Thrombosis of the central retinal vein. Blood clot in the eye: symptoms and treatment Thrombus in the eye has broken off

Thrombosis of the central retinal vein is an acute disease that leads to circulatory disorders. Most often it affects people over 60 years of age, and men are affected 2 times more often than women. The most obvious sign is a sharp painless deterioration in vision, which may disappear completely over time. Therefore, treatment of central retinal vein thrombosis must be carried out as early as possible.

The most common causes of the disease are:

atherosclerotic vascular damage;
hypertonic disease;
diabetes.

The consequence of these diseases is the thickening of blood vessels, so a nearby artery can compress the retinal veins. Blood circulation slows down and a blood clot appears in the eye. Venous congestion negatively affects the condition of the inner surface of the eyeball - the walls of blood vessels cease to be impenetrable, extensive hemorrhages and swelling occur, and plaques (blood clots) form. In approximately 80% of cases, the superior temporal branch of the central nervous system is affected, which plays an important role in the blood supply to the macular region.

In 80% of cases of thrombosis of the central branch of the retina, the superotemporal branch of the central retina is affected.

Blockage of the central retinal vein also occurs with primary glaucoma, eye injuries, thromboembolism and blood viscosity disorders. People who lead a sedentary lifestyle, suffer from obesity, and drink alcohol are at risk. Most often, they do not find out about their diagnosis at the primary stage and only after that they wonder why they had eye thrombosis and what kind of disease it is.

Patients with impaired functioning of the endocrine system are also at risk, especially if their treatment is untimely or ineffective, for example, with the help of folk remedies.

Age also plays a role - the disease usually affects older people. Over time, a natural deterioration of vision occurs - presbyopia, but in this case the regression occurs suddenly. Young people are less susceptible to this disease; in them it usually occurs due to past infections (influenza, sepsis, sinusitis).

Thrombosis of the central retinal vein occurs more often in people of the older age group.

Symptoms and stages of retinal vein thrombosis

Depending on the stage of the disease, symptoms will differ slightly:

Stage 1 – prethrombosis. The patient usually does not present any complaints; the disease is discovered by chance during a routine examination and proceeds without symptoms. Rarely, there is periodic deterioration and blurring of vision, while the acuity remains unchanged. At this stage, the veins of the fundus are dilated, tortuous, pinpoint hemorrhages are visible, and macular edema is possible;
Stage 2 – thrombosis. The stage is characterized by a sharp deterioration in vision, loss of acuity, and the possible appearance of a veil. The boundaries of the optic disc are difficult to determine, the loop-shaped veins are dilated and tense, there is a large number of hemorrhages from burst vessels;
Stage 3 – post-thrombotic change in the retina. Occurs approximately 3 months after the second stage. Vision is restored slowly, old hemorrhages are visible in the fundus, lipoprotein deposits are noted on the retina, and new blood vessels are formed.

The symptoms of the pathology directly depend on the stage of the disease.

Diagnosis of central vein thrombosis

Usually, an ophthalmologist can easily identify thrombosis of the central retinal vein (sometimes called occlusion). Primary emergency care includes collecting the patient’s medical history - whether he has eye injuries, hypertension, thrombophlebitis, glaucoma, varicose veins, vascular dementia.

The following studies help the doctor make a diagnosis:

Visometry is a well-known diagnostic for those who have ever been to an ophthalmologist. The patient sits on a chair, closes his left eye and names the letters that are written on a table hanging on the wall. After this, a similar procedure occurs with the right eye. All this helps determine visual acuity;
computer perimetry – determines the patient’s field of vision and those places where disturbances are observed (scotomas). The patient is required to fix his gaze on a certain point. Then objects begin to appear around the entire perimeter at different speeds, and the patient needs to press a special button as soon as he notices them;
biomicroscopy – using a target lamp, both eyes are examined under magnification. This allows you to determine even the smallest changes and identify the stage of the pathogenic process;
fundus ophthalmoscopy - reveals the presence of new vessels and hemorrhages, edema, dilated and dark veins, pallor of the retina;
fluorescein angiography - performed to diagnose the degree of thrombosis. To do this, fluorescein dye is injected intravenously, after which the doctor observes its passage through the vessels of the fundus. The retina of the eye acquires a certain color, and a special camera takes photographs of the fundus at different stages.

In addition, when diagnosing pathology, the doctor prescribes a general analysis of urine and feces, blood for sugar, cholesterol, lipids, protein fractions, as well as an electrocardiogram and blood pressure measurement.

Visometry is the main diagnostic method to determine the presence of central retinal vein thrombosis.

Treatment of central retinal vein thrombosis

With a diagnosis such as retinal thrombosis, treatment must be started as early as possible in order to avoid unpleasant consequences. The treatment regimen will adhere to the following objectives:

Resorption of emerging hemorrhages.
Improving blood supply and reducing retinal swelling.
Reduced intraocular pressure.
Improving retinal nutrition.

Plasminogen is prescribed to break up blood clots.

Drug treatment includes:

antihypertensive drugs to normalize blood pressure. 1 tablet of Nifedipine or Phenigidine under the tongue; intramuscular injections of Lasix are often used, which also reduces retinal swelling. To reduce pressure on the retina from the outside, Timolol drops are prescribed;
fibrinolytic "Plasminogen" helps to destroy blood clots, an injection is given under the eye for two weeks;
anticoagulants "Clexane" and "Novoparin" prevent the new formation of blood clots and stop the growth of existing ones;
antiplatelet agents "Plavix" and "Trental" for the prevention of thrombosis;
"Lucentis" and "Ozurdex" to reduce macular edema, reduce the risk of hemorrhages, and restore visual acuity;
antispasmodic “No-shpa” to relieve pain;
hormonal drugs in the form of tablets, capsules and injections to reduce inflammation;
vitamins of groups C and B to strengthen the immune system.

If conservative treatment fails, the patient may be offered surgery to remove hemorrhages, called laser coagulation. It usually lasts 15-20 minutes under local drip anesthesia, does not cause any discomfort to the patient and is well tolerated.

Trental is prescribed to prevent blood clots.

Complications and prognosis of the disease

Central retinal artery thrombosis is highly treatable if diagnosed early. Vision begins to recover 2-3 months after therapy, swelling gradually subsides, and hemorrhages resolve. If the doctor's recommendations are not followed, complications may occur:

secondary glaucoma;
retinal dystrophy;
optical neuropathy;
hemophthalmos (blood entering the vitreous body).

If CCV thrombosis is not adequately treated, vision may not return and the patient will no longer be able to see. In this case, he will lose his ability to work and will have to register for disability (at the moment it accounts for 0.85% of all ophthalmological pathologies for vision loss).

To reduce unpleasant consequences for the body, it is recommended to undergo preventive examinations with an ophthalmologist. If the diagnosis of thrombosis of the central nervous system of the eye has already been made, you need to follow all the specialist’s recommendations, and in that case, recovery will take place as soon as possible.

Nov 29, 2017 Anastasia Tabalina

Symptoms of a blood clot in the eye
Methods for diagnosing and treating a blood clot in the eye

Eye thrombosis is a dangerous pathology in which, due to the formation of blood clots, blood flow in the blood vessels that feed certain tissues is completely or partially blocked. It is worth noting that blood clots can form in absolutely any organs and tissues, and their appearance can provoke extensive tissue death.

The main risk group for the formation of a blood clot in the eye is represented by people over 40 years of age, and statistics show that this pathology occurs much more often in men than in women. With age, the risk of developing a blood clot in the blood vessels of the eyeball increases significantly.

Etiology and pathogenesis of a blood clot in the eyeball

In most cases, the appearance of a blood clot in a blood vessel is associated with existing diseases in a person that contribute to blood thickening and disruption of the normal functioning of blood vessels. The reasons for the development of a blood clot in the eye are often rooted in the following diseases;

diabetes;
atherosclerosis;
hypertension;
diseases of the heart and blood vessels;
focal infections of the oral cavity and paranasal sinuses;
acute respiratory infections.

Particularly often, thrombosis of the central vein occurs with sudden jumps in blood sugar, as well as in blood pressure levels. A special role in the development of retinal vein thrombosis is played by an increase in intraocular pressure, and in addition, swelling of the optic nerve head of various etiologies.

In rare cases, a blood clot appears due to external pressure on a blood vessel, for example, with the development of an intraocular tumor.

When considering the etiology of the appearance of a blood clot, it should also be noted that there are quite a few predisposing factors for the appearance of such a pathological condition, for example:

obesity;
sedentary lifestyle;
poor nutrition;
avitaminosis.

Predisposing factors on their own are not capable of provoking the appearance of a blood clot, but under certain conditions they can still contribute to this process. For example, a sedentary lifestyle leads to blood stagnation in all blood vessels and contributes to the development of atherosclerosis and other pathologies of the cardiovascular system.

The pathogenesis of the development of a blood clot in the eye has a pronounced staged pattern.

At stage 1, so-called prethrombosis is observed, characterized by the development of venous stagnation of blood. In this case, the veins acquire a dark tint, dilate, and in addition, obvious arteriovenous crossings and tortuosity appear. Angiovenous examination reveals a clear slowdown in blood flow. At this stage, expansion and darkening of the vein and small pinpoint hemorrhages are observed.

At stage 2, a clear circulatory disorder develops in the central retinal vein. The walls of the blood vessels are highly stressed, so extensive hemorrhages in the retina, vitreous body and other tissues of the eyeball are not uncommon. The permeability of the vein increases, so transudative tissue edema occurs along the vein. At stage 3, complete or incomplete thrombosis develops, which may be accompanied by atrophic and degenerative changes in the retina.

Approximately 1-2 months after thrombosis, the development of post-thrombotic retinopathy is often observed. This condition is accompanied by a very slow recovery of vision.

When examining the fundus, residual effects after previous hemorrhages, newly formed vessels and hard exudates are still visible. Newly formed vessels have significant permeability, so macular edema is often observed.

In addition, during this period, the appearance of newly formed vessels in the area of the optic disc may be observed, although anatomically they should not be there.

At the initial stage of blood clot development, most people do not notice obvious signs of decreased vision. In rare cases, periodic blurring of vision may occur, as well as a slight decrease in visual acuity. Most often, the patient learns about the appearance of a blood clot early in the morning, when, upon opening his eyes, he discovers obvious problems with vision.

The thing is that during sleep all stagnant processes progress, which is why the detection of blood clot formation, as a rule, occurs in the morning. The most characteristic symptoms of a blood clot in the eye are a severe decrease in visual acuity up to its loss, loss of part of the visual field, and the presence of a veil before the eyes.

Blocking blood flow in the blood vessels of the eye is very dangerous. In the absence of rapid targeted treatment, tissue necrosis occurs, which leads to complete and irreversible loss of visual ability. Vision loss is observed due to optic nerve atrophy, retinal neovascularization, recurrent hemorrhages, and secondary glaucoma.

If you detect the slightest sign of a blood clot in the eye, it is very important to immediately contact an ophthalmologist. The thing is that even with complete thrombosis of a vein in the eye, if blood flow can be restored within an hour, a decrease in visual acuity, and in some cases, complete blindness, can be avoided. In addition to interviewing the patient and collecting anamnesis to identify the characteristics of circulatory disorders of the eye, the following studies can be carried out:

visometry;
perimetry;
biomicroscopy;
ophthalmoscopy;
angiography;
retinal tomography;
blood pressure measurement;
general blood and urine tests.

In addition to consulting an ophthalmologist, you may need to visit a cardiologist, neurologist, endocrinologist and other highly specialized doctors.

In severe cases, surgery is prescribed to remove the blood clot.

In cases where incomplete thrombosis occurs, drug treatment has a good effect. Medicines used to treat a blood clot include:

antiplatelet agents;
angioprotectors;
antihypertensive drugs;
hormonal agents;
antispasmodics;
fibrolytics;
vitamin complexes.

http://www.youtube/watch?v=F0loauBG3LE

Even if treatment was carried out in a timely manner, blood clots do not go away without a trace, so after a few months laser coagulation of the retina is performed.

Source: http://ZdorovyeGlaza.ru/lechenie/tromboz-glaza.html

The article discusses the main features of the ophthalmological disease, the reasons for its development, the characteristic symptomatic manifestations of thrombosis, as well as modern methods of treatment in order to restore vision and prevent possible consequences and complications.

In modern medicine, vascular thrombosis of the eye is considered as a disease of the organ of vision, which is associated with impaired circulation of the central vein or certain of its branches.

Quite often, cases of occlusion of the retinal arteries and veins turn out to be a serious problem due to the rapid development and nature of the possible consequences. It should be emphasized that an advanced form of this problem can provoke the development of complete blindness. In most cases, the disease is of an “age-related” nature, since it develops in conjunction with other diseases that occur with age.

Pathology can be dangerous

Despite this, recently the development of thrombosis of the arteries of the eyes is also typical for young people. In this case, the disease may be associated with various infectious irritants. In addition, the treatment instructions also inform about a number of other common causes of the above ophthalmological pathology.

Reasons for development

This pathology may be associated with various kinds of concomitant problems with the health of the human body.

