Thrombosis of a branch of the central retinal vein. Methods of treatment of thrombosis of the central vein of the retina. Evaluation of the effectiveness of treatment

Alas, now ophthalmologists often state retinal thrombosis. Moreover, this phenomenon has become much younger over the past 5 years - the vessels of the eyes are in a “deplorable” state not only in the elderly. First of all, this condition should be feared by those suffering from diabetes mellitus and hypertension, as well as people with glaucoma (increased intraocular pressure).

Causes

Retinal vascular thrombosis is always a consequence of a long-standing chronic eye pathology and / or systemic therapeutic diseases.

Risk factors and precursor diseases of retinal thrombosis:

Atherosclerosis . The deposition of "harmful" lipids in the inner membrane (intima) of the vessels leads to damage to their walls. In response to this, inflammation occurs, which provokes the migration of coagulation factors to the site of damage and increased thrombus formation.
Diabetes. This disease not only exacerbates the course of atherosclerosis, but also contributes to fragility and pathological tortuosity of blood vessels. There is even a term "diabetic retinopathy" - pathological changes in the vessels of the retina as a result of damage by structurally altered glycosylated (saturated sugars) proteins.
Arterial hypertension . People with high blood pressure should be especially wary of retinal vascular thrombosis. Due to hypertension, the smallest vessels are damaged, the blood supply is disturbed and the formation of blood clots is accelerated.
Vasculitis - from Latin, the term literally translates as "inflammation of the vessels." It occurs as an allergic reaction or as a result of diseases of the connective tissue and blood (hemorrhagic vasculitis, systemic lupus erythematosus, scleroderma, etc.).
Bulging eyes due to prolonged and persistent thyrotoxicosis . An excess of thyroid hormones affects the periorbital tissue - it begins to grow. The eyeball literally "bulges" outward. The vessels do not keep up with it - they burst and thrombose.
Tumors . They can grow both from the tissue of the eye and metastasize from other organs. Sometimes a particle of the tumor that has entered the vessel blocks its lumen.

Stages and types of retinal thrombosis

Thrombosis of the central retinal vein (CRV) can be of two varieties:

thrombosis of the central vein, scientifically - central occlusion;
thrombosis of one or more branches of the central vein - peripheral occlusion.

Such a division is necessary to evaluate the following parameters:

Areas of defeat . In CVR thrombosis, a large part of the retina is damaged, and in the presence of a thrombus in a small venule, only a small area may be affected.
The severity of possible consequences and the urgency of hospitalization . Thrombosis of the central vein is dangerous with a significant loss of vision and requires immediate hospitalization. Thrombosis of the peripheral retinal veins with early diagnosis and a small area of damage can be treated even on an outpatient basis.
Volume of ophthalmic care . Treatment with central occlusion will be more prompt and voluminous than with peripheral occlusion.

Stages of the thrombotic process in the retina

The development of the disease proceeds in several stages:

Prethrombosis . It is characterized by the expansion and tortuosity of the veins, single point hemorrhages. At this stage, there are no clinical manifestations yet, but periodic blurring before the eyes may appear.
Thrombosis directly . Numerous linear hemorrhages are visible in the fundus, macular edema on the retina, which is responsible for color perception, fuzzy boundaries of the optic nerve head. There is a sharp fall in visual acuity and a persistent "veil" before the eyes.
Post-thrombotic changes . On the fundus, traces of hemorrhages and newly formed vessels with thin walls are visible. Visual acuity is restored slowly.

Clinical symptoms and diagnosis of retinal thrombosis

Symptoms largely depend on the location of the thrombus and the degree of narrowing of the vessel (occlusion).

If there is thrombosis of the central vein of the retina, at least 3/4 of the retina is damaged: there will be large multiple hemorrhages, a rapid deterioration in vision and a distortion of color perception.

If thrombosis of a branch of the central retinal vein (a small branching vessel) has occurred, visual acuity falls slowly and is often not regarded as an alarming symptom. Blurry black spots or "fog" may appear in the field of view in front of the gaze.

Complete occlusion (occlusion of the vein lumen by 95% or more) has severe clinical symptoms. Fortunately, it is rare. Partial occlusion may not be clearly manifested. The manifestation of signs of thrombosis begins with a narrowing of the lumen of the vessel by 70 percent or more.

Thrombosis of the central retinal artery is always an urgent (emergency) condition that requires prompt qualified assistance! If with venous occlusion there is a chance to save vision, then with occlusion of the CAC, complete blindness threatens.

Diagnostics

A 100% specific sign of thrombotic changes in the retina during examination of the fundus with a magnifying glass is the appearance of a “crushed tomato”.

Also, with visometry, reduced visual acuity is diagnosed - a person cannot see the lines of letters and notes that he began to see worse than the day before.

