Vitreous turbidity: causes, symptoms, diagnosis, treatment

Turmoil of the vitreous can arise as a result of metabolic disorders in diabetes mellitus, hypertension, atherosclerosis, as well as inflammatory diseases of the vasculature and injuries. The intensity of turbidity varies from insignificant, such as "flying flies", to coarse, dense opacities, sometimes fixed to the retina.

"Flying flies" are delicate opacities in the vitreous body (its modified and glued fibers), which in bright light cast a shadow on the retina and are perceived by the eye as floating in front of dark formations of varying size and shape (wavy lines, specks). They are most clearly visible when looking at a uniformly illuminated white surface (snow, bright sky, white wall, etc.) and move when the eyeball moves. The phenomenon of "flying flies" is usually caused by initial destructive processes in the glassy gel and often occurs with myopia and in old age.In objective studies (biomicroscopy, ophthalmoscopy), opacities are usually not detected.

With the increasing destruction of the vitreous, ie, its dilution (transition from the state of the gel to the sol), it reveals opacities in the form of flakes, bands, tapes, translucent films, etc., shifting when the eyeball moves. They are typical for filamentous destruction of the vitreous humor, often observed with high myopia, severe hypertension, pronounced atherosclerosis in old age. Granular destruction of the vitreous body, manifested in the formation of a suspension of grayish-brownish tiny grains (the accumulation of pigment cells and lymphocytes that migrate from surrounding tissues), is observed with retinal detachment, inflammatory processes in the vascular tract, intraocular tumors, trauma. The process of progression of filamentous and granular destruction of the vitreous humor may stop if successful treatment of the underlying disease occurs.

In old age and with diabetes mellitus, the destruction of the vitreous with the inclusion of crystals of cholesterol, tyrosine, etc., which float when the eyeball moves in the form of a "silver" or "golden rain" is often observed. Deep destructive processes usually develop with high degree of myopia, general disorders of metabolic processes, and also as a result of trauma.

In inflammatory processes in the vascular tract and retina (iridocyclitis, chorioretinitis) in the vitreous appear turbidity, consisting of cellular and fibrotic elements - exudates. The mechanism of their formation is as follows: cellular inclusions (leukocytes, lymphocytes, plasmocytes) are deposited on the posterior surface of the lens and in the retrolental space, where in the light of the slit lamp they have the appearance of brilliant small dots. Then these inclusions appear in large quantities in the anterior and posterior parts of the vitreous. Later, when voids are formed in it, the cells accumulate in them, deposited on walls like precipitates. In these cases, the fundus can be seen as in a fog due to the large amount of serous exudate.

The outcome of the exudative process is different. In some cases, exudates completely or partially dissolve, in others the cellular elements and protein exudate spread throughout the vitreous. With biomicroscopy and ophthalmoscopy, they have the appearance of flocculating floating opacities of various shapes and sizes.

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