Bleeding in the Eye
Bleeding in the eyes is associated with many underlying conditions like hyphema, blood vessel damage (subconjuctival hemorrhage), diabetic retinopathy and vitreous hemorrhage.
The conditions for diabetic retinopathy occur because of long term diabetics. Prolonged high blood sugar levels can damage the blood vessels associated with the retina of the eye. These blood vessels become leaky or clogged. The leaky blood vessels initiate the process of hemorrhages which are visualized as spots of bleeding. In some instances the clogged blood vessels obstruct the supply of oxygen to the retina causing ischemic condition. Maintaining proper blood sugar levels along with controlled pressure is essential.
Subconjuctival hemorrhage occurs due to damage caused to the sclera or the white portion of the eye. The blood released because of the damaged blood vessel is trapped under the conjunctiva. Subconjuctival hemorrhage associated eye bleeding is often painless. It is mainly caused because of high blood pressure and also triggered by cough, vomiting and sneezing. The blood spots disappear gradually. Medical attention is required if symptoms such as blurred vision, pain and recurrent hemorrhages occur. The choice of medication given for subconjunctival hemorrhage are blood thinners like heparin and Coumadin.
Hyphema is caused due to injury to the eye. The trauma caused in the eye can be of blunt or closed types depending upon the intensity of the damage. Most of these traumas which result in the bleeding of the eye are because of external sources such sharp objects, industrial chemicals, fumes, injuries associated with boxing and martial arts. Smaller hyphemas are associated with bleeding and swelling of the eye and extreme hyphemas are associated with pain, bleeding, swelling and reddening of the entire eye. The diagnosis for hyphema is usually performed by an ophthalmologist evaluating the entire history of the case followed by series of visual acuity tests. A CT scan is also recommended if there is a suspicion of bone damage in the eye region caused because of trauma.
Vitreous hemorrhage is another predominant cause for eye bleeding. Other factors include tumors adjacent to the vitreous humor of the eye and macro aneurysms. The treatment options for vitreous hemorrhages include vitrectomy and through Krypton laser therapy.
Rare causes for bleeding in the eye
Apart from the common factors that are associated with the hemorrhages caused in the eye, some rare conditions such cancers and iritis also cause bleeding in the eyes. Cancers of the eye are usually diagnosed by biopsy and also by careful visual examination. Since the symptoms of the bleeding eye disease may mask the diagnosis of underlying cancer or tumor, malignancy is confirmed by pathologic determination. Iritis is caused because of the inflammation in the iris of the eye. It may be the result of a trauma caused to the eye or underlying systemic conditions such as sarcoidosis and tuberculosis. Analgesics are recommended for common iritis. Patients are advised to wear dark sunglasses.
Exophthalmos, also known as Proptosis, refers to a protrusion or bulging of one (unilateral) or both (bilateral) the eyeballs out of the orbit. Exophthalmos is not a medical condition in itself; but a sign or a symptom of some other disease. There are many underlying conditions that can result in exophthalmos, but most often it is caused by thyroid- related conditions such as Graves disease. Graves disease induced Exophthalmos is one of the manifestations of thyroid eye problems.
Exophthalmos caused due to Graves' disease is usually bilateral. Apart from thyroid problems, there are other conditions that may lead to Exophthalmos. They include cancerous tumor, Mucocoele (mucus-filled cyst), blood clot, trauma (eye injury), inflammation of the orbit structures and very rarely Retrobulbar hemorrhage (bleeding in the eye socket).
Signs and symptoms of Exophthalmos
Exophthalmos caused by Graves disease normally produces symptoms such as pain, watering, dryness, irritation, sensitivity to light, double vision and loss of vision. Tumor-induced exophthalmos presents itself with severe eye pain, headaches and double vision.
Diagnosis of Exophthalmos
Exophthalmos is easily noticeable by its appearance during clinical examination. Ophthalmologist uses exophthalmometer to measure the degree of bulging or protrusion. Blood tests are normally advised, if doctor suspects hypothyroidism, to evaluate thyroid gland function.
If the bulging has occurred in one eye, MRI or CT scan is done to rule out the presence of tumor. These tests also help in diagnosing Orbital cellulitis and Retrobulbar hemorrhage.
Treatment of Exophthalmos
Treating the exophthalmos at an early stage is essential as it is a progressive disease and if left untreated patient may be unable to close the eyes totally. This may dry out the cornea leading to infections and ulcers eventually resulting in vision loss.
In case of thyroid related exophthalmos, the aim of the treatment is to restore the thyroid function and bring the thyroid hormones to normal levels. Medications such as thionamides and radio iodine are given orally to treat overactive thyroid gland. In severe cases, corticosteroids are also administered to provide relief from pain and inflammation. Lubricants are also prescribed to treat dry, red and sore eyes. If the exophthalmos is caused by a tumor, treatments such as radiotherapy, chemotherapy and surgery may be appropriate.
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Bibliography / Reference
Collection of Pages - Last revised Date: January 27, 2023