Angiography with fluorescent contrast agent will help to make a definitive diagnosis and accurately indicate the location of the thrombus.

Treatment

Treatment is carried out in 4 stages:

Restoration of blood flow in a thrombosed vessel.
Reduced retinal edema.
Dissolution and elimination of the resulting hemorrhages (if they are small in area).
Improvement of microcirculation in the retina.

Therapy Methods

For the treatment of retinal thrombosis, an integrated approach is used:

A thrombus can dissolve Fibrinolysin or Plasminogen. They are injected with a syringe under the eye. The only caveat: no more than 2 hours should pass from the onset of clinical manifestations of thrombosis.
Heparin in the form of injections, Warfarin or Clopidogrel - are used to prevent further thrombosis and reduce blood clotting in small vessels.
Trental is able to improve blood circulation and protect the walls of blood vessels from hypoxia. It is administered intravenously 2 times a day.
Retinal edema is treated by introducing solutions of glucocorticosteroids (Prednisolone, Hydrocortisone) into the tissue around the eye. With severe soreness in the eye, anti-inflammatory drugs are prescribed intravenously.

folk therapy

In addition to traditional therapy, there are many traditional medicines. But they are used only for preventive purposes. To maintain the elasticity of the walls of blood vessels, a decoction of nettle, tincture of sage, mint in all varieties (tincture, tea, juice) is suitable. Helps improve vision forest honey.

Excellent help in the prevention of eye diseases drops made from freshly squeezed clover or cornflower juice. Take 1 tablespoon of chopped herbs in a glass of boiling water. The mixture is infused for 2 days, then filtered. You need to drip 2 drops in each eye at least 4 times a day.

Natural remedies, of course, are good, but not for emergency help. They can slow down the rate of development of pathological changes. But in the presence of complications or severe neglect of the process, only traditional, scientifically proven methods can save.

Since the complications of a blood clot in the retina are at least a decrease in vision, the maximum is atrophy of the optic nerve and complete blindness, it is important to recognize the symptoms in time and provide qualified assistance. But it is easier to prevent negative consequences.

Prevention measures

Retinal thrombosis is really preventable. It is only necessary to undergo annual examinations and follow the doctor's prescriptions. Ways to prevent retinal vein thrombosis depend on the presence of a specific risk factor and comorbidity.

In hypertension, funds are needed to normalize blood pressure. There are many of them, an individual combination is selected for each patient. Concerning action of concrete preparations it is necessary to consult at the cardiologist.
With all types of diabetes, the main task is to achieve a constant normal level of blood glucose. This can be achieved by diet, adequate physical activity and carefully selected medications. In type 1 diabetes, you need to set the dosage of insulin, in type 2 diabetes, the type and frequency of use of hypoglycemic drugs.
Any eye disease requires increased attention. In no case should you start glaucoma. Not only does it threaten with thrombosis of the vessels of the eye, it also leads to a complete absence of lateral vision. People with various types of retinopathy (diabetic or hypertensive) should be checked by an ophthalmologist once every six months.
Correction of hormone levels. With excessive work of the thyroid gland, drugs that reduce the level of thyroxine are needed. Women are not recommended to "get carried away" with oral contraceptives - they increase the risk of blood clots.
Prevention of increased aggregation ("clumping") of platelets - take Aspirin (TromboASS or Plavix) daily, 1 tablet a day. This is especially true for those who suffer from cardiovascular diseases.

Vision is a special sense organ, without which a person loses the ability to self-service and a normal social life. Patients with eye diseases should understand that ocular thrombosis leads to irreversible changes. No operation will return or “resurrect” retinal neurons that died as a result of oxygen starvation. It is better to start prevention of retinal thrombosis right now.

Useful video about retinal thrombosis

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

What is this disease, what is dangerous

Retinal vein thrombosis develops due to blockage of a blood vessel by a blood clot. In this case, a reverse reflux of blood into the capillary vessels of the specified area of the eye occurs. Because of this, blood pressure rises in the capillaries, contributing to retinal hemorrhage and significant edema.

If you do not treat thrombosis, the development of glaucoma is inevitable - a disease that leads to loss of vision.

Thrombosis can be accompanied by a decrease in vision, sometimes up to 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 slowly recover. With a blockage in the central vein, the situation is not so favorable, since vision is restored worse. With advanced pathology, restoration of vision occurs only in rare cases.

Causes of the disease

The main cause of the disease is thrombosis (blockage) of the central vein of the retina, the lower branch or the upper temporal branch of the CVR (central retinal vein).

