Ophthalmopathy
eye diseases
What would cause blindness from bleeding behind the eye?
May 25th
Trauma is the first reason of the blindness from bleeding behind the eye. Such as orbital compound fractures and orbital emphysema(often seen in medial orbital wall fractures) that are caused by fighting, skiting, falling and traffic accidents related to the head and faces.
The second reason is hypertension or high level blood-fat and cholesterin that would occlude the vessels behind the eye. Occlusion would finally lead to bleeding.
Tumor, general blood system diseases like leucocythemia are the uncommon etiological factor.
Schwartz syndrome: retinal detachment with high intraocular pressure
May 11th
Schwartz syndrome: retinal detachment with high intraocular pressure
A famous painter of 40 years old man in local came to me with his left eye seeing blur and covered for a month. No swelling feelings of his both eyes. But the intraocular pressure are OD 55mmHg, OS 35mmHg. I dilated both eyes. His left retina were nearly fully detached. Right eye had 4 hole in different three peripheral zones. So scleral buckling was performed on the right eye and vitrectomy performed on the left eye. A lot of tiny holes were found in the left eye during operation process. Pneumatic retinopexy was inevitablely.
Retinal detachment always accompanies with low intraocular pressure. But Schwartz syndrome do the opposite. The reason is that aqueous humor secretion increases when peripheral retina drawed by the contraction of the vitreous body. And inflammations occurs at the trabecular meshwork. When the retinal detachment is repaired, the IOP will down.
Lymphoepithelial carcinoma in orbit
May 3rd
lymphoepithelial carcinoma in orbit
A middle age man with manifestation of right eye swelling and without pain, eye movement disability and exophthalmos. CT scan was made to define the limitation and location of the tumor. A 3.0mm*2.5mm tumor was extracted from the upper orbit in the surgery. Pathology and immunization results demonstrated as follow:
I supposed that the tumor was a metastatic one. Maybe origined from nasopharynxor sinus nearby. But the CT image didn’t show anything.
There were four articles mentioned in the pubmed.
1. [On a primary lymphoepithelial tumor (Schmincke) of the orbit]
2. A 20-year series of orbital exenteration.
3. Lymphoepithelial carcinoma of the maxillary sinus with orbital invasion.
4. Visual loss secondary to orbital apex invasion as the first manifestation of recurrent nasopharyngeal carcinoma.
This kind of tumor occured in orbit was rare and need more research.
Vitrectomy and a young man with type 1 diabetes mellitus
Apr 20th
Vitrectomy and type 1 diabetes mellitus
A 20 years old undergraduate who was a patient of type 1 diabetic mellitus, had a vitrectomy surgery days ago because of the proliferative diabetic retinopathy. There were heavy multiple hemorrhages and neovascular tissues in front of the retina. Fortunately, the retina detachment was not total because of the 8 times laser therapy on the retina pre-surgery. A lot of time was spent on the removal of the neovascular tissue in surgery.
As we know, diabetic retinopathy is one of the leading causes of blindness in the world. The diabetic retinopathy does not occur for at least 3-5 years after the onset of this systemic disease. Vessels bleed, massive vitreous hemorrhage may cause sudden visual loss.
Patients with type 1 diabetes mellitus was recommended to ophthalmologist within 3 years after diagnosis and reexamined on at least an annual basis. Type 2 diabetic patients should be referred for examination at the time of diagnosis and reexamined at least annually.
Diabetic retinopathy was divided into nonproliferative and proliferative categories. The rate of proliferative is 50\% in 15 years. Macular edema would also happen during disease process.
Argon laser panretinal photocoagulation is usually indicated in proliferative diabetic retinopathy. Because it can significantly reduce the chance of massice vitreous hemorrhage and retinal detachment. Like the 20 years old man, four times argon laser panretinal photocoagulation in each eye reduced the risk of the total retinal detachment. We pity that the man was sent to us too late because the early vitrectomy for severe vitreous hemorrhage and proliferative diabetic retinopathy was a good means to vision restored or maintained.
Now the patient only has hand movement visual acuity.
Congenital cataract of a young man
Apr 17th
Congenital cataract of a young man
I met a young man came to me asking for eye routine test. I found both of his eyes are presenting crystal lens local opacity. Left lens is more severer than right. I asked him to alternately cover one eye to feel which eye could see more clearly. He could not tell which one. You know, some of mild congenital cataract does not effect visual acuity.
Relation between sleep quality and glaucoma
Apr 17th
Relation between sleep quality and glaucoma
As we know, glaucoma is a blind leading disease. The crowd people of glaucoma have more or less psycho manifestations,such as anxious, insomnia, tension, and sensitive. Some of them take diazepam to help them to sleep or sleep well. But do you know, diazepam would increase the intraocular pressure and accelerate the process of glaucoma. So if you are taking diazepam or some kind of these medicine, quickly drop it and consult your doctor. Or your visual acuity left would lose. Have a good sleep quality means a significance.
Right eye blur for a year after a beat by the fist when box trainning
Apr 16th
Right eye blur for a year after a beat by the fist when box trainning
A 20 years old boy who is a boxer occasionly found his right eye could not see clearly when covered the other eye in one morning. He came to us with his right eye blur for a year after a beat by the fist when trainning. For a year, he felt no eye pain, red eye, swelling, omiting and so on. I examed the fundus with three mirror contact lens. And found the retina was nearly detached from the inner eye wall, and with server proliferation. The proliferation zone reached as far as to the ora serrata. The crystal lens was also a little opacity caused by the retina detachment. So I performed vitrectomy on him. Since the retina was in heavy PVR, three big hole were found in the peripheral retina. This was the typical presentation of ora serrata truncation. The peripheral retina incision was inevitable. The aim to do this was to preserve some central visual acuity for him. And I supposed his sport career was terminated after this surgery. Silicon oil was injected to support the retina to recover and adhere to the choroid.