Diabetic Retinopathy

Diabetic Retinopathy is a common complication with Diabetes where the production or use of insulin levels are not regulated resulting in fluctuating blood sugar levels. Diabetic Retinopathy results in 90% of the cases of type 1 Diabetes and 65% of the cases of type 2 diabetes. Retinopathy is the damage or hemorrhaging of small blood vessels of the retina. It is a non-inflammatory disease of the retina. There are many types of retinopathy. Non Proliferative Retinopathy refers to the condition where the damaged or leaking vessels do not spread. Symptoms include vision spots, loss of vision in some cases, floaters - floating regions of blurred vision or loss of fine vision. On the other hand, Proliferative Retinopathy refers to the spread of the damaged retina - specifically the rupture of the newly formed blood vessels resulting in sudden loss of vision.

Hardening of the retinal arteries is known as Arteriosclerotic Retinopathy. Increased pressure in the affected region may result in the retina detaching itself from the back of the eye that can cause partial or total blindness.

Hypertensive Retinopathy: Hypertension can cause damage to the blood vessels of retina resulting in Hypertensive Retinopathy which has symptoms that include blurred vision or decreased visual perception.

Risk Factors for Retinopathy

• Diabetes mellitus
  
• Hypertension
  
• Hypercoagulability (abnormal tendency of the blood to clot - thrombosis), Thrombophilia
  
• Hyperlipidemia (Abnormally high blood lipid levels)
  
• Hyperviscosity
  
• Trauma
  

Diagnosis and Treatment

Retinal Specialists may use ophthalmoscope or Fluorescein Angiography for a detailed evaluation of the eye condition. Laser Surgery is usually the first choice of treatment to seal the bleeding blood vessels in the retina (retinal hemorrhages). Treatment of diabetic retinopathy would also involve treating the overall condition. Nutritional supplements like Vitamins A, C, E and Lutein may also be tried.

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.

Fluorescein Angiography

Fluorescein Angiography is a diagnostic test that aids visualization of the blood circulation in the retina and choroid. Fluorescein is a water-soluble dye that is injected into a vein in the patient's arm. It travels through the blood vessels of the body thereby aiding multiple photographing of the retina. The images obtained help in detecting any swelling or leakage in the blood vessels. The patient's eyes are dilated with mydriatic eye drops so that photographs of the inside of the eye can be taken.

Some patients may notice skin rash, itching or allergic reaction to the dye. Nausea or vomiting may be noticed. But this non-invasive test can usually be safely repeated. Abnormal results of fluorescein angiography test may indicate diabetic retinopathy, macular degeneration, or cancer. Ischaemia or edema in the retina circulation can be detected with the help of fluorescein angiography.