Blockage occurs for the following reasons:

Arteriosclerosis. It often leads to the fact that the patient develops thrombosis of the central retinal artery. Such a violation inevitably leads to occlusion of the veins.
Arterial hypertension.
Diabetes mellitus of insulin-dependent or non-insulin-dependent type. Especially dangerous are sharp jumps, poor compensation for diabetes.
Flu.
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 (a sedentary lifestyle);
weight gain;
cardiovascular diseases;
violations of the endocrine glands;
improper treatment of hypertension, diabetes and other diseases.

Such a pathology is very dangerous because if you visit a specialist late, it can cause an absolute loss of vision.

The main signs of the disease

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

Initially, patients do not complain of visual impairment, although this is the most important symptom of the disease. Sometimes patients note a distortion of the visibility of objects, some blurring of vision. But if the macula area is not involved in the pathological process, these signs do not bother patients either.

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

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

Stages of the disease

CVD thrombosis develops gradually in humans. If treatment is started too late, the person may develop vision loss. Sometimes absolute or partial thrombosis can be discovered by chance during a routine examination.

The blockage is of the non-ischemic type (in this case, visual acuity is maintained at a level above 0.1). With ischemic thrombosis, massive hemorrhages develop, 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 noted. Usually patients at this stage do not show any symptoms. In some cases visual acuity is insignificantly reduced. Visible objects can often become cloudy.
At the stage of occlusion of the vein or its branches, hemorrhages of various sizes are often noticeable. If the central vein collapses, then they are on the entire retina. There are also cases when foci of hemorrhages appear only in the region of one branch of the vein. On examination, the boundaries of the nerve are usually indistinguishable or indistinct. Edema develops in the macula. Typical symptoms are a significant decrease in visual acuity, scotoma (loss of part of the visual field). Often the patient notes a characteristic veil in the visual field.
Some time after thrombosis, post-thrombotic retinopathy develops. The patient's vision is restored 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..

Features of diagnostics

Determining the diagnosis is not difficult for an experienced ophthalmologist. Sometimes it is enough to conduct an ophthalmoscopy of the fundus. Angiography is used to more accurately determine the degree of damage to the eye. Particular attention should be paid to diagnosing the anterior parts of the eyes.

Inspection of the bottom of the eye is carried out, as a rule, using a Goldman lens. Additionally, there are:

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

General principles of disease therapy

Treatment for retinal thrombosis should begin as soon as a doctor makes a diagnosis. Mandatory drug therapy for vein occlusion. The patient is prescribed the means of several pharmacological groups:

Drugs that lower blood pressure. For this, the patient is prescribed Nifedipine, Phenigidine (sublingually). 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 instilled into the eye to reduce intraocular pressure.
To restore normal blood flow in the affected vessel, funds from the group of fibrinolytics are prescribed. Within one to two weeks, Plasminogen is injected under the eye. In addition, the introduction of direct anticoagulants (also under the eye) is preferable.
Antiplatelet agents are indicated for the prevention of recurrence of the disease. The most commonly prescribed drugs from this group are Acetylsalicylic acid or Plavix. Medicines of this group are necessarily administered under the control of the blood coagulation system.
To reduce swelling and inflammation, hormonal drugs 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.
Reopoliglyukin and Trental are used to improve blood circulation in the capillaries of the eye.
Appointed and, such as Dicinon, Emoksipin.
Of the antispasmodics, the use of No-shpa, Papaverine is preferable.
Finally, the use of vitamins - ascorbic acid, group B is shown.

After drug therapy, it is desirable to carry out laser coagulation of the retina.

But treatment with folk remedies in most cases is not beneficial, since a complex of highly effective medical preparations is needed to achieve the desired therapeutic effect.

Consequences of thrombosis

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

Some patients may not tolerate certain medications very well.

When using thrombolytic agents, there is a high risk of bleeding.
As a result of laser therapy, macular edema may resume.
The rarest complications of the treatment of vein thrombosis are retinal detachment, hemorrhages (such conditions threaten a person with complete blindness).

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.

Disease prevention

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

Maintaining a healthy lifestyle - avoiding smoking and drinking alcohol.
Nutritional adjustments to limit the intake of foods that increase blood pressure.
Prevention of low physical activity (for this it is desirable to play sports).
It is necessary to perform exercises for the development of the ciliary muscle.
It is extremely important to have regular check-ups with an ophthalmologist.
It is necessary to qualitatively and fully treat diseases of the cardiovascular system, control blood pressure.

Retinal vein thrombosis is much easier to prevent than to treat. Keep this in mind, because the eyes are the most important sense organs of the body, and often only the preservation of vision depends on the person himself.

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

Thrombosis of the central vein develops in most cases in the elderly. As for younger patients, the disease occurs in them an order of magnitude less frequently.

Even diseases that, it would seem, are not directly related to the eyes, can provoke it. For example, this can include focal or viral infections (pneumonia, influenza, etc.). More often, the central vein undergoes occlusion, and its branches are clogged only in 30% of cases.

