Blood diseases and eye changes

Blood diseases affect all systems and organs, including the organ of vision.

In anemia (aplastic, hypochromic, pernicious, secondary) there is pallor of the skin and mucous membranes, hemorrhages under the conjunctiva and into the thickness of the eyelids, which are based on tissue hypoxia, paralysis of the external muscles of the eyeball may occur. Characteristic symptoms are dilation of the retinal vessels, microaneurysms of the vessels, hemorrhages in the form of stripes, smears along the vessels or rounded if they are located in the outer layers of the retina. Most often, hemorrhages are concentrated around the optic nerve and the macula. Preretinal hemorrhages and hemorrhages into the vitreous body may be observed. The most severe manifestations of anemia are exudation in the form of a star figure in the macular area, as well as exudative retinal detachment and congestion of the optic nerve head.

In leukemia, microcirculation disorders are detected in the vessels of the conjunctiva of the eyeball. This manifests itself in the unevenness of the caliber and tortuosity of the veins, the formation of single aneurysms. As the process progresses, arterioles narrow. In some patients, microthrombi of the conjunctival veins are detected. In the late stages of the disease, almost half of the patients have subconjunctival hemorrhages, which are more pronounced in chronic myeloblastic leukemia.

A feature of the fundus in leukemia is a general pale background with a yellowish tint, decolorization of the optic nerve head, blurring of its borders due to peripapillary edema of the retina. In acute leukemia, 15% of patients have a congested optic nerve head. The retinal vessels are pale, accompanied by white stripes. In chronic lymphocytic leukemia, the earliest changes in the vessels are dilation and tortuosity of the retinal veins, unevenness of their caliber.

As the process progresses, narrowing of the retinal arteries is observed, and in the terminal stage, their expansion (a prognostically unfavorable sign). Oval or round hemorrhages, bordered by a reddish ring, are characteristic only of leukemia. Preretinal hemorrhages may also be observed. The cause of hemorrhages is thrombocytopenia, anemic dysproteinemia, and the anticoagulant effect of globulins.

In myeloid leukemia, the retina has many nodules rising above its surface, surrounded by a ring of hemorrhages - myelomas. Similar formations are present in the bones and dura mater, but they cannot be seen there. The fundus is pale, the optic disc is difficult to detect. Vascular tone is reduced, an artery cannot be distinguished from a vein: visual acuity is reduced in the presence of centrally located myelomas and hemorrhages.

Quite often, eye symptoms are detected earlier than other clinical manifestations of the disease.

Treatment of eye manifestations is carried out jointly with a hematologist. In case of massive hemorrhages in the retina, general treatment is supplemented with angioprotectors (dicynone, ascorutin) and corticosteroids (locally - dexazone in drops).

In the stage of improvement of the general condition of patients, the condition of the organ of vision also improves. A tendency for resorption of hemorrhage in the retina has been established.

In hemorrhagic diathesis, general increased bleeding is observed. Hemorrhages are found in the conjunctiva and in the inner layers of the retina near the optic nerve head. Hemorrhages are often accompanied by exudation.

In erythremia, due to changes in the rheological properties of the blood, microcirculation is disrupted, which leads to the formation of blood clots in both small and large vessels of the retina. The optic disc is swollen, red, the veins are tortuous and dilated, and there are a large number of hemorrhages around them. The arteries are unchanged. The fundus is dark and cyanotic. Studying changes in the fundus in blood diseases allows for a timely diagnosis, monitoring the dynamics of the process and the effect of drugs, and assessing the prognosis.

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