In medicine, all possible causes of vascular thrombosis of the organ of vision are divided depending on the age category of the patient.

Age category of the patient	Possible causes of the disease
Elderly patients	atherosclerosis; diabetes; hypertension
Young patients	Diseases of infectious origin: flu; sepsis; focal sinus infections; oral infections.
All age categories of patients	ophthalmohypertension (when there is increased intraocular pressure, the optic disc swells and tumors form, putting pressure on the eyeball); thrombus formation in ophthalmic hypertension glaucoma; leukemia; use of diuretic drugs; polycythemia; taking medications with contraceptive effects.

The development of the disease in older people is characterized by thickening and hardening of the artery walls. Due to compression of the artery adjacent to the retinal vein, blood flow slows down significantly, provoking the formation of a blood clot as in the photo.

No less common factors predisposing to the development of the disease are the following:

excess body weight;
excessive consumption of alcoholic beverages;
maintaining a sedentary lifestyle.

Thrombosis of the arteries of the eyes occurs with identical frequency in both women and men.

What symptoms accompany the pathology?

A characteristic feature of the disease is painlessness. The patient experiences a gradual decrease in vision for no apparent reason. Quite often, the doctor diagnoses in this case defects (blind areas) in the field of vision.

In most cases, the problem is diagnosed by a doctor during the next examination for preventive purposes, since it is very difficult for the patient to independently suspect such a serious pathology. It is for this reason that doctors recommend regularly attending ophthalmological examinations, paying close attention to your vision, and if you have the slightest suspicion, seek help from a specialist (for example, objects begin to become distorted or fogging appears).

It is worth emphasizing that symptoms can accumulate over several days and even months, so it is quite difficult for a person to experience a sharp deterioration in vision.

Main features of the disease

Retinal vascular thrombosis is associated with occlusion or blockage of one of the vessels or branches due to a blood clot. In this case, the blood flow is directed in the opposite direction, so it enters the capillaries.

Due to the reverse flow of blood, the pressure is increased, resulting in an increased risk of hemorrhage in the retina, progression of edema and the occurrence of hypoxia (when there is not enough oxygen for normal functioning)

Ignoring the first symptoms or unwillingness to immediately begin treatment can lead to the development of glaucoma.

The consequences of thrombosis also vary: the video in this article shows that the affected area has the greatest impact on the patient's visual impairment. Thus, blockage of a branch of the retinal vein allows the doctor to remain more optimistic in his forecasts: with the help of gradual resorption of hemorrhage in the retina, vision can gradually improve.

Hemorrhage into capillaries

At the same time, the formation of a blood clot in the v. centralis retina turns out to be much more serious. This is due to the involvement of a part of the retina, which is medically called the macula.

In this case, the prognosis is more unfavorable, since the ability to restore vision is significantly reduced to minimal chances. An important role in such clinical cases is played by the degree and neglect of the disease, on which the prescribed treatment depends.

How to deal with the problem?

One of the main features of a blood clot forming in the vessels of the eye is the possibility of its dissolution within the first five minutes after formation. That is why treatment of the disease does not involve the use of drugs for resorption or enzymatic treatment of the blood tumor.

This feature is associated with its insufficient effectiveness due to the lost time for the formation of a blood clot (see also Vessels burst in the eyes: why does this happen?).

It is necessary to pay attention to the fact that modern methods of combating thrombus formation in the vessels of the eyes are focused on treating not the disease itself, as such, but its possible complications. For this purpose, doctors carry out preliminary diagnostics to determine the degree, which, in turn, is associated with the immediate localization and neglect of the blood clot.

Diagnostic test

A fairly common complication is vitreous hemorrhage. In most cases, the cost of such treatment will be significantly higher, since the patient requires surgery to remove the clotted blood. This surgical intervention is called vitrectomy in modern medicine.

Laser coagulation of the retina is considered no less effective, which is widely used to prevent the formation of newly formed vessels located on the retina of the eye, as well as on the iris.

The result of the operation is to improve metabolism in the retina. Thus, it is possible to prevent the development of such a serious complication as glaucoma.

Glaucoma is one of the complications

In addition to surgical intervention, complex therapy, which allows you to restore vascular patency, normalize homeostasis and clot lysis, consists of taking three types of medications, including:

antiplatelet agents;
anticoagulants;
thrombolytic agents.

Thanks to long-term treatment, the consequences of hemorrhage and swelling of the retina can be cured. On average, treatment lasts about several months, after which the patient’s vision is restored (see also Inflammation of the blood vessels of the eye: causes and treatment).

The use of a laser is explained by the presence of ischemic areas of the retina, as well as in cases where newly formed vessels are constantly developing, causing regular hemorrhages. With the help of Lucentis injections, the growth of such vessels stops, as a result of which the swelling of the macula decreases.

Features of treatment of lesions of large vessels

In modern medicine, occlusion in the central vein is of two types. As for the ischemic type, it consists of a severe disturbance of blood flow, when visual acuity is greatly reduced.

Due to the risk of complications, the patient is required to undergo frequent follow-up examinations during the first three months of treatment.

Ischemic type of lesion

Non-ischemic thrombosis is characterized by less pronounced changes in the retina and fairly high visual acuity. Repeated examinations in this case are carried out regularly after one, three, six and twelve months.

After a comprehensive diagnosis, the doctor prescribes appropriate treatment and, if necessary, surgery. To combat hemorrhages, injections of hemase and streptokinase are effective.

To improve blood supply, drops are used that can reduce intraocular pressure. Dexamethasone and diprospan help reduce retinal swelling. At the same time, with the help of injections of Ozurdex or Lucentis, it is possible to stop the formation of blood vessels that provoke swelling and hemorrhage.

Complications

In addition to ignoring the disease, which can lead to the development of more serious vision problems, treatment of thrombosis also has side effects in rare cases. This may be due to the individual reaction of the patient's body and his inability to tolerate certain medications.

For example, fibrinolytics can cause bleeding, and laser coagulation can cause exudative retinal detachment and hemorrhage.

Source: https://uflebologa.ru/klinicheskaya-simptomatika/tromboz-glaza-sosudov-318

Cardiovascular diseases have become the problem of the century, the main cause of disability and mortality among people of working age. Central retinal vein thrombosis (CRV) is one of these most dangerous diseases, leading to rapid loss of visual function. This pathology is a condition when the central vein supplying the retina or its branches is thrombosed in the human eye, as a result of which the venous outflow of blood is disrupted.

Filling of the veins and vessels with an excess amount of blood causes them to stretch and deform, while fluid leaks into the intercellular space, which forms edema and leads to hemorrhages. The vein becomes tortuous, affected by hemorrhages, and the retina around it becomes pale and swollen. All this threatens the development of ischemic zones, dead areas of the eye shell, unable to further perform visual function.

Causes

In very rare cases, retinal thrombosis occurs as an independent disease; it is mainly the result of existing problems such as:

vascular atherosclerosis;
eye tumors;
diabetes;
hypertension;
systemic vasculitis;
glaucoma;
disorders of blood clotting processes.

The listed ailments contribute to thickening and deformation of the walls of the color of its branches, and this inevitably leads to disruption of blood flow and the formation of clots. Some medications taken by the patient, for example, contraceptives or diuretics, can also provoke the thrombotic process.

According to statistics, out of a thousand people forty years and older, every two are diagnosed with retinal vein thrombosis. This disease is mainly characteristic of older people and is more often observed in patients over sixty years of age.

There are also cases when the disease develops in young people. At risk are people with endocrine pathologies and congenital blood diseases (leukemia, bleeding disorders).

This can also be caused by complications after infectious diseases (for example, influenza, sinusitis, sinusitis), or chronic inflammatory processes of the mouth and paranasal sinuses.

In addition, thrombosis of the central retinal vein more often develops in people who lead a sedentary lifestyle, are overweight, or abuse alcohol.

Signs and symptoms

Thrombosis of the central vein of the retina is very difficult to detect in time, since the disease mainly manifests itself in people already suffering from any problems with the organs of vision. At the initial stage, redness of the vessels of the retina of the eyes is simply observed, and minor minor hemorrhages may occur. An important sign is the unilateral nature of the lesion, that is, the process occurs in only one eye.

Another feature is that most often signs of thrombosis develop during sleep, so patients discover them in the morning after waking up.

The disease goes through several stages in its development.

Prethrombosis - has no external manifestations, but during examination the doctor can see venous stagnation of the fundus. Veins are deformed, blood circulation is slow. At this stage, rare pinpoint hemorrhages, a slight decrease in visual acuity are observed, and there may be complaints of occasional fog in the eyes. But the disease does not reveal itself in any other way.
The stage of developed central nervous system thrombosis is characterized by hemorrhages of various shapes and sizes throughout the retina. If the pathology touches the branches of the vein, then hemorrhages occur only along them in a limited area of the fundus. The ophthalmologist detects redness and swelling of the optic nerve head and blurring of its contours. Such signs are also called the “squashed tomato symptom.” The patient complains of a significant, but not very sharp, deterioration in the quality of vision (from several hours to several weeks); a partial loss of the field of vision may occur in areas of dead vessels. This stage is also accompanied by fog and a veil before the patient’s eyes, and flickering of flies.
During the period of postthrombotic retinopathy, which occurs several months after the previous one, hemorrhages in the retina resolve and degenerative and atrophic processes begin to occur. Vision slowly returns, but not until it is completely restored. Proliferation of newly formed vessels in the area of the disc and the fundus of the eye is observed, even where they should not normally be, which threatens the occurrence of repeated hemorrhages. Pathological changes lead to various complications: maculopathy, glaucoma, optic nerve atrophy.

Diagnostics

Diagnostic examinations are necessary for an accurate diagnosis and correct choice of treatment. First of all, this is an appointment with the attending ophthalmologist, who will:

visual acuity test;
perimetry - determining the presence of affected visual fields and narrowing of the visual field due to them;
biomicroscopy - examination of the vitreous body of the eye and its iris, pupil:
study of the condition of the retina of the eye - fluorescence antiography (FA), - an examination that makes it possible to determine the type, degree of thrombosis, size of lesions, condition of veins and vessels, the presence of neoplasms;
computed tomography of the retina.

In addition, the doctor prescribes blood tests for sugar levels and coagulation tests, as well as a urine test. If necessary, the patient is sent for examination by specialists such as a therapist, cardiologist, endocrinologist and neurologist.

Treatment

The treatment prescribed by the attending physician depends on the identification of one of the types of ocular thrombosis, which differ in the complexity of restoring functioning:

ischemic – with pronounced pathological changes (multiple hemorrhages, severe swelling, significant decrease in vision and the appearance of blind spots, critical impairment of blood flow). In this case, after starting treatment, it is necessary to undergo follow-up examinations every two to three weeks during the first three months, as there is a risk of developing severe complications;
non-ischemic, with minimal deviations from the norm. In this case, the first examination is carried out after a month of treatment, then after three, and repeated after six months and a year.

Treatment of thrombosis of the central nervous system of the eye should begin immediately after diagnosis. With proper treatment, after two to three months the patient's symptoms disappear and vision returns.

In the first stages of development, medications and injections are usually prescribed to dilate blood vessels, resolve hemorrhages, liquefy formed clots, relieve edema syndrome and improve the quality of nutrition of the retina.

Fibrinolytics are prescribed to dissolve existing blood clots and restore blood circulation. These include plasminogen, as well as streptodecase and hemase injectables. They are administered parabulbarly (injections into the eye) daily for a week or two.

Direct anticoagulant drugs are indicated that act on blood proteins in such a way as to prevent the processes of converting prethrombin into thrombin, which forms a blood clot. These include, for example, heparin. They are also injected into the eye for five days.

Antiplatelet agents may be prescribed to thin the blood. They have a milder effect than anticoagulants, and their effect is aimed at platelets, blocking signals that cause blood clotting. These include aspirin, emoxypine and others. During treatment, it is necessary to constantly monitor changes in blood clotting parameters.

To reduce pressure in the eye and reduce swelling, drops are prescribed into the eyes - timolol, and intramuscularly - Lasix. The drugs nifedipine and phenigidine help lower blood pressure. Antispasmodics may be prescribed - no-spa, papaverine.

In some cases, when swelling is significant and inflammation occurs, it may be necessary to treat the disease with hormonal drugs. Dexol is used for these purposes.

After several months of treatment, if the swelling persists, there is a possibility of swelling of the mocular area, which is dangerous for the development of complete blindness. Then laser coagulation of the retina is performed. This is a surgical method designed to quickly drain fluid, cauterize newly formed vessels and veins, and limit the affected area. The use of laser treatment prevents the further development of secondary glaucoma and other complications in the patient.

For a speedy and more complete restoration of all functions, it is useful to take a course of vitamins A, E, C and B.

Consequences, possible complications

With the ischemic nature of the disease, complications such as optic nerve atrophy, relapse of glaucoma and mocular edema, or the appearance of a membrane - mocular fold, or fibrosis - often occur.

After the treatment prescribed by the doctor, vision usually returns to its original value, but degenerative changes of varying degrees occur in the eye in one hundred percent of cases of the disease.