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

By stages, occlusion can be divided into several stages:

Prethrombosis. It is characteristic that the veins become uneven in size, dilated and tortuous. In the macular region, edema is often found, and small (filamentous) hemorrhages are also present. The patient may not feel the development of the disease in any way, only sometimes the vision is clouded, but in most cases this phenomenon is attributed to ailments.
Initial thrombosis, in which streaky hemorrhages extend to almost 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 basin of the central vein. At this stage, visual impairment becomes more noticeable, the appearance of flies, fog before the eyes is more often disturbing.
Post-traumatic retinopathy develops immediately after the occurrence of blockage of the vein. To some extent, the lost sharpness and quality of vision are restored, but very slowly. In the central zone, edema persists in a cystic form. Of particular difficulty and danger at this stage is the pathological growth of the vascular network, even in the area where, according to the norm, it should not be.

The disease may recur. 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. Least of all, the retina undergoes changes in this form of the disease. At the same time, visual acuity often remains at a high level.
ischemic form. The blood flow is seriously impaired, vision deteriorates significantly. The retina shows a large amount of edema and hemorrhage. This type of disease needs not only timely treatment, but also constant monitoring.

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. The blood flow worsens, and this process leads to the appearance of a blood clot in its cavity. Stagnation of blood negatively affects the state of the fundus: the vessels become permeable, hemorrhages become more extensive, and edema appears.

The central vein is often clogged with glaucoma, as well as with diseases that are characterized by an increase in blood viscosity. A blood clot can also occur due to the intake of certain medications (contraceptives, diuretics).

The risk group includes people who prefer a sedentary lifestyle, having problems with blood vessels and the heart, and obesity. A special category is occupied by patients with endocrine disorders, as well as those who prefer to treat them using folk methods. We will talk about the symptoms of retinal vascular thrombosis further.

Pathology is almost asymptomatic, with the exception of a gradual loss of visual acuity. In the absence of proper therapy, the risk of blindness increases significantly. Sometimes blind spots can occur

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

Perimetry. Of particular value is in the detection of 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. With the help of this technique, all the signs inherent in thrombosis are revealed, whether it is a change in the veins, swelling, new vessels, or the presence of hemorrhages.

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

Sometimes, fluorescein angiography is used as a definitive confirmation of the diagnosis.

Therapeutic

Treatment of thrombosis must begin as soon as possible, otherwise the health consequences will be serious. It will be necessary to dose the loads, exclude from the diet any products that affect the level of blood pressure and can provoke its increase.

It is important to remember: you should not treat thrombosis of the central vein of the retina with folk remedies! It can be dangerous for your health!

One of the most important measures in the medical 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 a complete treatment, drugs of groups that are included in the following list are used:

Fibrinolytics. Restore damaged areas of blood vessels.
Antihypertensive drugs. Often, unstable blood pressure becomes the impetus for the development of pathology, so it is imperative to use the appropriate medications. Many of the funds have the ability to reduce swelling. Injections are most effective, but in addition to them, hypotensive drops are often used.
Vitamin remedies. Particular attention is paid to vitamins B and C, since they play a special role in the treatment of pathology.
Hormonal drugs 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 funds necessarily require monitoring of blood clotting.
Antispasmodics.
Angioprotectors.

Injections of diprospan and dexamethasone are necessary if vascular edema has formed. Ozurdex and Lucentis also help to reduce swelling and stop the formation of new vessels. In many cases, Trental or rheopolyglucin is used, as they help restore blood microcirculation.

Thus, permanent hemorrhages are eliminated and the treatment gives a greater effect. Laser coagulation is used after the end of drug treatment.

The main preventive measures are the constant monitoring of blood pressure, as well as the exclusion of 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.

With thrombosis of the central vein, 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.

The prognosis is almost always favorable with timely therapy. 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 retinal vein or retinopathy of venous stasis is an acute ophthalmic disease caused by impaired blood flow in the CVT 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 that most often occurs in people with pathologies of the visual apparatus, so the initial signs of the disease are rarely diagnosed on time. An appeal to a specialist almost always occurs already with the formation of a significant blood clot, which can lead to the most serious complications. Often, the onset of the development of the disease occurs after the narrowing of the vein or the closure of the lumen of the vessel, which can occur due to many reasons. Depending on the degree of reduction 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, 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, the first signs of venous blood stagnation can be seen. At the same time, the veins expand, their structure changes. Puffiness appears in the macular region, small capillary hemorrhages often occur;
initial thrombosis. The patient has blurred vision, flies or flickering before the eyes. When examining the eyeball, one can notice significant hemorrhages of varying degrees that extend to the retina, and optic disc edema occurs. Decreased visual acuity may begin;
Directly retinopathy. Small hemorrhages begin to resolve, degenerative changes and retinal atrophy develop. Within 2-3 months, the blood vessels branch over the entire area of the fiber, numerous ophthalmic dysfunctions are observed. Vision is almost always reduced.

