying sizes. The surface has retinal blood vessels passing through it, and the retina is smoky gray or white, and the visual field appears at the corresponding position. dark spot. If the bleeding causes the macular area to be affected, the central vision is significantly reduced. The process of bleeding absorption is slow and generally lasts for several months. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: eye disease
Cause
Cause of choroidal hemorrhage
(1) Causes of the disease
There are many causes of choroidal hemorrhage, of which choroidal neovascularization is an important cause, mainly seen in age-related macular degeneration and macular degeneration in high myopia, usually bleeding close to the macular area, causing a sudden drop in central vision, in addition, central exudative choroidal retina Lesions, acute choroiditis, optic disc edema, traumatic choroidal rupture, idiopathic polypoid choroidal vasculopathy, and systemic diseases such as hypertension, arteriosclerosis, hematological diseases, diabetes, etc. may occur in choroidal hemorrhage, except In addition to the situation, the choroid has a severe massive fulminant hemorrhage called choroidal bleeding.
(two) pathogenesis
Most of the choroidal hemorrhage comes from the choroidal supply artery, that is, the posterior ciliary artery. Pathological studies have found that the affected eye has necrosis and rupture of the posterior ciliary artery. There are several risk factors:
1. In glaucoma clinical and pathological reports, many cases have glaucoma.
2. Hypertension and arteriosclerosis This disease is more common in the elderly and has varying degrees of arteriosclerosis and hypertension. Therefore, it may be one of the important factors in this disease, but there are also reports of congenital cataract patients in infants and young adults. This disease occurs during surgery.
3. Other systemic diseases and eye diseases such as diabetes, bleeding quality, polycythemia and increased vascular fragility and other systemic diseases such as high myopia, central retinal vein occlusion and choroidal vascular sclerosis.
4. Problems related to surgical operation When the internal eye surgery is performed, the incision is too fast, and the intraocular pressure suddenly drops to the atmospheric pressure level, which may cause the choroidal large or posterior ciliary artery to rupture from the sclera into the suprachoroidal space, and the eyeball is not in operation. Proper compression, excessive loss of vitreous, etc., may increase the incidence of this disease.
Zauberman passed the experiment and concluded that the vortex vein was blocked during the operation of the inner eye, and the excessive anesthetic or the hemorrhage caused by the hemorrhage after the ball was injected, which could cause the vortex venous return to be blocked, showing the choroidal vessel highly dilated and hyperemia. When the intraocular pressure drops, the blood vessels rupture and bleed.
Prevention
Choroidal bleeding prevention
In order to prevent the occurrence of this disease, a comprehensive examination before surgery, including vascular fragility and coagulation function check, control blood pressure and intraocular pressure; operation should be light and easy to avoid eye spillage too fast.
1, usually pay attention to rest do not overuse the eyes. Avoid "eyes", pay attention to frequent and complete blinking movements, often blinking to reduce the exposure of the eyeball to the air, to avoid tear evaporation.
2, to maintain good living habits, adequate sleep, do not stay up late. Avoid running the computer continuously for a long time, pay attention to the rest in the middle, usually operate for 1 hour and rest for 5-10 minutes. You can look at the distance or do eye exercises while you are resting.
3. Usually pay attention not to direct light to the eyes. Also prevent eye injuries. Active treatment of the primary disease, so as not to cause choroidal bleeding.
4. Maintain a good working posture. Maintaining the most appropriate position, allowing both eyes to look flat or look down slightly on the screen, so that the neck muscles are relaxed and the area of the eye exposed to the air is minimized.
5, eat a variety of fruits, especially citrus fruits, you should also eat green vegetables, food, fish and eggs. Drinking plenty of water can also help to reduce dry eyes.
6, air conditioning does not blow too long, to avoid air flow in the seat, and put tea near the seat to increase the surrounding humidity.
7. If the eyes are red, there is burns or foreign body sensation, the eyelids are heavy, the things are blurred, and even the eyeballs have pain or headache. After the break, there is still no obvious improvement, then you need to go to the hospital.
Complication
Choroidal bleeding complications Complications
The eye content is out and the eyeball is damaged.
Symptom
Symptoms of choroidal bleeding Common symptoms Increased intraocular pressure Spontaneous intrabulbar hemorrhage Severe pain Irritability
If it occurs during surgery, it can be seen that the wound is lifted, the iris and lens are moved forward, the contents of the eye are released from the wound, the lens is self-extracted, and a large amount of vitreous is overflowed, followed by retinal and choroidal prolapse. Finally, bright red blood continuously flows from the eye. Local anesthesia patients often have irritability and severe pain. This is a typical manifestation of a patient with severe choroidal hemorrhage in a large incision surgery. In mild cases, the bleeding is less or slower, and the intraocular pressure is closed after the wound is closed. Elevated, bleeding stopped, and the upper choroidal space was seen under the fundus.
Examine
Examination of choroidal hemorrhage
Choroidal hemorrhage examination items: blood sugar, clotting time.
Conduct laboratory tests related to primary diseases such as diabetes and hemorrhagic diseases, such as blood sugar, bleeding and coagulation indicators.
The sugar in the blood is called blood sugar, and in most cases it is glucose. Most of the energy required for cell activity in various tissues in the body comes from glucose, so blood sugar must be maintained at a certain level to maintain the needs of various organs and tissues in the body. Normal blood glucose: Normal people have a fasting blood glucose concentration of 80 to 120 mg% in the morning.
The onset of the disease is sudden, and after the condition is stable, ultrasound examination can be considered to confirm the retinopathy caused by choroidal hemorrhage.
Diagnosis
Diagnosis and diagnosis of choroidal hemorrhage
1. Fundus hemorrhage: A common manifestation of many fundus vascular lesions. Systemic vascular and hematological lesions can be reflected from the retina and its blood vessels, and can also directly cause hemorrhagic lesions in the retina.
2, retinal vasculitis: retinal vasculitis like a non-intentional perivascular invasion of the blood vessel wall to form a white sheath. Invasive arteries or arteries are rare, and most are affected by both.