Therefore, regular examination by an ophthalmologist will be the best guarantee of timely detection of the disease and preservation of the quality of vision.

Source: http://CardioGid.ru/tromboz/cvs-glaza.html

Thrombosis of the central vein of the retina: treatment with folk remedies, symptoms, medical history

The central retinal vein, as well as its branches, are the most important vessels. When occlusion occurs, blood flow slows down, which provokes serious complications. The pathology most often affects one eye; the bilateral form is much less common. So, let's talk today about the medical history of central retinal vein thrombosis.

Features of the disease

Central vein thrombosis develops in most cases in older people. As for younger patients, the disease occurs much less frequently in them.

It can even be provoked by diseases that, it would seem, are not directly related to the eyes. For example, this includes focal or viral infections (pneumonia, influenza, etc.). The central vein is most often subject to occlusion, and its branches are blocked only in 30% of cases.

Elena Malysheva will talk about retinal artery thrombosis in her video:

Classification of central retinal vein thrombosis

By stages, occlusion can be divided into several stages:

Prethrombosis. Characteristically, the veins become uneven in size, dilated and tortuous. Swelling is often found in the macular area, and small (thread-like) hemorrhages are also present. The patient may not feel the development of the disease in any way, only sometimes the vision becomes blurred, but in most cases this phenomenon is attributed to ailments.
Initial thrombosis, in which streak-like hemorrhages spread almost to the entire retina. If the branches of the central vein are blocked by a clot, then they are located in this area or in the central vein basin. At this stage, visual impairment becomes more noticeable, and the appearance of spots and fog before the eyes is more common.
Post-traumatic retinopathy develops immediately after a vein blockage occurs. To some extent, the lost sharpness and quality of vision are restored, but very slowly. In the central zone, swelling remains in a cystic form. Particular difficulty and danger at this stage is the pathological growth of the vascular network, even in an area where it should not normally be located.

The disease may recur again. In this case, the stages of its development are repeated.

Thrombosis of the central retinal vein can also be of two types:

Non-ischemic thrombosis. The retina undergoes the least changes in this form of the disease. At the same time, visual acuity often remains at a high level.
Ischemic form. Blood flow is seriously impaired, vision deteriorates significantly. A large amount of edema and hemorrhage is noticeable on the retina. This type of disease requires not only timely treatment, but also constant monitoring.

Causes

The cause of thrombosis of the central branch is often diabetes mellitus, atherosclerosis, as well as arterial hypertension. Against the background of these diseases, a gradual thickening of the vessel occurs, so the adjacent artery can compress the retinal veins. Blood flow worsens, and this process leads to the appearance of a blood clot in its cavity. Stagnation of blood negatively affects the condition of the fundus of the eye: the vessels become permeable, hemorrhages become more extensive, and swelling appears.

The central vein is often clogged with glaucoma, as well as with diseases characterized by increased blood viscosity. A blood clot can also occur due to taking certain medications (contraceptives, diuretics).

People who prefer a sedentary lifestyle, have problems with blood vessels and heart, and obesity are at risk. A special category is occupied by patients with endocrine disorders, as well as those who prefer to treat them using traditional methods. We’ll talk about the symptoms of retinal vascular thrombosis further.

Symptoms

The pathology is practically asymptomatic, with the exception of a gradual loss of visual acuity. In the absence of proper therapy, the risk of blindness increases significantly. Blind spots may sometimes occur

Diagnostics

Detecting thrombosis is not difficult for a highly qualified doctor. A complete diagnosis may consist of the following methods:

Perimetry. It is of particular value in identifying scotoma.
Visometry. The current visual acuity is determined.
Biomicroscopy is used to examine the vitreous body.
Ophthalmoscopy helps to determine the condition of the fundus. Using this technique, all the signs inherent in thrombosis are identified, be it changes in veins, swelling, new vessels or the presence of hemorrhages.

In addition to the examination methods described above, laboratory tests are also used. It is mandatory to conduct an ECG, measure blood pressure, and do coherent optical tomography of the retina.

Sometimes fluorescein angiography is used as a final summary to confirm the diagnosis.

Treatment

Therapeutic

Treatment for thrombosis must be started as soon as possible, otherwise the health consequences will be serious. It will be necessary to dose the load, exclude from the diet any foods that affect blood pressure levels and can provoke its increase.

It is important to remember: you should not treat thrombosis of the central retinal vein with folk remedies! This may be dangerous to your health!

One of the most important measures in the drug treatment of thrombosis is the dissolution of the formed clot, which caused the blockage. Agents such as hemase and streptokinase partially contribute to this, but to a greater extent help to resolve hemorrhages.

For complete treatment, drugs from groups that are included in the following list are used:

Fibrinolytics. Restore damaged areas of blood vessels.
Antihypertensive drugs. Often the impetus for the development of pathology is unstable blood pressure, so it is imperative to use appropriate medications. Many of the products have the ability to reduce swelling. Injections are most effective, but in addition to them, antihypertensive drops are often used.
Vitamin products. Particular attention is paid to vitamins B and C, since they play a special role in the treatment of pathology.
Hormonal medications are used when indicated, not only systemically, but also locally. This group of drugs is necessary to reduce not only swelling, but also inflammation.
Antiplatelet agents are used to eliminate the risk of recurrent thrombosis. These drugs necessarily require monitoring of blood clotting.
Antispasmodics.
Angioprotectors.

Injections of diprospan and dexamethasone are necessary if vascular edema occurs. The drugs Ozurdex and Lucentis also help reduce swelling and stop the formation of new blood vessels. In many cases, Trental or reopolyglucin are used, as they help restore blood microcirculation.

Operation

In this way, constant hemorrhages are eliminated and the treatment has a greater effect. Laser coagulation is used after the end of drug treatment.

Disease prevention

The main preventive measures include constant monitoring of blood pressure, as well as eliminating the likelihood of falling into a risk group. To do this, it will be enough not to miss medical examinations, actively engage in sports and not overload the body with harmful products.

Complications

With central vein thrombosis, complications develop with incorrect or untimely treatment. In such cases, glaucoma, nerve atrophy, retinal neovascularization, its subatrophy or dystrophy, and retinal hemorrhages may occur.

Against the background of all these complications, vision can seriously deteriorate.

Forecast

The prognosis is almost always favorable with timely treatment. The development of various complications begins only under the influence of inadequate treatment.

In the next video, the doctor will tell you more about retinal vein thrombosis.

Central retinal vein thrombosis (CRVT) is the second most common serious retinal vascular disease after diabetic retinopathy. Thrombosis of the central vascular system can be divided into two main categories - thrombosis of the central vascular system and branches of the central vascular system, depending on the site of occlusion, with thrombosis of the branches of the central vascular system observed more often.

Central retinal vein (v.centralis retinae) accompanies the corresponding artery and has the same distribution as it. In the optic nerve trunk it connects with the central retinal artery in the so-called central connecting cord through processes extending from the pia mater. It flows either directly into the cavernous sinus ( sinus cavernosus), or first into the superior ophthalmic vein ( v. oplithalmica superior).

Occlusion of the central retinal vein is a complete violation of its patency, with diffuse hemorrhages in all quadrants of the retina, dilatation and tortuosity of the veins, cotton wool lesions, swelling of the optic disc, formation of optociliary shunts on the disc, neovascularization of the disc, iris and retina. Complaints of unilateral vision loss (not accompanied by pain).

Ischemic type - multiple cotton wool-shaped foci, extensive hemorrhage in the retina; fluorescein angiography reveals a large zone of lack of capillary perfusion. Visual acuity decreases to 0.1 or less.
Non-ischemic type - moderate changes in the fundus, visual acuity above 0.1.

According to Cugati's research, one in five patients (26%) with retinal vein thrombosis will die from acute myocardial infarction over the next 12 years, and one in eighteen (5.3%) will die from cerebrovascular disease. According to The Blue Mountains Eye Study, the prevalence of central vein thrombosis is 1.6% among those under 49 years of age. Thus, approximately 16.4 million adults worldwide suffer from retinal vein thrombosis. Thrombosis of the central vein is a serious pathology leading to permanent vision loss.

Etiology

The pathogenesis of retinal vein thrombosis is determined by a combination of processes occurring in the body. Etiological factors can be divided into systemic and local.

To the main system factors should be attributed atherosclerosis(atherosclerosis of the adjacent central artery, which presses on the central retinal vein at the site of the lamina cribrosa, causing secondary thrombus formation in the vein) and arterial hypertension. These two reasons come first in patients with thrombosis of elderly and senile age. Among other systemic etiological factors, it should be noted changes in the hematopoietic system(anemia, polycythemia, hemoglobinopathies, leukemia, thrombocytopenic purpura, etc.), disturbance of blood protein composition(macroglobulinemia, para- and disproteinemia, cryoglobulinemia, hypergammaglobulinemia, etc.), congenital or acquired decrease in the activity of the fibrinolytic system, for example, with plasminogen deficiency and high lipoprotein levels.

Venous thrombosis can be a consequence of such diseases as: Reiter's and Behcet's syndromes, ankylosing spondylitis, scleroderma and systemic lupus erythematosus, sarcoidosis, multiple sclerosis, diabetes mellitus, as well as Horton's disease, Crohn's disease, ulcerative colitis, pancreatitis, mitral valve stenosis or insufficiency . Infectious lesions (toxoplasmosis, syphilis, tuberculosis, leprosy, herpesvirus and cytomegalovirus infection) can lead to vein occlusions.

There is also evidence that with long-term use of oral contraceptives by young women, retinal vein thrombosis develops in some cases. There are examples where vaccination provoked venous thrombosis.

Among local reasons thrombosis in elderly and senile people, the first place is occupied by an increase in intraocular pressure (ophthalmic hypertension and primary glaucoma). Other local causes leading to thrombosis include: brain tumors, subdural cerebral hemorrhages, the presence of carotid-cavernous anastomosis and its treatment, thrombosis of the cavernous sinus, trauma to the organ of vision (for example, with contusion), tumor lesions of the optic nerve, disc drusen and its edema, optic neuritis, hyperplasia of the tissue forming the lamina cribrosa of the optic nerve, inflammatory diseases of the retina and its vessels (Eales disease, acute posterior multifocal placoid pigment epitheliopathy, etc.).

A separate group consists of venous occlusions that developed as a result of medical manipulations, for example, during retrobulbar anesthesia, subconjunctival administration of drugs (mitomycin B) and surgical interventions (cataract extraction or trabeculectomy).

Diagnostics

Mandatory list of tests:

Additional list of tests (according to indications):

clinical blood test;
determination of blood sugar levels;
determination of blood lipid spectrum;
coagulogram;
electrocardiogram;
general urine analysis;
feces on worm eggs;
consultation with a therapist;
consultation with an endocrinologist (if necessary).

immunological examination;
determination of the concentration of proteins C and S in the blood;
determination of antithrombin III concentration;
determination of markers of endothelial dysfunction (von Willebrand factor, thrombomodulin, number of endothelial cells circulating in the blood, concentration of tissue plasminogen activator and its inhibitors, etc.);
determination of intravascular platelet activity (IAT);
complete molecular genetic typing of the hemostasis system;
determination of the level of antiphospholipid antibodies;
determination of homocysteine level in blood plasma;
consultation with a hematologist (if indicated);
Dopplerography of cerebral vessels;
fluorescein angiography of fundus vessels;
electrophysiological examination;
MRI of the brain.

Typically, patients complain of a painless, sharp deterioration in vision that occurs against the background of high blood pressure, after physical or emotional stress, after overheating, drinking alcohol and other factors affecting hemostasis (smoking, coffee abuse, drug use).

Depending on the localization of the process, there may be complaints about the appearance of a “spot in front of the eye,” small dropouts in the field of vision, and distortion of objects. Sometimes patients note the presence of precursors of the disease: a short-term decrease and “foggy” vision the day before. As a rule, patients can clearly indicate when their vision decreased and even at what time of day it happened.

It is necessary to identify concomitant diseases - as mentioned earlier, the following can contribute to the development of retinal vein thrombosis: arterial hypertension, atherosclerosis, diabetes mellitus, blood diseases, vasculitis and systemic diseases, trauma and surgical interventions, ophthalmic hypertension. It is important to find out whether the patient had other acute vascular “catastrophes”, such as acute myocardial infarction, stroke, thrombosis of the deep and superficial veins of the lower extremities, etc.

Indications of existing acute vascular diseases in blood relatives, especially at a young age, may indicate congenital thrombophilia.

It is necessary to clarify what medications the patient is taking - oral contraceptives, long-term use of diuretics, drugs that affect the blood coagulation system can provoke the development of thrombosis.

Assessment of the patient's general condition

The occurrence of retinal vein thrombosis very often occurs against the background of decompensation of chronic cardiovascular diseases. In this regard, it is necessary to consult the patient with a therapist or cardiologist, and if this is not possible, measure blood pressure yourself, determine pulse characteristics, etc.

Ophthalmological examination

Visometry - with non-ischemic thrombosis of the central retinal vein, visual acuity is usually above 0.1. With ischemic thrombosis of the central vein, visual acuity is below 0.1 and can decrease to hundredths and thousandths. However, due to the presence of a central scotoma, vision may be eccentric.