Since thrombosis of the retinal vein 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 is due to the fact that dilated arteries in some functional or ophthalmic 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;
Ophthalmic pathologies in which intraocular pressure increases, for example, glaucoma.

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

It is believed that the risk of pathology increases in people who lead a sedentary lifestyle, are obese and endocrine disrupted.

There are clinical cases of retinal vein thrombosis in patients with cancers of the blood and hematopoietic organs. But it is not customary to single them out 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 can 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 ophthalmic disorders;
Non-ischemic or incomplete occlusion. Lesions of the retina and blood vessels are much less pronounced, there are no profuse hemorrhages, visual acuity can remain intact.

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

During the diagnosis of the fundus, the so-called “crushed tomato” symptom is often found. It is characterized by the appearance of puffiness on 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 fiber degeneration are possible, as well as a general thinning of blood vessels, which can lead to their rupture. 1 in 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 lies in the risk of subsequent relapses. To avoid this, it is necessary to regularly undergo 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, the following pathologies are likely to develop:

Glaucoma;
Retinal degeneration of varying degrees;
Atrophy of the optic nerve;
Violation of the functioning of blood vessels - the development of uveitis and iridocyclitis;
Complete or partial loss of vision.

The risk of complications can be reduced only with timely access to an ophthalmologist and competent treatment of this disease.

Therapy is always prescribed immediately after the results of the diagnosis and confirmation of the diagnosis, because 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 task of which is:

Resorption of hemorrhages on any element of the eye;
Restoration of blood circulation in the affected vein;
Removal of puffiness of the retina;
Nutrition and improvement of trophism of the main components of the visual apparatus.

For this, fibrolytics are usually prescribed, as well as direct-acting coagulants. Of no small importance for the treatment of thrombosis is the normalization of arterial eye pressure, which makes it possible to alleviate the general condition of the patient 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. With severe pain, it is also necessary to take broad-spectrum antispasmodics. And throughout the treatment, a prerequisite is the use of vitamins and biological mineral supplements for the general strengthening of 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 recurrence 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 mellitus and hypertension, are at risk, it is necessary to undergo medical examinations on time and monitor the state of blood pressure and blood glucose levels. And for the normal functioning of the circulatory system of the body, excessive consumption of caffeine and nicotine should be abandoned, which increase blood pressure and affect blood clotting, causing the risk of thrombosis.

Of great importance is the timely appeal to a specialist 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.

Eye drops Okomistin with instructions for use

The rules for the treatment of eye diseases using Dexa-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 ophthalmic diagnoses, since even with proper treatment, there is a possibility of a relapse of the disease. The disease 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, therefore, from an early age, you need to take good care of your body and undergo medical examinations on time.

Also read about optic neuritis and choriothetinitis.

If you do not treat thrombosis, the development of glaucoma is inevitable - a disease that leads to loss of vision.

Thrombosis can be accompanied by a decrease in vision, sometimes up to blindness. The degree of visual impairment depends on which part of the vein is affected by the pathological process.

The main cause of the disease is thrombosis (blockage) of the central vein of the retina, the lower branch or the upper temporal branch of the CVR (central retinal vein).

Blockage occurs for the following reasons:

Arteriosclerosis. It often leads to the fact that the patient develops thrombosis of the central retinal artery. Such a violation inevitably leads to occlusion of the veins.
Arterial hypertension.
Diabetes mellitus of insulin-dependent or non-insulin-dependent type. Especially dangerous are sharp jumps in glycemia, poor compensation for diabetes.
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 (a sedentary lifestyle);
weight gain;
cardiovascular diseases;
violations of the endocrine glands;
improper treatment of hypertension, diabetes and other diseases.

Such a pathology is very dangerous because if you visit a specialist late, it can cause an absolute loss of vision.

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

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

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 noted. Usually patients at this stage do not show any symptoms. In some cases visual acuity is insignificantly reduced. Visible objects can often become cloudy.
At the stage of occlusion of the vein or its branches, hemorrhages of various sizes are often noticeable. If the central vein collapses, then they are on the entire retina. There are also cases when foci of hemorrhages appear only in the region of one branch of the vein. On examination, the boundaries of the nerve are usually indistinguishable or indistinct. Edema develops in the macula. Typical symptoms are a significant decrease in visual acuity, scotoma (loss of part of the visual field). Often the patient notes a characteristic veil in the visual field.
Some time after thrombosis, post-thrombotic retinopathy develops. The patient's vision is restored 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..

