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Diseases of the vitreous body

Last updated: April 19, 2021

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The vitreous body is the transparent, gelatinous substance that fills the space of the eye between lens and retina. It allows light to pass from the lens to the retina and normally has enough mass to maintain the eyeball's spherical shape and counteract retinal detachment. This article covers the most common diseases of the vitreous body, including posterior vitreous detachment and vitreous hemorrhage.
Posterior vitreous detachment is the separation of the posterior vitreous cortex from the internal limiting membrane of the retina. Etiologies include age-related degeneration of the vitreous tissue, elongation of the ocular bulb, and eye injuries. Patients are usually asymptomatic, but may complain of floaters and photopsia. Vitreous detachment is confirmed on slit lamp examination. Asymptomatic individuals do not require treatment. Symptomatic individuals with retinal injury (e.g., retinal tears/holes, retinal detachment) require prompt treatment with, e.g., laser photocoagulation.
Vitreous hemorrhage is the extravasation of blood into the vitreous body and its adjacent structures. It can be caused by trauma and a variety of diseases, e.g., proliferative diabetic retinopathy, posterior vitreous detachment, and tumors. Clinical features include painless sudden onset of unilateral floaters and/or visual loss. Slit lamp examination confirms the presence blood in the vitreous body. Initially, a wait-and-see approach is recommended, since the condition typically resolves spontaneously. However, if the retina is affected or severe disease progression occurs, vitrectomy is indicated.

The sudden onset of floaters and/or the perception of flashes require urgent examination of the ocular fundus to rule out retinal injury!

Refernces:[1]

Refernces:[2][3]

Refernces:[3]

Infants with leukocoria should be examined for the presence of life- or sight-threatening conditions, such as retinoblastoma.

A severe increase in floaters accompanied by photopsia is a typical symptom of acute posterior vitreous detachment, which bears a risk of retinal tearing and retinal detachment.

Showers of floaters indicate the presence of free cells in the vitreous and are usually associated with vitreous hemorrhage.

Synchysis scintillans (cholesterolosis bulbi)

Asteroid hyalosis (synchysis nivea) [6]

  • Definition: degenerative liquefaction of the vitreous body involving vitreous opacities due to deposits of fatty calcium salts
  • Etiology
  • Clinical features
    • Usually asymptomatic
    • Unilateral floaters or vision loss may occur
  • Diagnostics
  • Treatment
    • Not indicated (since typically asymptomatic)
    • Vitrectomy if vision is significantly impaired
  1. Reichel E, Duker J, Goldman D, Fein J, Vora R. Handbook of Retinal Disease: a Case-based Approach. JP Medical Ltd ; 2015
  2. Medina CA, Townsend JH, Singh AD. Manual of Retinal Diseases. Springer ; 2016
  3. Vitreous Hemorrhage: Diagnosis and Treatment.
  4. Flaxel CJ, Adelman RA, Bailey ST, et al. Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern®. Ophthalmology. 2020; 127 (1): p.P146-P181. doi: 10.1016/j.ophtha.2019.09.027 . | Open in Read by QxMD
  5. Vitreous Floaters. https://www.ncbi.nlm.nih.gov/books/NBK470420/. Updated: May 21, 2020. Accessed: February 18, 2021.
  6. Milston R, Madigan MC, Sebag J. Vitreous floaters: Etiology, diagnostics, and management. Surv Ophthalmol. 2016; 61 (2): p.211-227. doi: 10.1016/j.survophthal.2015.11.008 . | Open in Read by QxMD