Tonometry - in a fresh case (the first day from the onset of the disease), IOP in the eye with thrombosis may be lower by 2-4 mmHg. Art. than on the paired organ. Apparently, this is due to impaired blood circulation in the arterial bed. It should be remembered that retinal vein thrombosis is often combined with primary glaucoma. In doubtful cases, it is better to prescribe daily tonometry and evaluate IOP dynamics in both eyes. If the patient is examined several months after the development of venous occlusion, increased intraocular pressure may indicate the development of postthrombotic neovascular glaucoma.

Perimetry - as a rule, when examining patients with central vein thrombosis, a central or paracentral scotoma is determined. It can be either relative or absolute in nature. Less commonly, a concentric narrowing of the visual field is observed. With thrombosis of the branches of the central vein, scotomas are localized in the quadrants corresponding to the affected retina. In this case, the density of the scotoma directly depends on the massiveness of the hemorrhages and the presence of ischemic foci. If it is not possible to detect a scotoma using kinetic perimetry, it is advisable to conduct a visual field study using a computer visual field analyzer. This method of studying the visual field is the most sensitive and allows you to track the restoration (or depression) of visual functions over time. Standard visual field testing has great limitations when examining patients with low visual acuity. In these cases, traditional perimetry is insensitive to small scotomas (< 5°). Она не дает возможности точно оценить размер, форму и интенсивность скотом, а также не позволяет определить точку экстрафовеальной фиксации.

Microperimetry (so-called fundus perimetry) allows you to estimate the photosensitivity threshold of the retina at any specific point and transfer this data to the image of the fundus. A fundamentally important feature of microperimetry is the ability to observe the retina in real time during the study and project a specific light stimulus onto a single selected point. Since the projection of light is directly related to a pre-selected anatomical landmark in the fundus and does not depend on fixation or movement of the eye, the doctor receives a functional response from this selected zone.

At the beginning of the study, an infrared photograph of the fundus is taken. The software allows the operator to select an anatomical landmark in the fundus that is highly reflective in infrared light - for example, a branch of a retinal vessel. The image is then digitally captured and matched to the corresponding area on the patient's retinal video in real time. All stimuli are projected directly onto the retina in accordance with this landmark. All this is projected on the computer screen at the same time. Adjustments to compensate for eye movements are made 25 times per second. This active tracking of the patient's eye position allows obtaining reliable perimetric data even in the absence of gaze fixation. After the examination is completed, a color photograph of the fundus is taken. A similar registration technique is used to overlay visual field data onto a fundus photograph. Thus, it is easy to identify the correlation of scotoma with pathology in the fundus.

Biomicroscopy - in the first days after the occurrence of thrombosis, shredding of the anterior chamber of the eye may be observed (this is probably due to a deterioration in venous outflow). When biomicroscopy of the iris, great attention should be paid to examining the pupillary girdle. Severe ischemic occlusions are complicated quite early by neovascularization of the iris. Most often, the first newly formed vessels are localized in the area of the pupillary border. However, there are cases when neovascularization begins to develop in the hilar part of the iris and in the angle of the anterior chamber of the eye.

With severe retinal ischemia, as a rule, there is a relative afferent pupillary defect (Marcus-Gunn sign). It occurs in 85% of cases of ischemic thrombosis and is an important diagnostic criterion.

In the vitreous body, you can see a suspension and floating blood clots, and with the inflammatory etiology of thrombosis, an effusion of exudate (usually in the posterior layers of the vitreous body).

OCT retina

Optical coherence tomography (OCT) is a new non-invasive method that allows you to image optical sections of the retina using a scanning laser beam. The study is carried out transpupillary; The light source is an infrared laser. The resolution of the method, depending on the type of device used, reaches from 10-15 to 1-3 microns, which makes it possible to obtain optical sections comparable in information content to histological ones.

The “mapping” mode allows you to evaluate the thickness of the neurosensory retina of the macular zone. The method is used for diagnosis, dynamic monitoring and evaluation of the effectiveness of treatment of retinal diseases. In cases of retinal vein occlusion, OCT allows:

determine the height and area of macular edema;
determine the structural characteristics of edema (cystic changes, neuroepithelial detachment);
identify the presence of vitreoretinal tractions;
identify the presence of epiretinal fibrosis;
determine the position of the posterior hyaloid membrane of the vitreous body;
monitor the effectiveness of macular edema treatment.

Fluorescein angiography (FA) - this is the main method of examining a patient with damage to the retinal vascular bed. It is the data obtained from FA that help the ophthalmologist determine the type of retinal vein thrombosis and differentiate it in doubtful cases from other diseases.

Using FAG you can obtain information about:

duration of retinal vein occlusion;
localization of the site of occlusion;
degree of occlusion (complete or partial);
condition of the venous wall;
state of capillary perfusion;
pathological changes in the arterial bed;
the presence or absence of anastomoses (veno-venous, arteriovenous, arterio-arterial);
presence of neovascularization;
the state of the macular zone (assessment of the degree of preservation of the perifoveolar capillary network);
state of the optic disc;
blood circulation in the choroidal vessels.

It is advisable to perform FA at the patient’s first visit. An exception may be cases where fluorescein angiography cannot be performed due to opacity of the optical media or multiple intraretinal hemorrhages, which complicate the interpretation of the angiographic study.

It is advisable to perform repeat angiography after three months. At the same time, the doctor will have the opportunity to objectively assess the effectiveness of treatment and identify data indicating the need for laser coagulation of the retina.

FA data in non-ischemic thrombosis of the central vein

delay in arteriovenous transit time, i.e., the time from the moment when fluorescein is first detected in the retinal arterioles to the time when it first appears in the retinal veins.
lengthening the time of venous perfusion (the interval from the parietal contrast of the vein to its complete filling with contrast).
The venules and capillaries of the retina are dilated and their caliber is uneven.
If there is a defect in the endothelium, the walls of the venous vessels are stained with fluorescein.

Intraretinal hemorrhages block fluorescence, so they appear as irregular black fields on an angiogram. In the late phases of FA, diffuse sweating from the retinal capillaries and hyperfluorescence in the area of the optic nerve head are often detected. With this type of thrombosis, capillary perfusion is usually preserved. Small zones of impaired capillary perfusion may be detected in places where “soft” exudates are localized.

FA data in ischemic thrombosis of the central vein and hemicentral thrombosis

Arteriovenous transit and venous perfusion times are prolonged.
The veins fill unevenly with contrast, resulting in a grainy appearance of the blood flow.
The veins are dilated and their caliber is uneven.
Possible staining of the vascular wall (especially in areas of pathological arteriovenous intersections).
Over a large area (10 optic disc diameters or more), there is a lack of capillary perfusion - black zones.

At the borders of ischemic zones, the retinal capillaries are sharply dilated and look “chopped off”. Capillary aneurysms are visible in the same area. It is possible for fluorescein to leave the vessel, indicating a violation of the integrity of the capillary endothelium.

The arteries are narrowed, their normal branching is absent, and there are often occlusions of individual branches (including the cilioretinal artery). Perfusion is often impaired in the macula area. It is necessary to assess how much the perifoveal capillary network is damaged (number of quadrants), since the prognosis of visual functions depends on this. Depending on the area of damage, disturbances in the perfusion of the macular region are classified as I, II, III and IV degrees.

In the late phases of FA, hyperfluorescence is observed in the area of the optic disc and in the area of retinal edema. Extensive intraretinal hemorrhages shield fluorescein and sometimes complicate the assessment of capillary perfusion. In doubtful cases, FA should be repeated after resorption of hemorrhages.

Electrophysiological methods record electrical activity of the retina or occipital cortex in response to visual stimulation. For retinal vein occlusions, electroretinography (ERG) studies are most often used. This term currently refers to a whole range of methods for recording electrical potentials that arise in the retina in response to light stimulation.

General ERG allows you to get an idea of the bioelectrical activity of the entire retina as a whole. In response to stimulation by a flash of light, ions move from the cells into the intercellular space. The main role is played by sodium and potassium ions. Both retinal neurons and glial cells participate in the production of electrical potentials. When assessing an ERG curve, attention is usually paid to two main elements, waves “a” and “b”. The negative "a" wave is considered to reflect the photoreceptor response. The positive "b" wave is generated primarily by the flow of potassium ions through the cell membranes of Müller cells into the intercellular space.

Since the amplitude of the a-wave reflects the functional state of photoreceptors receiving power from the choroidal vessels, in conditions of impaired patency of even the largest vessel, the central retinal vein, there may not be a decrease in the amplitude of the a-wave during scotopic ERG.

Wave "b" reflects the activity of Müller cells and, accordingly, the inner layers of the retina. Therefore, any pathological process affecting the elements of these layers, including retinal vein thrombosis, will lead to a decrease in the amplitude of the b-wave. At the same time, the b/a ratio also changes. The lower the b wave, the more severe the retinal ischemia and the worse the prognosis for vision and neovascular complications. At the same time, an increase in wave latency is also noted. Oscillatory potentials may be absent.

In the presence of macular edema, rhythmic ERG studies (especially when using a red stimulus with a frequency of 30 Hz) are of particular importance. In this way, the response of the cone system is assessed.

In recent years, multifocal topographic study of the bioelectrical activity of the visual pathways has been increasingly used in clinical practice. Multifocal ERG (mfERG) allows you to assess the density of distribution of bioelectrical activity of the retina in each stimulated
areas. The ERG is presented in the form of color maps and three-dimensional graphs. The spatial distribution of pathological bioelectric responses in the diagram corresponds to the localization of focal changes in the retina (edema, ischemic zones, etc.). The use of mfERG for thrombosis of the central vein allows one to differentiate ischemic maculopathy from non-ischemic one and monitor the effectiveness of both conservative and surgical treatment.

To assess the condition of the retinal pigment epithelium in case of vein thrombosis, it is used electrooculography - measurement of the resting potential existing between the cornea and the posterior parts of the eyeball. In retinal vein thrombosis, the severity of EOG changes depends on the degree of ischemia. If certain branches of the central vein are affected, EOG results may remain normal. It should be noted that significant changes in ERG and EOG are most often observed only in ischemic forms of retinal vein occlusion. Therefore, they should be used only as an addition to the main examination protocol - to confirm the severity of ischemia, determine a possible prognosis and to assess the process over time.

Differential diagnosis

Despite the fact that retinal vein thrombosis has a typical clinical picture, nevertheless, sometimes this disease must be differentiated from such lesions as:

chronic ischemic retinopathy,
radiation retinopathy,
diabetic retinopathy,
and in rare cases - with optic neuritis, congestive disc and external exudative Coats retinitis.

When differentiating ischemic and non-ischemic types of central retinal vein thrombosis (in the acute early period), it is necessary to use an integrated approach, since none of the separately used research methods (ophthalmoscopy, electroretinography, fluorescein angiography, etc.) allows one to accurately establish one or another type of occlusion .

Clinic

According to the classification, thrombosis of the central retinal vein is divided into non-ischemic (incomplete) type and ischemic (complete) type.

Non-ischemic thrombosis is a lesion in which capillary perfusion is preserved or ischemic zones occupy less than 50% of the area, and ischemic thrombosis has an area of non-perfused zones of 50% or more.

Non-ischemic type of central vein thrombosis

Non-ischemic occlusion of the central retinal vein has a more varied clinical picture and is more benign than the ischemic type of thrombosis.

Patients with non-ischemic central retinal vein thrombosis are on average 5 years younger (mean age 63 years) than those with the ischemic type. The initial visual acuity in most patients is 0.4 or higher, rarely - counting fingers or hundredths.

Ophthalmoscopic changes in the fundus with non-ischemic thrombosis are similar to changes in patients with the ischemic type, but are less pronounced. In the venous system, including capillaries, the phenomena of stagnation are pronounced: the veins are tortuous. dilated, the blood in them is dark. Retinal hemorrhages are polymorphic in nature (from small pinpoint to significant striped), and they quickly change their color and size, which is easy to notice. Hemorrhages are mainly located on the periphery, but in severe cases they can also be localized in the posterior pole.

“Soft exudate” in the form of cotton wool lumps is rare and occurs in small quantities. Visual acuity is usually reduced due to macular edema and hemorrhage located in the macula. With the non-ischemic type of thrombosis, papilledema is often encountered.

During an angiographic study, an increase in the time of venous perfusion is recorded (the time interval from parietal contrast to complete filling of the vein with contrast is normally 6-10 seconds). In addition, there is an expansion of capillaries and venules, staining of the walls of venous vessels, extravasal release of fluorescein, as well as hyperfluorescence of the optic nerve head, retina, and macular area as a result of edema. Extensive non-perfusion zones and retinal neovascularization are usually absent. However, a fluorescein angiogram may not be very informative.

The electroretinogram is often normal, which indicates insufficient ischemic changes in the retina.