Inspection of the bottom of the eye is carried out, as a rule, using a Goldman lens. Additionally, there are:

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

Treatment for retinal thrombosis should begin as soon as a doctor makes a diagnosis. Mandatory drug therapy for vein occlusion. The patient is prescribed the means of several pharmacological groups:

Drugs that lower blood pressure. For this, the patient is prescribed Nifedipine, Phenigidine (sublingually). 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 instilled into the eye to reduce intraocular pressure.
To restore normal blood flow in the affected vessel, funds from the group of fibrinolytics are prescribed. Within one to two weeks, Plasminogen is injected under the eye. In addition, the introduction of direct anticoagulants (also under the eye) is preferable.
Antiplatelet agents are indicated for the prevention of recurrence of the disease. The most commonly prescribed drugs from this group are Acetylsalicylic acid or Plavix. Medicines of this group are necessarily administered under the control of the blood coagulation system.
To reduce swelling and inflammation, hormonal drugs 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.
Reopoliglyukin and Trental are used to improve blood circulation in the capillaries of the eye.
Angioprotectors are also prescribed, such as Dicinon, Emoksipin.
Of the antispasmodics, the use of No-shpa, Papaverine is preferable.
Finally, the use of vitamins - ascorbic acid, group B is shown.

After drug therapy, it is desirable to carry out laser coagulation of the retina.

But treatment with folk remedies in most cases is not beneficial, since a complex of highly effective medical preparations is needed to achieve the desired therapeutic effect.

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

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

Maintaining a healthy lifestyle - avoiding smoking and drinking alcohol.
Nutritional adjustments to limit the intake of foods that increase blood pressure.
Prevention of low physical activity (for this it is desirable to play sports).
It is necessary to perform exercises for the development of the ciliary muscle.
It is extremely important to have regular check-ups with an ophthalmologist.
It is necessary to qualitatively and fully treat diseases of the cardiovascular system, control blood pressure.

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

Thrombosis of the central retinal vein as an independent disease rarely develops. Pathologies in the form of atherosclerosis, hypertension, diabetes mellitus, systemic vasculitis, thrombophilia and other blood diseases associated with increased clotting lead to it.

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

The formed 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 edema.

The causes of thrombosis of the CVA of the eye also include:

infectious diseases;

ophthalmic hypertension;

swelling of the optic nerve;

tumors localized within the ocular system;

orbitopathy;

excess weight;

endocrine disorders;

sedentary lifestyle;

alcohol intake.

The development of CVD thrombosis is divided into three stages:

Prethrombosis
there is venous congestion;

veins gradually expand, change color, obvious crossings and tortuosity are formed;

in the process of diagnosis, one can detect a slowdown in blood flow, darkening of the vein and petechial hemorrhages of small sizes.

2 stage
it is already characterized by obvious circulatory disorders, as a result of which the walls of the vessels of the veins are strained, provoking hemorrhages in the retina and other tissues of the eyeball;

due to an increase in the permeability of the vein, transudative tissue edema is formed.

3 stage Thrombosis develops in a complete or incomplete form, accompanied by atrophic or degenerative changes in the retina.
Retinal vein occlusion is provoked by a thrombus formed in the lumen. But sometimes the pathology develops in connection with the thickening of the wall of the arteriole, which gradually leads to squeezing of the venule.

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

Damage to the retina of an ischemic nature gradually increases the production of vascular endothelium, which, in turn, contributes to the emergence of newly formed vessels located on the surface. The danger of post-thrombotic retinopathy lies in hemorrhage into the eye cavity and the development of neovascular glaucoma.

There are the following factors that affect the development of post-thrombotic retinopathy:

advanced age of the patient;

somatic diseases in the form of hypertension, diabetes and others;

high IOP;

inflammation;

various disorders of the blood coagulogram.

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 branch.

The symptomatology of the pathology directly depends 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 defeat;

blurred vision that does not cause pain;

gradual decrease in visual acuity;

metamorphopsia - a characteristic distortion of objects;

other visual impairments.

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

Macular lesions directly affect visual acuity. Thrombosis of the central retinal artery leads to a modification of the fundus - during the diagnosis, the specialist sees numerous hemorrhages of a dashed character, edema is often noted.

Diagnosis of CVD thrombosis involves a survey of the patient by a specialist, as well as a complete 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 and additional symptoms.

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

Additional symptoms in the form of clouding, 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 if the patient has “precursors” of the disease, which can accurately reveal the picture of visual impairment and the development of thrombosis. It is also important to clarify the presence of vascular pathologies in relatives.
Taking medications Medications in the form of oral contraceptives and diuretics directly affect the blood coagulation system, which provokes the development of CVA thrombosis.
General condition of the patient Thrombosis often occurs against the background of vascular diseases, which may additionally be accompanied by dizziness, headaches, high blood pressure and pain in the heart.

