Vitreous opacity: causes, symptoms, diagnosis, treatment

Opacities of the vitreous body may occur as a result of metabolic disorders in diabetes mellitus, hypertension, atherosclerosis, as well as inflammatory diseases of the vascular tract and injuries. The intensity of opacities varies from minor, like "flying flies", to coarse, dense opacities, sometimes fixed to the retina.

"Flying spots" are delicate opacities in the vitreous body (its altered and glued fibers), which, in bright light, cast a shadow on the retina and are perceived by the eye as dark formations of various sizes and shapes (wavy lines, spots) floating in front of it. They are most clearly visible when looking at a uniformly illuminated white surface (snow, light sky, white wall, etc.) and move when the eyeball moves. The phenomenon of "flying spots" is usually caused by initial destructive processes in the vitreous gel and often occurs in myopia and old age. Objective examinations (biomicroscopy, ophthalmoscopy) usually do not reveal opacities. Local treatment is not required; the underlying disease is treated.

With increasing destruction of the vitreous body, i.e. its liquefaction (transition from a gel to a sol), opacities in the form of flakes, stripes, ribbons, translucent films, etc. are detected in it, shifting with the movement of the eyeball. They are characteristic of filamentous destruction of the vitreous body, often observed in high myopia, severe hypertension, pronounced atherosclerosis in old age. Granular destruction of the vitreous body, manifested in the formation of a suspension of grayish-brown tiny grains (an accumulation of pigment cells and lymphocytes migrating from the surrounding tissues), is observed in retinal detachment, inflammatory processes in the vascular tract, intraocular tumors, and injuries. The process of progression of filamentous and granular destruction of the vitreous body can be suspended in the case of successful treatment of the underlying disease.

In old age and diabetes mellitus, destruction of the vitreous body with inclusions of cholesterol, tyrosine, etc. crystals floating during eye movement in the form of "silver" or "golden rain" is often observed. Deep destructive processes usually develop with high myopia, general metabolic disorders, and also as a result of trauma.

In inflammatory processes in the vascular tract and retina (iridocyclitis, chorioretinitis), opacities consisting of cellular and fibrous elements - exudates - appear in the vitreous body. The mechanism of their formation is as follows: cellular inclusions (leukocytes, lymphocytes, plasma cells) are deposited on the back surface of the lens and in the retrolental space, where they look like shiny small dots in the light of a slit lamp. Then these inclusions appear in large quantities in the anterior and posterior sections of the vitreous body. Later, when voids form in it, cells accumulate in them, depositing on the walls like precipitates. In these cases, the fundus is visible as if in a fog due to the large amount of serous exudate.

The outcome of the exudative process varies. In some cases, the exudates are completely or partially absorbed, in others, cellular elements and protein exudate spread throughout the vitreous body. With biomicroscopy and ophthalmoscopy, they look like flocculent floating opacities of various shapes and sizes.

The most severe and prognostically unfavorable pathological condition of the vitreous body is endophthalmitis, characterized by significant expression of inflammatory changes in it and the possibility of their spread to the surrounding structures of the eye. In these cases, due to diffuse opacity of the vitreous body, the light reflex from the fundus is absent, the pupil becomes gray or yellow.