In the natural course of hemorrhage, retinal edema, and congestion in the venous system gradually, over several months, decrease. Often cystoid macular edema is resorbed, then preretinal fibrosis and/or pigment deposits and retinal folds can be ophthalmoscoped in this area. In some patients, cystic edema turns into cystic dystrophy with pigment deposition in the foveal zone. Other residual effects may include microaneurysms and pathological tortuosity of blood vessels. Newly formed vessels are usually not found. The outcome of the process is a moderate decrease in visual acuity (0.5, sometimes higher) and a relative central scotoma.

Ischemic type of central retinal vein thrombosis

Patients with the ischemic type of thrombosis are usually older than those with non-ischemic occlusion, their average age is 68.5 years. On examination, visual acuity is 0.05 or lower, which depends on the degree of involvement of the macula in the process.

During ophthalmoscopy, attention is drawn to intraretinal polymorphic confluent hemorrhages, predominantly located in the posterior pole. A significant amount of hemorrhage is formed in the superficial layers of the retina, having the shape of a flame, emphasizing the course of the nerve fibers. If the hemorrhages are located directly under the internal limiting membrane, then they cover not only the underlying retina, but also the retinal vessels. Extensive hemorrhages can break through the internal limiting membrane, then preretinal or intravitreal hemorrhages appear. Multiple pinpoint hemorrhages indicate damage to the deep layers of the retina. Small hemorrhages can be isolated and isolated, but more often they are grouped around venules.

All venous vessels are filled with dark blood, dilated, tortuous, while at the same time the arterioles are narrowed. Retinal edema is most pronounced in the posterior pole, and areas of edematous retina may cover the vessels. The long-term existence of retinal edema, especially in the macula area, ultimately leads to its permanent structural changes. With the ischemic type of thrombosis, a significant amount of soft exudate is also often ophthalmoscoped. The disc is swollen, its borders are blurred or not defined, the peripapillary retina is also swollen. Physiological excavation on the disc is not determined, since it is filled with edematous tissue, and there is no venous pulse. Often, hemorrhages are localized on the swollen disc with dilated capillaries, which spread to the surrounding retina. It should be noted that retinal microaneurysms, as a rule, are not detected immediately, but after an acute period of thrombosis.

Fluorescein angiography reveals slow filling of the retinal venous system. In the later phases, hyperfluorescence of the optic nerve head and macular region and extravasal release of contrast are recorded. The main symptom of ischemic thrombosis is extensive hypo- and non-fluorescent areas of the retina, which are explained by the development of non-perfused (ischemic) zones.

Electroretinogram values are reduced, which indicates ischemic changes in the retina.

In the natural course of hemorrhage and retinal edema are gradually resorbed, but in the macular area the latter can persist for many months or transform into cystic degeneration with a decrease in the number of photoreceptors and reactive changes in the retinal pigment epithelium. Sometimes in the foveal zone, in addition to cysts, ruptures and an epiretinal membrane are formed.

Three types of lesions of the macular region with venous occlusion can be distinguished:

Edema as a result of pathological permeability of retinal microvessels
Ischemia - with occlusion of perifoveal capillaries
Mixed - with the simultaneous existence of edema and ischemia.

Around the macula, deposits of hard exudate often form an irregular ring-shaped pattern that becomes clearly visible months after thrombosis. Low visus is associated with macular changes (edema, cystic degeneration, ischemia, or rupture) and sometimes with the organization of preretinal or intravitreal hemorrhages in the posterior pole (above the macula). The optic disc is often pale with neovascularization and papillochoroidal shunts.

The prognosis for the ischemic type of central retinal vein thrombosis is serious; retinal, papillary neovascularization and rubeosis of the iris are often formed. Visual acuity usually remains low.

Unspecified type of central retinal vein thrombosis

In most cases, this type of thrombosis is temporary and involves blockages that cannot be classified as ischemic or non-ischemic. This is often associated with the presence of extensive hemorrhages, which may completely cover non-perfused areas or the intact retina. Such patients require close monitoring and repeated fluorescein angiographic studies. For timely detection of ischemic areas and their elimination, which often prevents more serious complications.

Complications

Postthrombotic retinopathy - ischemic retinopathy, which is characterized by zones of lack of capillary perfusion and the development of intraocular neovascularization. Ischemia and hypoxia induce the formation of angiogenic factors, including vascular endothelial growth factor (VEGF), which activates endothelial cells and stimulates their migration and proliferation.

Retinal neovascularization often appears at the border between perfused and nonperfused zones and is always associated with increased vascular permeability. The area of capillary lack of perfusion correlates with the risk of retinal neovascularization. Proliferative processes in postthrombotic retinopathy (as in any ischemic retinopathy) usually have a clear stage:

growth of newly formed vessels along the surface of the posterior hyaloid membrane of the vitreous body;
posterior vitreous detachment;
traction of newly formed vessels leads to preretinal and vitreal hemorrhages;
progression of posterior vitreous detachment and proliferation of glial cells along the posterior hyaloid membrane in areas of dense vitreoretinal adhesions (along the vascular arcades);
traction retinal detachment;
further vasoproliferative processes can lead to the appearance of newly formed vessels in the iris and in the angle of the anterior chamber.

Recurrent vitreous hemorrhages

The cause of these complications is a vasoproliferative process with the formation of a fibrovascular membrane that spreads along the posterior hyaloid membrane of the vitreous body. With inertial vibrations of the vitreous body, the newly formed vessels are damaged and cause repeated hemorrhages, which, in turn, leads to the development of vitreoretinal traction with the formation of tractional retinal detachment.

Conservative therapy, as a rule, gives only a temporary positive effect, since it does not eliminate the causes of recurring bleeding. In this regard, the method of choice is surgical treatment. The operation includes standard three-port vitrectomy, elimination of vitreovascular-retinal traction and diathermocoagulation of bleeding newly formed vessels. Ischemic zones, places where proliferative tissue was removed, as well as single, iatrogenic retinal breaks are subject to coagulation with an endolaser.

Formation of the epiretinal membrane is a nonspecific condition characterized by contraction of the thin fibrous membrane on the surface of the retina, at the level of the internal limiting plate.

This complication may be accompanied by the development of cystoid macular edema and the appearance of a holey defect in the macula. If visual acuity decreases to 0.1–0.2, surgical treatment is possible - posterior vitrectomy with partial or complete removal of the epiretinal membrane.

Neovascular glaucoma is a secondary glaucoma that occurs under the influence of angiogenic factors that stimulate the migration and proliferation of endothelial cells. A characteristic symptom is the growth and development of newly formed vessels in the iris, retina, trabecular meshwork, and UPC. The progression of neovascularization, the appearance of signs of autoimmune inflammation leads to the formation of fibrovascular membranes, which, when contracting, lead to ectropion of the pigment layer of the iris, pupil deformation and, most importantly, blockade of the UPC and an increase in IOP.

The division of secondary neovascular glaucoma into stages is quite arbitrary, but at the same time expedient, since it determines treatment tactics.

Stage of preglaucoma (rubeosis of the iris). Occurs against the background of normal intraocular pressure. Biomicroscopy at the initial stage reveals dilated branches of capillaries and thin randomly oriented vessels on the surface of the iris along the pupillary edge. Neovascularization then spreads to the UPC. Histological studies have shown that the newly formed vessels arise from normal iris arteries. Blood flows through them into the veins of the iris and ciliary body. Newly formed vessels in the UPC originate from the arteries of the iris and ciliary body and connect to the peripheral neovascular network on the iris. Newly formed vessels are characterized by a tortuous course and size variability. Unlike the iris’s own vessels, which are located posterior to the scleral spur, the newly formed ones cross both it and the ciliary body. The Criminal Procedure Code is open.
Stage of secondary glaucoma with open glaucoma. Newly formed vessels are located more densely on the surface of the iris and in the UPC, which is still open. Intraocular pressure is increased, hyphema is often present (this clinical picture was previously described as hemorrhagic glaucoma), signs of inflammation may be detected (opalescence of aqueous humor). At this stage, the presence of a fibrovascular membrane covering the iris and UPC interferes with the outflow of intraocular fluid and explains the increase in intraocular pressure.
Stage of secondary glaucoma with closed glaucoma. At this stage, contraction of the fibrovascular membrane occurs, which leads to changes on the surface of the iris and in the UPC. The iris is displaced anteriorly, its stroma is flattened, there is an eversion of the pigment leaf and a mechanical dilatation of the pupil. Gonioscopy reveals anterior displacement of the peripheral part of the iris, local or total goniosynechia, which impedes the outflow of intraocular fluid. This stage may be accompanied by severe pain.

Treatment of neovascular glaucoma

At the rubeosis stage:

PRLC (with the possibility of pupil dilation and sufficiently transparent optical media);
intravitreal administration of angiogenesis inhibitors (Avastin, Lucentis) followed by PRLC
transscleral cryoretinopexy (if the media are not transparent enough);
their combination.

At the stage of secondary open-angle glaucoma:

PRLC and/or transscleral cryoretinopexy (if not previously performed);
medications (beta blockers, carbonic anhydrase inhibitors, corticosteroids);
fistulizing operations, as a rule, are not very effective due to occlusion of the outflow zone by fibrovascular tissue (at the same time, it is possible to bypass the anterior chamber using nipple devices such as the Achmad valve). There is positive experience in combination treatment, including intravitreal administration of the angiogenesis inhibitor Lucentis with implantation of the Achmad´a valve.

At the stage of secondary angle-closure glaucoma:

medications (beta blockers, carbonic anhydrase inhibitors, corticosteroids, atropine);
cyclodestructive interventions (cryodestruction or diode laser cyclodestruction);
intravitreal injection of crystalline corticosteroids.

The use of pilocarpine for neovascular glaucoma is contraindicated!

Treatment

Restoring blood flow in the central vascular system and early diagnosis are critical for preserving visual functions and reducing the risk of irreversible complications. This became the starting point for the study of a new approach to the complex treatment of central vascular thrombosis - the use of the calcium channel blocker (CCB) Nimodipine, which is a vasodilator and can significantly improve cerebral circulation. It has been proposed for the treatment of ischemic retinal conditions due to its positive effects on visual function (such as widening visual fields, enhancing color vision and contrast, etc.) as well as neuroprotective functions. In addition, Nimodipine has a beneficial effect on cerebral vasospasm, significantly improves cognitive function and reduces the intensity of depression.

To select the optimal therapy for venous occlusions and achieve maximum effect, the ophthalmologist must: determine the stage of thrombosis, its type, the presence of complications, identify, eliminate or weaken the effect of etiological factors (for example, compensate for blood pressure in arterial hypertension, intraocular pressure in glaucoma), select a method treatment corresponding to the stage and type of thrombosis, together with a general practitioner, treat the underlying disease.

When treating retinal vein occlusions, the following is used:

conservative therapy (with local or systemic administration of fibrinolytic agents, disaggregants, anticoagulants, antioxidants, etc.);
surgical treatment, and among surgical methods it is necessary to separately highlight laser coagulation of the retina:
extracorporeal therapy (plasmapheresis, ultraviolet and laser irradiation of autologous blood);
other methods (hyperbaric oxygenation, etc.). In the clinic, these methods usually complement each other.

The treatment of patients with retinal vein blockages can be based on the following principles:

Restoration of blood flow in the occluded vessel and the corresponding area
Decreased intravascular pressure in the affected vein
Elimination or weakening of the action of the etiological factor
Normalization of local and general hematological parameters
Limiting metabolic disorders
Blocking complications of retinal vein thrombosis
Prevention of recurrent thrombosis and occlusive diseases both in the fellow eye and in other organs

Among the main medicinal substances used in the treatment of patients with blockages of the retinal veins, there are: thrombo- or fibrinolytics, disaggregants, anticoagulants, corticosteroids.

It is logical to begin therapy of patients with retinal vein thrombosis with the administration of fibrinolytic drugs, glucocorticoids, if necessary, combined with agents that inhibit platelet aggregation, reduce blood viscosity, as well as direct anticoagulants. It is advisable to use thrombolytic drugs only in the first seven days from the onset of the disease.

Currently, thrombolytics created by recombinant methods are mainly used: tissue plasminogen activator (Actilyse), urokinase and prourokinase (Gemaza). The advantage of these drugs is low toxicity, minimal allergenicity, and the absence of side effects associated with the impact on the general hemostatic system. The listed drugs have an affinity for fibrin and activate the process of fibrinolysis only on the surface of the clot. They belong to the group of direct plasminogen activators.

Indirect plasminogen activators include streptokinase and drugs that are its derivatives - “Streptodecase” and “Celiase”. When these medications are used topically, both local and general allergic reactions may occur. In this regard, in recent years the frequency of their use in ophthalmology has decreased.

In the treatment of retinal vein thrombosis, thrombolytic drugs are administered subconjunctivally, parabulbarly, and some of them intravitreally. Such methods of administration are the most effective and safe.

All of the above thrombolytics are contraindicated in hemorrhagic diathesis, fresh hemorrhages, including intraocular, erosive and ulcerative lesions of the gastrointestinal tract in the acute phase, severe liver and kidney diseases, a history of hemorrhagic stroke, active pulmonary tuberculosis, radiation sickness, fibrinogenopenia, high blood pressure, recent injuries , individual intolerance.