Visometry
check visual acuity;

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

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

such indicators are associated with impaired blood circulation;

often, to detect pathology, daily measurements of IOP are used to study them in dynamics.

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

PCV in this case is characterized by the detection of scotoma at the sites of retinal lesions;

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

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

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

allows you to determine the location of the lesion.

biomicroscopy
determination of the development of thrombosis by detecting grinding of the anterior chamber of the eye, which is provoked by a deterioration in venous outflow;

ischemic occlusions are accompanied by the formation of 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 (violation of the pupil's reaction to directional light), which is diagnosed in 85% of cases. When examining the retina, floating blood clots and inflammation can often be seen.

For the diagnosis of thrombosis, the following modern research methods are also used:

Optical coherence tomography
an invasive method with which you can get a complete image of the retina in section;

it uses a scanning beam emitting a thin jet of an infrared laser;

the presented method allows you to determine the optical sections in terms of histology;

using OCT, it is possible to determine the height, area and structure of edema, the presence of vitreoretinal tractions and other important features in the development of thrombosis;

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

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

localization of the lesion;

degree of pathology;

condition of the venous wall and capillary perfusion;

pathology of the arterial bed;

the presence or absence of anastomoses;

development of neovascularization;

assessment of the macular zone;

state and nature of blood circulation.

FAG is often performed already at the first appointment, but there may be exceptions related to the opacity of the optical media and multiple hemorrhages, which make angiography difficult.

Already in the process of treatment, FAG is carried out 3 months after the first treatment in order to evaluate the effectiveness of the prescribed drugs.

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 age of the patient;

ischemic neuroopticopathy.

The treatment of retinopathy is started immediately, since the effectiveness directly depends on the area and degree of damage, the nature of thrombosis, and the formation of complications.

At the initial stage, the patient is prescribed a treatment regimen using conservative therapy methods. It uses the use of drugs or injections to dilate blood vessels, eliminate edema and thin the blood clot.

The main task in the treatment is to prevent further progression of the pathology and reduce ischemic changes. If the patient is given timely medical care, the blood flow can be fully restored, the hemorrhages resolve, and vision returns to normal.

Conservative therapy is presented in the form:

Decreased IOP
clonidine or ethacrynic acid is used to reduce edema and reduce external pressure on the vessels;

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

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

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

Recovery of 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 the indicators of blood clotting.

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

If the treatment did not give positive results, there is a high probability of the formation of edema in the macular zone. It leads to the death of retinal cells, resulting in partial or complete loss of vision. Therefore, specialists use such methods of treatment that allow you to quickly extract fluid from the layers of the retina.

For the treatment of CVA thrombosis, laser coagulation is sometimes used, which allows you to quickly achieve a similar result as in the case of conservative treatment.

Ischemia of the posterior pole of the eye leads to complications in the form of the development of post-thrombotic retinopathy. Such complications often arise in connection with the defeat of the entire central retinal vein with an ischemic nature of the pathology. Post-thrombotic retinopathy is diagnosed in 10% of cases.

Also, the causes of the development of complications include the occurrence 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 the case of timely and correct treatment, the patient's vision is fully restored. But in 10% of cases, even with a complete anatomical restoration of the fundus, vision remains low or practically disappears.

Date: 01/04/2016

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Thrombosis of the eye 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, while 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 old, and statistics show that in men this pathology is much more common 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 thrombus in the eyeball

In most cases, the appearance of a blood clot in a blood vessel is associated with human diseases that contribute to thickening of the blood and disruption of the normal functioning of blood vessels. The causes of 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.

Especially often, thrombosis of the CVA occurs with sharp jumps in blood sugar, as well as 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 pressure on the blood vessel from the outside, 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;
malnutrition;
avitaminosis.

Predisposing factors alone are not able to provoke the appearance of a blood clot, but nevertheless, under certain conditions, they can contribute to this process. For example, a sedentary lifestyle leads to stagnation of blood 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 thrombus in the eye has a pronounced staging.

At stage 1, the so-called prethrombosis is observed, characterized by the development of venous blood stasis. In this case, the veins acquire a dark shade, expand, and in addition, there are obvious arteriovenous crossings and tortuosity. When conducting an angiovenous study, a clear slowdown in blood flow is revealed. At this stage, there is an expansion and darkening of the vein, small pinpoint hemorrhages.

At stage 2, a clear circulatory disorder develops in the central retinal vein. The walls of the blood vessels are very tense, so extensive hemorrhages in the retina, vitreous body and other tissues of the eyeball are not uncommon. The permeability of the vein increases, so there is a transudative edema of the tissues along the location of 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 hemorrhages that have taken place, newly formed vessels and solid 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 region of the optic disc may be observed, although anatomically they should not be there.