Rapid dissolution of the fibrin base of the thrombus makes it possible to restore the patency of the occluded vein in the shortest possible time. However, it should be remembered that the root cause of the appearance of a blood clot is a violation of the integrity and functional capacity of the vascular endothelium. Therefore, thrombolytic therapy must be combined with the use of drugs that have an endothelial-protective effect and also affect platelet aggregation. Otherwise, the clot may appear again and, increasing in size, cause reocclusion.

Thrombosis of the central retinal vein is an acute condition in which the vessel is partially or completely blocked. Why does pathology occur? How does it manifest itself? How is it diagnosed and can it be cured? This is discussed later in the article.

What it is

Thrombosis of the central vein is a violation of the patency of a blood vessel. The disease progresses rapidly and often develops secondary against the background of existing complications of other diseases.

Blockage in a certain area of the visual apparatus provokes backflow of blood into the capillaries and an increase in blood pressure in patients.

The degree to which the visible quality is reduced in full depends on which part of the vein is affected. If the lateral vein is blocked, doctors slowly, but manage to partially or completely restore the functions of the visual apparatus.

In case of central blockage, the prognosis is the most unfavorable.

The organ atrophies. The retina undergoes degenerative changes.

More often, CVS develops in older people; it provokes a disruption of the circulatory process and a decrease in organ functions.

At the first appearance of unpleasant symptoms, you should consult a doctor, undergo diagnostics and the proposed treatment.

Classification

The disease is divided by type into:

non-ischemic, in which the occlusion is partial, there is no hemorrhage and only a small part of the blood flow is affected;
ischemic with complete occlusion, extensive hemorrhage and large lesions.

The disease occurs in stages:

Prethrombosis state. The veins gradually expand, and slight stagnation appears.
Blood circulation is impaired, the vascular walls are tense, a yellow spot appears on the central vein and severe hemorrhage. The optic disc acquires unclear boundaries.
The most difficult stage is when the ischemic type of disease begins to progress.

Why there are risk groups

Development may be preceded by:

diabetes;
hypertension;
atherosclerosis;
influenza, otitis with infection of the paranasal sinuses, oral cavity;
blood pressure surges;
high intraocular pressure or pressure exerted on the eyeball from the outside, for example, by a tumor body.

The risk group includes people:

leading a passive lifestyle;
suffering from obesity, cardiovascular diseases, failure of the function of the endocrine glands.

Occlusion is caused by arterial hypertension, glaucoma, cataracts with stable levels of high blood eye pressure.

Thrombosis of the eye is a blockage of the vein of the superior temporal or inferior branch of the vessel. This is the main reason for the violation.

How it develops

Organ blockage is characterized by a transient course. If central occlusion is involved in the pathology, then 2/3 of the central nervous system is immediately affected.

Extensive hemorrhages begin to appear. Vision and color vision can deteriorate in a matter of hours.

If occlusion in the periphery is involved in the process, the sharpness of the image decreases slightly. However, patients begin to experience dark spots and fogs, and blurred objects.

With partial occlusion in the early stages, symptoms may be completely absent and appear only when the lumen is clearly narrowed by 80-90%.

Vision deteriorates slowly as the disease progresses. This is the only early symptom that is difficult to track.

Only as it progresses does the general well-being of patients deteriorate sharply.

Patients have no special complaints at the stage of prethrombosis, when the vision only periodically becomes blurred and acuity decreases.

At the peak of disease progression, the macular area begins to swell. The boundaries of the optic disc become unclear. The vitreous body is subject to hemorrhage.

Patients have partial loss of vision, and dark circles appear before the eyes.

Reference! Symptoms become noticeable at the progression stage, when the destructive process of CVS reaches a certain level. If the macula area is not involved in the pathology, signs may be completely absent for a long time. The disease is identified by a specialist ophthalmologist during a routine examination.

The dangerous thing is that people often ignore a slight decline in vision and do not consult a doctor. Meanwhile, with incomplete thrombosis, visual functions gradually fade away and are impaired.

Degenerative processes may become irreversible.

Why is it dangerous?

If treatment is not carried out in a timely manner, then the consequences of a blood clot in the eye are:

optic nerve atrophy;
glaucoma;
macular fibrosis with the formation of a membrane against the background of collagen accumulation, which reduces the quality of the image.

The disease takes a relapsing course with severe swelling of the macula and pathological changes in the fundus of the eye. At first glance, harmless swelling, puffiness and the periodic appearance of dark circles ultimately result in serious consequences.

Degenerative processes begin to develop. Manifestations of iridocyclitis and uveitis are possible.

If the functioning of blood vessels is impaired, partial or complete loss of vision may occur.

The note! Thrombosis of the central retinal vein and its branches is in almost all cases considered an emergency condition when the decision on treatment must be made immediately. This will increase the chances of preserving the functions of the organ in case of venous narrowing, and will avoid complete blindness in case of damage to the central artery.

Signs of the disease

Symptoms completely depend on the degree of occlusion or the location of the thrombus. In thrombosis, almost the third part of the retina is involved in the pathology.

Common manifestations of the disease:

blurry black spots, fog before the eye;
distortion of the perception of colors, visibility and outline of objects;
lacrimation;
photophobia.

In most cases, patients do not complain of poor vision at an early stage.

The main symptoms of retinal vascular thrombosis are clearly expressed with complete occlusion, blocking the lumen by 96-98%.

Although this is a rare occurrence. Typically, partial occlusion is observed with a narrowing of the lumen by 60-70%.

When and who to contact

An ophthalmologist carries out diagnostic measures and prescribes treatment. If this is not available, you can first visit a therapist, who, if indicated, will refer you for consultation to an endocrinologist, neurologist, or cardiologist.

It is necessary to consult a doctor if you experience:

partial loss of field of view;
the appearance of black flies or circles at night and in the morning;
frequent dizziness, headaches;
squinting;
impaired visibility of objects in front of you;
extensive hemorrhages;
decreased visual acuity.

As people age, blood vessels inevitably wear out.

Stress and mental disorders only aggravate the situation: they provoke narrowing and spasms, fragility and a decrease in their elasticity, and blood clots.

Diagnostics

An experienced doctor can quickly and easily make a diagnosis as soon as he conducts a visual examination of the fundus using a Goldmann lens.

If in doubt, he redirects to the following ophthalmological procedures:

Visometry to identify the degree of deviation from the norm.
Perimetry for the purpose of recognizing the boundaries of the field of view of that space, if you focus your gaze on one point.
Ophthalmoscopy to determine changes in blood vessels, the degree of hemorrhage and general condition.
Biomicroscopy to visualize the vitreous body and determine the degree of its opacity.
Fluorescein angiography, allowing for an accurate diagnosis.

Blood pressure indicators must be recorded, i.e. An ECG is performed.

Treatment methods

To understand how to treat eye thrombosis, the answer is step by step. Doctors take measures to:

restoration of blood flow in the injured vascular area;
reduction of edema;
elimination of hemorrhages;
normalization of blood microcirculation in the central nervous system area.

Atrophic processes develop quickly, therefore, after diagnosis, conservative therapy should be carried out immediately in order to:

promote the resorption of hemorrhages on the eyelids;
nourish and improve the trophism of the main components of the visual apparatus;
relieve swelling.

Medication

Prescribed medications:

drugs for dissolving blood clots;
direct acting coagulants;
hormonal drugs to relieve inflammation and swelling of the central nervous system;
antiplatelet agents that improve blood circulation;
vitamins, mineral supplements to improve immunity.

The disorder requires an integrated approach to therapy.

If hypoxia of the vascular wall occurs, drugs administered intravenously or glucocorticosteroids administered for edema are prescribed.

Injections of anti-inflammatory drugs are indicated to relieve inflammation and pain.

Traditional methods

Treatment with folk remedies for eye thrombosis will help significantly improve blood circulation and lower blood pressure. Infusions, decoctions, and teas are prepared from medicinal herbs and plants. Honey and beebread help prevent hemorrhage and strengthen the walls.

If macular edema continues to increase after treatment, then the only correct solution is laser coagulation with separation of the central zone from the affected one.

Forecasts

If you start treating the disease in a timely manner, the prognosis is positive. To consolidate the result, doctors perform laser coagulation of the retina 2 months after drug treatment. This makes it possible to reduce the likelihood of relapses.

It is especially difficult for people at risk. For hypertension and diabetes, it is important to monitor blood pressure and blood glucose levels. Periodically consult a doctor for examination.

The pathology develops at lightning speed. It is impossible to prevent its development, so preventive measures are not provided.

The violation causes irreversible changes: it reduces the quality of the visible, provokes atrophy of the optic nerve and complete blindness. If the retinal neurons begin to experience oxygen starvation, it is unlikely that it will be possible to correct the situation with medications or even surgery.

The outcome of the disease is fully influenced by time. Only timely diagnosis and proper treatment will help patients avoid the development of cataracts and partial or complete loss of vision.

Educational video: Retinal vein thrombosis

Contents [Show]

Central vein thrombosis develops in most cases in older people. As for younger patients, the disease occurs much less frequently in them.

Elena Malysheva will talk about retinal artery thrombosis in her video:

By stages, occlusion can be divided into several stages:

Prethrombosis. Characteristically, the veins become uneven in size, dilated and tortuous. Swelling is often found in the macular area, and small (thread-like) hemorrhages are also present. The patient may not feel the development of the disease in any way, only sometimes the vision becomes blurred, but in most cases this phenomenon is attributed to ailments.
Initial thrombosis, in which streak-like hemorrhages spread almost to the entire retina. If the branches of the central vein are blocked by a clot, then they are located in this area or in the central vein basin. At this stage, visual impairment becomes more noticeable, and the appearance of spots and fog before the eyes is more common.
Post-traumatic retinopathy develops immediately after a vein blockage occurs. To some extent, the lost sharpness and quality of vision are restored, but very slowly. In the central zone, swelling remains in a cystic form. Particular difficulty and danger at this stage is the pathological growth of the vascular network, even in an area where it should not normally be located.

The disease may recur again. In this case, the stages of its development are repeated.

Thrombosis of the central retinal vein can also be of two types:

Non-ischemic thrombosis. The retina undergoes the least changes in this form of the disease. At the same time, visual acuity often remains at a high level.
Ischemic form. Blood flow is seriously impaired, vision deteriorates significantly. A large amount of edema and hemorrhage is noticeable on the retina. This type of disease requires not only timely treatment, but also constant monitoring.

Detecting thrombosis is not difficult for a highly qualified doctor. A complete diagnosis may consist of the following methods:

Perimetry. It is of particular value in identifying scotoma.
Visometry. The current visual acuity is determined.
Biomicroscopy is used to examine the vitreous body.
Ophthalmoscopy helps to determine the condition of the fundus. Using this technique, all the signs inherent in thrombosis are identified, be it changes in veins, swelling, new vessels or the presence of hemorrhages.

In addition to the examination methods described above, laboratory tests are also used. It is mandatory to conduct an ECG, measure blood pressure, and do coherent optical tomography of the retina.

Sometimes fluorescein angiography is used as a final summary to confirm the diagnosis.

Therapeutic

It is important to remember: you should not treat thrombosis of the central retinal vein with folk remedies! This may be dangerous to your health!

For complete treatment, drugs from groups that are included in the following list are used:

Fibrinolytics. Restore damaged areas of blood vessels.
Antihypertensive drugs. Often the impetus for the development of pathology is unstable blood pressure, so it is imperative to use appropriate medications. Many of the products have the ability to reduce swelling. Injections are most effective, but in addition to them, antihypertensive drops are often used.
Vitamin products. Particular attention is paid to vitamins B and C, since they play a special role in the treatment of pathology.
Hormonal medications are used when indicated, not only systemically, but also locally. This group of drugs is necessary to reduce not only swelling, but also inflammation.
Antiplatelet agents are used to eliminate the risk of recurrent thrombosis. These drugs necessarily require monitoring of blood clotting.
Antispasmodics.
Angioprotectors.

In this way, constant hemorrhages are eliminated and the treatment has a greater effect. Laser coagulation is used after the end of drug treatment.

Against the background of all these complications, vision can seriously deteriorate.

The prognosis is almost always favorable with timely treatment. The development of various complications begins only under the influence of inadequate treatment.

In the following video, the doctor will tell you more about retinal vein thrombosis:

Thrombosis of the central vein of the retina or venous stasis retinopathy is an acute ophthalmological disease caused by impaired blood flow in the central vein and nearby small capillaries. According to statistics, even timely and competent treatment rarely leads to a positive result, since irreversible degenerative and atrophic processes in the visual apparatus develop at a high speed. This pathology is much more common than arterial occlusion, which has similar symptoms and causes.

Retinal vein thrombosis is always an acute condition, which most often occurs in people with pathologies of the visual system, so the initial signs of the disease are rarely diagnosed on time. A visit to a specialist almost always occurs when a significant blood clot has formed, which can lead to the most serious complications. Often, the onset of the development of the disease occurs after the narrowing of a vein or the closure of the lumen of a vessel, which can arise for many reasons. Depending on the degree of decrease in the lumen of the blood vessel, there may be ischemic or non-ischemic vein thrombosis. With ischemia, a critical state of blood flow is observed, retinal hemorrhages are possible, swelling occurs, and visual acuity is lost.

The process of thrombosis always goes through several stages:

Prethrombosis. There are no external manifestations of the disease, but during an ophthalmological examination of the fundus, you can notice the first signs of stagnation of venous blood. At the same time, the veins expand and their structure changes. Swelling appears in the macular area, and small capillary hemorrhages often occur;
Initial thrombosis. The patient experiences blurred vision, spots or flickering before the eyes. When examining the eyeball, you can notice significant hemorrhages of varying degrees, which spread to the retina, and swelling of the optic nerve head occurs. Visual acuity may begin to decrease;
Retinopathy itself. Minor hemorrhages begin to resolve, degenerative changes and retinal atrophy develop. Within 2-3 months, blood vessels branch throughout the entire area of the fiber, and numerous ophthalmological dysfunctions are observed. Vision almost always decreases.

Since retinal vein thrombosis in the initial stages can only be diagnosed with a thorough ophthalmological examination of the fundus, the disease is detected when visible external manifestations occur, starting from the second stage of the disease.

The disease occurs due to pathological changes in the functioning of the walls of blood vessels or a violation of blood viscosity. As a rule, this occurs due to the fact that dilated arteries in some functional or ophthalmological diseases begin to compress nearby veins, thereby disrupting the natural outflow of blood. Similar problems are most often observed with the following ailments:

Arteriosclerosis;
Diabetes mellitus of any type;
Blood pressure disorders;
Diseases accompanied by changes in blood clotting;
Ophthalmological pathologies in which intraocular pressure increases, for example, glaucoma.

In most cases, retinal vein thrombosis is diagnosed in elderly people over the age of 65 years. In addition, it is in this group that bilateral lesions occur in every 10 cases. The disease can also develop at a young age, usually as complications after acute infectious diseases or severe inflammation of the nasopharynx.

It is believed that the risk of pathology increases in people who lead a sedentary lifestyle, suffer from obesity and disruption of the endocrine system.

There are clinical cases of retinal vein thrombosis in patients with cancer of the blood and hematopoietic organs. But it is not customary to classify them as a separate risk group.

The clinical picture of the disease largely depends on the severity of the thrombotic process in the retinal vein. In this regard, there may be 2 types of pathology:

Ischemic thrombosis. Severe bleeding into the retina occurs, and damage to the blood flow leads to a decrease in visual acuity and the development of serious ophthalmological disorders;
Non-ischemic or incomplete occlusion. Damage to the retina and blood vessels is much less pronounced, there are no profuse hemorrhages, and visual acuity may remain intact.

The disease often develops rapidly, with critical condition occurring within a few hours after the onset of thrombosis. First, general malaise and weakness, painful sensations in one or both eyes occur, and only then characteristic visual disturbances are added - fog or spots before the eyes, distortion of the perception of objects. If the hemorrhages do not affect the central part of the retina, then visual acuity may remain unchanged for some time, but then gradually decrease.

During fundus diagnostics, the so-called “crushed tomato” symptom is often detected. It is characterized by the occurrence of swelling in most structures of the visual apparatus, and extensive hemorrhages pass from the fiber into the vitreous body.

Usually, 1-2 months after thrombosis, vision begins to return to normal, but complete recovery is extremely rare. Even after a full course of therapy, maculopathy and tissue degeneration are possible, as well as a general thinning of blood vessels, which can lead to their rupture. Every 5 patients with thrombosis subsequently develop glaucoma.

The consequences of the disease largely depend on the general state of health, the degree of visual impairment before thrombosis and the time of contacting a specialist. With timely treatment, it is almost always possible to preserve visual function at least partially. The great danger of retinal vein thrombosis is the risk of subsequent relapses. To avoid this, it is necessary to undergo regular ophthalmological examinations in order to notice the onset of the disease in time. In 100% of cases, changes in the fundus occur. They can be completely harmless, but with extensive ischemic thrombosis, there is a high probability of developing the following pathologies:

Glaucoma;
Retinal degeneration of varying degrees;
Optic nerve atrophy;
Impaired functioning of blood vessels - development of uveitis and iridocyclitis;
Complete or partial loss of vision.

The risk of complications can be reduced only with timely consultation with an ophthalmologist and proper treatment of this disease.

Therapy is always prescribed immediately after the diagnostic results and confirmation of the diagnosis, since the sooner treatment is started, the lower the risk of irreversible atrophic processes. In case of thrombosis of the central retinal vein at the initial stage, only conservative therapy is always prescribed, the main goal of which is:

Resorption of hemorrhages on any element of the eye;
Restoring blood circulation in the affected vein;
Removing retinal swelling;
Nutrition and improvement of trophism of the main components of the visual apparatus.

For this purpose, fibronolytics, as well as direct-acting coagulants, are usually prescribed. Of no small importance for the treatment of thrombosis is the normalization of arterial ocular pressure, which makes it possible to alleviate the patient’s general condition and prevent the likelihood of ischemic thrombosis. Subsequently, it is necessary to take antiplatelet agents to improve blood circulation, as well as hormonal drugs to relieve swelling and inflammation of the retina. In case of severe pain, it is also necessary to take broad-spectrum antispasmodics. And throughout the entire treatment, a mandatory condition is the use of vitamins and biological mineral supplements to generally improve health and immunity.

Arutimol drops lower intraocular pressure

In most cases, after 2-3 months of drug therapy, laser coagulation of the retina is performed to reduce the likelihood of relapse of the disease.

To date, there are no effective measures to prevent the development of this serious pathology. Due to the fact that people with functional diseases such as diabetes and hypertension are at risk, it is necessary to undergo medical examinations on time and monitor blood pressure and blood glucose levels. And for the normal functioning of the body’s circulatory system, one should avoid excessive consumption of caffeine and nicotine, which increase blood pressure and affect blood clotting, causing the risk of thrombosis.

It is of great importance to contact a specialist in a timely manner at the first signs of the development of the disease, since the disease develops at a high speed, time plays an important role for a favorable prognosis of treatment.

Okomistin eye drops with instructions for use

Rules for the treatment of eye diseases using Dex-Gentamicin eye ointment are presented here.

The purpose and use of the drug Polinadim is described in this article.

Thrombosis of the central retinal vein is one of the most serious ophthalmological diagnoses, since even with proper treatment there remains a possibility of relapse of the disease. The disease more often affects older people, but this does not mean that at a young age you do not need to take care of your health. Retinopathy directly depends on the normal functioning of the cardiovascular system as a whole, so from an early age you need to take care of your body and undergo medical examinations on time.

Also read about optic neuritis and choriotetinitis.

Thrombosis of the central vein of the retina is a violation of the patency of the joint, leading to a progressive decrease in vision. Often occurs as a complication of other pathologies. Let's consider the main causes of this disease, its varieties, signs, methods of treatment and prevention.

Retinal vein thrombosis develops due to blockage of a blood vessel by a blood clot. In this case, blood flows back into the capillary vessels of the specified area of the eye. Because of this, blood pressure increases in the capillaries, which promotes hemorrhage into the retina and significant swelling.

If thrombosis is not treated, the development of glaucoma, a disease that leads to vision loss, is inevitable.

Thrombosis can be accompanied by decreased vision, sometimes even blindness. The degree of visual impairment depends on which part of the vein is affected by the pathological process.

The outcome of the disease is most favorable if the lateral vein is affected: in this case, vision will be slowly restored. If there is a blockage in the central vein, the situation is not so favorable, since vision is restored worse. With advanced pathology, vision restoration occurs only in rare cases.

The main cause of the disease is thrombosis (blockage) of the central retinal vein, the lower branch or the superotemporal branch of the central retinal vein (central retinal vein).

Blockage occurs for the following reasons:

Atherosclerosis of the arteries. It often leads to the patient developing thrombosis of the central retinal artery. Such a violation inevitably leads to venous occlusion.
Arterial hypertension.
Diabetes mellitus of insulin-dependent or non-insulin-dependent type. Sharp jumps in glycemia and poor compensation of diabetes mellitus are especially dangerous.
Flu.
Blood poisoning.
Spread of infections from the mouth and sinuses.
A persistent increase in blood pressure inside the eye (occurs as a result of glaucoma and some other diseases.
Swelling of the optic nerve.
Tumors.

Factors contributing to the occurrence of retinal vein thrombosis include:

physical inactivity (sedentary lifestyle);
weight gain;
cardiovascular diseases;
disruption of the endocrine glands;
improper treatment of hypertension, diabetes and other diseases.

This pathology is very dangerous because if you contact a specialist late, it can cause absolute loss of vision.

This pathology is characterized by the fact that its manifestations become noticeable only at the stage when the processes of retinal destruction reach a certain level.

At first, patients do not complain of blurred vision, although this is the most important symptom of the disease. Sometimes patients note a distortion in the visibility of objects, some blurring of vision. But if the macula area is not involved in the pathological process, patients are not bothered by these signs.

The process of gradual deterioration of vision can last a very long time - from several months to several years. However, even over this long period of time, a person’s vision can remain relatively high.

The danger of the pathology is that a person does not pay attention to the dangerous signs of decreased vision. After all, often incomplete thrombosis may not bother a person and may not manifest itself as noticeable disturbances in visual function.

Thrombosis of the central vein develops gradually in humans. If treatment is started too late, the person may develop vision loss. Sometimes absolute or partial thrombosis can be discovered accidentally during a routine examination.

The blockage is of a non-ischemic type (in this case, visual acuity remains above 0.1). With ischemic thrombosis, massive hemorrhages develop and signs of impaired capillary function are noted.

There are several stages of retinal vein thrombosis:

Prethrombosis. In this case, the presence of tortuous, dilated, pathologically altered veins with an uneven diameter is observed. Macular edema is sometimes observed. Typically, patients at this stage do not present any symptoms. In some cases, visual acuity is slightly reduced. Visible objects may often become foggy.
At the stage of occlusion of a vein or its branches, hemorrhages of various sizes are often noticeable. If the central vein is destroyed, then they are present throughout the retina. There are also cases where foci of hemorrhage appear only in the area of one branch of the vein. On examination, the boundaries of the nerve are usually not distinguished or are unclear. Swelling develops in the area of the macula. Characteristic symptoms are a significant decrease in visual acuity, scotoma (loss of part of the visual field). Often the patient notices a characteristic haze in the visual field.
Some time after thrombosis, postthrombotic retinopathy develops. The patient's vision returns very slowly. Exudates and blood clots are visible at the bottom of the eye. Vascularization is noted, that is, unnatural formations of capillaries (normally they are not visualized at all).

Finally, recurrent thrombosis is also possible, when vein occlusion occurs repeatedly.

Determining the diagnosis is not difficult for an experienced ophthalmologist. Sometimes it is quite enough to perform an ophthalmoscopy of the fundus. Angiography is used to more accurately determine the extent of eye damage. Particular care should be taken to diagnose the anterior areas of the eyes.

Examination of the fundus of the eye is usually performed using a Goldmann lens. Additionally carried out:

blood pressure measurement;
determination of the degree of blood clotting;
general clinical examinations - urine and blood tests (plus biochemistry);
additional examinations are prescribed by a neurologist, endocrinologist, and cardiologist.

Treatment for retinal thrombosis should begin immediately after the doctor makes the diagnosis. Drug therapy for venous occlusion is mandatory. The patient is prescribed drugs from several pharmacological groups:

Medicines that lower blood pressure. For this, the patient is prescribed Nifedipine, Phenigidine (sublingual). Dibazol is administered intravenously, Lasix is administered intramuscularly. The latter drug not only lowers blood pressure, but also reduces swelling, which is very important for thrombosis. Timolol is dropped into the eye to reduce intraocular pressure.
To restore normal blood flow in the affected vessel, drugs from the group of fibrinolytics are prescribed. Plasminogen is injected under the eye over the course of one to two weeks. In addition, it is preferable to administer direct anticoagulants (also under the eye).
Antiplatelet agents are indicated to prevent relapses of the disease. The most commonly prescribed drug from this group is Acetylsalicylic acid or Plavix. Medicines of this group must be administered under the control of the blood coagulation system.
To reduce swelling and inflammation, hormonal medications are prescribed (in the form of injections and tablets). Dexon is injected under the eye. It is possible to use this drug in the form of intravenous droppers.
Reopoliglucin and Trental are used to improve blood circulation in the capillaries of the eye.
Angioprotectors, such as Dicynon and Emoxipin, are also prescribed.
Among antispasmodics, it is preferable to use No-shpa and Papaverine.
Finally, the use of vitamins is shown - ascorbic acid, group B.

After drug therapy, it is advisable to perform laser coagulation of the retina.

But treatment with folk remedies in most cases does not bring benefit, since a complex of highly effective medications is needed to achieve the necessary therapeutic effect.

In some cases, side effects may occur as a result of the therapeutic measures taken.

The prognosis of the disease is favorable, but subject to early treatment. In most cases, it is possible to maintain high visual acuity and performance. In advanced cases, the consequences of such a disease are often unfavorable, but the course of each specific case is individual. Good vision can be maintained even if there are no complications.

Retinal vein thrombosis can be prevented. To do this, you should follow these recommendations:

Maintaining a healthy lifestyle - quitting smoking and drinking alcohol.
Correction of nutrition in order to limit the consumption of foods that increase blood pressure.
Prevention of low physical activity (for this it is advisable to play sports).
It is necessary to perform exercises to develop the ciliary muscle.
It is extremely important to have regular eye exams with an ophthalmologist.
It is necessary to qualitatively and fully treat diseases of the cardiovascular system and control blood pressure.

Preventing retinal vein thrombosis is much easier than treating it. Remember this, because the eyes are the most important sensory organs of the body, and often the preservation of vision depends only on the person himself.

Retinal thrombosis is an eye pathology characterized by impaired circulation in the central retinal vein (CRV). The presented defeat is dangerous in its consequences. Often the patient completely loses vision.

Thrombosis of the central retinal vein rarely develops as an independent disease. It is caused by pathologies in the form of atherosclerosis, hypertension, diabetes mellitus, systemic vasculitis, thrombophilia and other blood diseases associated with increased coagulability.

“Precursors” provoke thickening of the artery wall, which leads to its compaction and compression of the adjacent vein. Gradually, the presented phenomena provoke disruption of blood flow and the formation of clots.

The resulting stagnation leads to an increase in vascular permeability, which provokes a reverse flow of blood into the capillaries, and this increases intraocular pressure. All actions lead to retinal hemorrhage and swelling.

The causes of thrombosis of the central vein of the eye also include:

infectious diseases;

ocular hypertension;

swelling of the optic nerve;

tumors localized inside the ocular system;

orbitopathy;

excess weight;

endocrine disorders;

sedentary lifestyle;

drinking alcohol.

The development of central vein thrombosis is divided into three stages:

Prethrombosis
venous congestion is observed;

the veins gradually expand, change color, and obvious crossings and tortuosity form;

during the diagnostic process, slowing of blood flow, darkening of the vein and small pinpoint hemorrhages can be detected.

Stage 2
is characterized by obvious circulatory disorders, as a result of which the walls of the veins become tense, provoking hemorrhages in the retina and other tissues of the eyeball;

due to increased vein permeability, transudative tissue edema is formed.

Stage 3 Thrombosis develops in complete or incomplete form, accompanied by atrophic or degenerative changes in the retina.
Occlusion of the retinal veins is provoked by a blood clot formed in the lumen. But sometimes the pathology develops due to thickening of the arteriole wall, which gradually leads to compression of the venule.

Violations of the permeability of the vascular walls of the veins occur due to the release of blood from the vascular bed, which is quite often combined with hypoxia. Such phenomena lead to new lesions and bleeding - the disease progresses and provokes complications.

Ischemic damage to the retina gradually increases the production of vascular endothelium, which, in turn, contributes to the appearance of newly formed vessels located on the surface. The danger of postthrombotic retinopathy is hemorrhage into the eye cavity and the development of neovascular glaucoma.

The following factors are identified that influence the development of postthrombotic retinopathy:

old age of the patient;

somatic diseases such as hypertension, diabetes and others;

high IOP;

inflammation;

various blood coagulation disorders.

It should be noted that branch vein thrombosis is diagnosed more often than lesions of the central vein. The prognosis and further development of the pathology depends on the location of the thrombus - in the central vein, in the macular or peripheral branches.

The symptoms of the pathology directly depend on the area of the lesion and the presence of collateral blood flow - the presence of additional small branches of blood vessels that allow blood to flow out.

Common signs include:

unilateral lesion;

blurred vision that does not cause pain;

gradual decrease in visual acuity;

metamorphopsia - a characteristic distortion of objects;

other visual defects.

Symptoms can make themselves felt at any time, but experts note that characteristic signs form at night during sleep. As a result, the patient notices vision problems only in the morning after waking up.

Damage to the macula directly affects visual acuity. Thrombosis of the central retinal artery leads to changes in the fundus of the eye - during diagnosis, the specialist sees numerous hemorrhages of a streaked nature, and swelling is often noted.

Diagnosis of central vein thrombosis involves interviewing the patient with a specialist, as well as a full comprehensive examination using the latest technologies. So, initially the patient turns to a specialist for help only in case of visual impairment, which occurs without pain or additional symptoms.

The specialist begins to examine the patient, asking him questions to determine:

Additional symptoms in the form of cloudiness, black spots before the eyes and the time during which the changes occurred This indicates the localization of the formed thrombus.
Accompanying illnesses The specialist must find out whether the patient has “predecessors” of the disease, which can accurately reveal the picture of visual impairment and the development of thrombosis. Here it is important to clarify the presence of vascular pathologies in relatives.
Taking medications Medicines in the form of oral contraceptives and diuretics directly affect the blood coagulation system, which provokes the development of thrombosis of the central vein.
General condition of the patient Thrombosis often occurs against the background of vascular diseases, which may additionally be accompanied by dizziness, headaches, increased blood pressure and heart pain.

Visometry
check visual acuity;

the results are further studied: non-ischemic thrombosis is characterized by visual acuity above 0.1, and ischemic thrombosis - below 0.1.

Tonometry
internal ocular pressure is measured, where differences are noted in the first day of thrombosis development in the form of a decrease in values by 2-4 mmHg. Art. unlike a healthy eye;

such indicators are associated with impaired blood circulation;

Often, to identify pathology, daily IOP measurements are used to study them in dynamics.

Perimetry
determine the narrowing of the visual field - scotoma, which can be central or paracentral;

CVS in this case is characterized by the detection of scotoma in areas of retinal lesions;

The density of the scotoma depends on the mass of the hemorrhage and the presence of ischemic foci.

Microperimetry
determines the light sensitivity threshold of the retina at certain points;

during the examination, the retina is observed in real time, projecting a light stimulus onto it at a certain point;

allows you to determine the location of the lesion.

Biomicroscopy
determining the development of thrombosis by identifying the fragmentation of the anterior chamber of the eye, which is provoked by deterioration of venous outflow;

ischemic occlusions are accompanied by the formation of blood vessels on the surface of the retina in the pupillary zone.

Retinal ischemia often provokes the development of a pupillary defect - the Marcus-Gunn symptom (impaired reaction of the pupil to directional light), which is diagnosed in 85% of cases. When examining the retina, floating blood clots and inflammation can often be seen.

The following modern research methods are also used to diagnose thrombosis:

Optical coherence tomography
an invasive method with which you can obtain a complete cross-sectional image of the retina;

it uses a scanning beam that emits a thin stream of infrared laser;

the presented method allows you to determine optical sections from a histological point of view;

using OCT, you can determine the height, area and structure of edema, the presence of vitreoretinal traction and other important features in the development of thrombosis;

Also, using the presented method, you can monitor the effectiveness of treatment.

FAH FA or fluorescein angiography is an important method for examining a patient who has damage to the retinal vasculature. This method allows a specialist to determine the type of thrombosis and detect it if other research methods have not revealed the picture. FA makes it possible to determine:
time of onset of thrombosis development;

localization of the lesion;

degree of pathology;

state of the venous wall and capillary perfusion;

pathology of the arterial bed;

presence or absence of anastomoses;

development of neovascularization;

assessment of the macular zone;

state and nature of blood circulation.

FA is often performed at the first appointment, but there may be exceptions due to the opacity of optical media and multiple hemorrhages, which complicate angiography.

Already during the treatment process, FA is carried out 3 months after the first treatment to assess the effectiveness of the prescribed medications.

In the process of differential diagnosis, accompanying pathologies are often determined in the form of:

diabetic retinopathy;

retinal detachment;

retinal artery occlusion;

macular degeneration caused by the patient's age;

ischemic neuroopticopathy.

Treatment of retinopathy begins immediately, since the effectiveness directly depends on the area and extent of the lesion, the nature of thrombosis, and the formation of complications.

At the initial stage, the patient is prescribed a treatment regimen using conservative therapy methods. This involves the use of drugs or injections to dilate blood vessels, eliminate swelling and dilute the blood clot.

The main goal in treatment is to prevent further progression of the pathology and reduce ischemic changes. If the patient receives medical attention in a timely manner, blood flow can be completely restored, hemorrhages resolve, and vision returns to normal.

Conservative therapy is presented in the form of:

Decrease in IOP
use clonidine or ethacrynic acid to reduce swelling and reduce external pressure on the vessels;

to reduce swelling, you can also use Diacarb using 0.25 per day for 5 days or Pilocarpine - a 2% solution, which is instilled according to the instructions and advice of the doctor.

Liquefaction of formed blood clots
here they use a solution of Fibrinolysin, which is administered intravenously at a rate of 25 drops per minute;

the solution may cause pain in the lower back or chest area, as a result of which such treatment is stopped.

Restoring a collapsed system
can be carried out by intramuscular administration of heparin with a dosage of 5-10 thousand units;

The dosage is determined by the doctor in accordance with blood clotting indicators.

Among other things, treatment is based on the use of angioprotectors (Lucentis and Avastin), antispasmodics, corticosteroids (Kenalog) and other drugs whose action is aimed at improving microcirculation and blood circulation in general. A course of using vitamins to restore damaged tissues is useful.

If the treatment does not produce positive results, there is a high probability of swelling in the macular area. It leads to the death of retinal cells, resulting in partial or complete loss of vision. Therefore, specialists use treatment methods that allow fluid to be quickly removed from the layers of the retina.

To treat thrombosis of the central vein, laser coagulation is sometimes used, which allows one to quickly achieve a similar result as in the case of conservative treatment.

Ischemia of the posterior pole of the eye leads to complications such as the development of postthrombotic retinopathy. Such complications often arise due to damage to the entire central retinal vein with an ischemic nature of the pathology. Postthrombotic retinopathy is diagnosed in 10% of cases.

Also, the reasons for the development of complications include the appearance of newly formed vessels on the entire surface of the retina, which is facilitated by the production of growth factors due to insufficient blood supply.

The most common complications include:

secondary glaucoma;

nerve atrophy;

recurrence of macular edema;

epiretinal fibrosis.

In case of timely and correct treatment, the patient’s vision is completely restored. But in 10% of cases, even with complete anatomical restoration of the fundus, vision remains low or practically disappears.

Prethrombosis	venous congestion is observed; the veins gradually expand, change color, and obvious crossings and tortuosity form; during the diagnostic process, slowing of blood flow, darkening of the vein and small pinpoint hemorrhages can be detected.
Stage 2	is characterized by obvious circulatory disorders, as a result of which the walls of the veins become tense, provoking hemorrhages in the retina and other tissues of the eyeball; due to increased vein permeability, transudative tissue edema is formed.
Stage 3	Thrombosis develops in complete or incomplete form, accompanied by atrophic or degenerative changes in the retina.

Additional symptoms in the form of cloudiness, black spots before the eyes and the time during which the changes occurred	This indicates the localization of the formed thrombus.
Accompanying illnesses	The specialist must find out whether the patient has “predecessors” of the disease, which can accurately reveal the picture of visual impairment and the development of thrombosis. Here it is important to clarify the presence of vascular pathologies in relatives.
Taking medications	Medicines in the form of oral contraceptives and diuretics directly affect the blood coagulation system, which provokes the development of thrombosis of the central vein.
General condition of the patient	Thrombosis often occurs against the background of vascular diseases, which may additionally be accompanied by dizziness, headaches, increased blood pressure and heart pain.

Visometry	check visual acuity; the results are further studied: non-ischemic thrombosis is characterized by visual acuity above 0.1, and ischemic thrombosis - below 0.1.
Tonometry	internal ocular pressure is measured, where differences are noted in the first day of thrombosis development in the form of a decrease in values by 2-4 mmHg. Art. unlike a healthy eye; such indicators are associated with impaired blood circulation; Often, to identify pathology, daily IOP measurements are used to study them in dynamics.
Perimetry	determine the narrowing of the visual field - scotoma, which can be central or paracentral; CVS in this case is characterized by the detection of scotoma in areas of retinal lesions; The density of the scotoma depends on the mass of the hemorrhage and the presence of ischemic foci.
Microperimetry	determines the light sensitivity threshold of the retina at certain points; during the examination, the retina is observed in real time, projecting a light stimulus onto it at a certain point; allows you to determine the location of the lesion.
Biomicroscopy	determining the development of thrombosis by identifying the fragmentation of the anterior chamber of the eye, which is provoked by deterioration of venous outflow; ischemic occlusions are accompanied by the formation of blood vessels on the surface of the retina in the pupillary zone.

Decrease in IOP	use clonidine or ethacrynic acid to reduce swelling and reduce external pressure on the vessels; to reduce swelling, you can also use Diacarb using 0.25 per day for 5 days or Pilocarpine - a 2% solution, which is instilled according to the instructions and advice of the doctor.
Liquefaction of formed blood clots	here they use a solution of Fibrinolysin, which is administered intravenously at a rate of 25 drops per minute; the solution may cause pain in the lower back or chest area, as a result of which such treatment is stopped.
Restoring a collapsed system	can be carried out by intramuscular administration of heparin with a dosage of 5-10 thousand units; The dosage is determined by the doctor in accordance with blood clotting indicators.