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Symptoms of a blood clot in the eye

At the initial stage of the development of a blood clot, most people do not notice obvious signs of decreased vision. In rare cases, there may be periodic blurring of vision, and in addition, a slight decrease in acuity. Most often, the patient learns about the appearance of a blood clot early in the morning, when, having opened his eyes, he discovers obvious vision problems.

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

Blockage of blood flow in the blood vessels of the eye is a very dangerous phenomenon. In the absence of rapid targeted treatment, tissue necrosis is observed, which leads to a complete and irreversible loss of visual ability. Loss of vision is observed due to neovascularization of the retina, recurrent hemorrhages, secondary glaucoma.

Thrombosis of the vessels of the eye- a condition characterized by the formation of blockage of the central vessel of the retina or its branches. As a result, blood circulation is disturbed, stagnant processes begin. Retinal thrombosis is currently one of the causes of progressive vision loss. In most cases, the disease affects the elderly, but the development of pathology at any age is possible.

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Thrombosis of the eye. What's this?

Thrombosis of the central retinal artery- acute violation of blood flow in the retinal artery or its branches, leading to the development of ischemia. It is this condition that has a rapid development and poses a danger to visual function.

Blockage of the central retinal vein and its branches disrupts blood flow. Overcrowding of vessels with an excess amount of blood provokes their overstretching and deformation. The wall thickens, becomes denser. The blood flow slows down, a blood clot forms in the vessel.

As a result of stagnation of blood, the permeability of the vascular wall increases, which contributes to the formation of a reverse flow of blood into the capillaries and its further exit into the tissues surrounding the vessel. Intraocular pressure rises, as a result, hemorrhage may occur, edema is formed. In more than 80% of cases, the blockage occurs in the superior temporal branch of the central retinal vein.

Retinal vein thrombosis is divided into:

ischemic - there is a significant violation of blood circulation, visual function is impaired, hemorrhages are found on the retina, the tissue is edematous, immediate treatment is required;
non-ischemic - retinal damage is less pronounced, visual acuity is reduced or remains at the same level.

Reasons for development

Thrombosis of the eye is rarely formed as an independent disease. More often it is a consequence of the development of concomitant pathology. Among the main causes of the development of the disease:

atherosclerosis;
diabetes;
systemic vasculitis;
violation of the blood coagulation system;
hypertonic disease;
thyrotoxicosis;
infectious processes in the oral cavity and sinuses;
increased intraocular pressure;
intraocular neoplasms.

Especially often, thrombosis of the CVA is formed with sudden changes in the concentration of glucose, as well as with changes in blood pressure. In addition, it is possible to identify factors, the presence of which creates a predisposition to pathology:

excess weight;
age;
endocrine diseases, taking hormonal drugs;
inactive lifestyle.

Stages of development

Thrombosis of the CVD and its branches goes through several stages in its development:

Stage 1 (prethrombosis): congestive processes begin, the veins become dark, dilated, arteriovenous decussations and tortuosity form, blood flow slows down, small hemorrhages occur, vision is periodically clouded;
Stage 2 (thrombosis): the vascular walls are tense, extensive hemorrhages are formed in the retina, vitreous body, permeability is increased, swelling is noted along the vein, thrombosis is formed, the patient complains of visual impairment, loss of field of vision in the affected areas;
Stage 3 (post-thrombotic retinopathy): occurs 1-2 months after thrombosis, hemorrhages resolve, atrophy and degenerative changes in the retina begin, vision is restored, but not to the initial level, new vessels grow, and even in places where they should not this may create an increased risk of recurrent retinal vein thrombosis.

Symptoms

In the early stages of the development of the disease, most patients do not notice a pronounced impairment of visual function. Rarely, blurring and a slight decrease in visual acuity may occur. The greatest severity of symptoms is observed in the morning, after waking up. This is due to the fact that during sleep, all stagnant processes are intensified. Intense symptoms begin with blockage of more than 70% of the lumen of the vessel.

Symptoms are determined by the location of the thrombus and the degree of stenosis of the vessel. When blocking the central vein, at least 75% of the retina is damaged. There are multiple hemorrhages, vision deteriorates, color perception is disturbed. When a branch of the central vein is blocked, functions are slowly disturbed, often such changes do not cause alarm in the patient. Blurry dark spots are found in the field of vision, vision is blurred. Complete occlusion of the central vein is characterized by severe symptoms, in this condition the lumen of the vessel is blocked by at least 95%, but this is rare.

Diagnostics

When the slightest appears, you should contact an ophthalmologist as soon as possible. If there is a complete blockage of the central vein, help should be provided within an hour. If the blood flow is restored during this time, visual impairment can be avoided.

To diagnose this condition, the doctor clarifies the patient's complaints, anamnesis and conducts an examination. Instrumental research methods are also used:

visometry - checking visual acuity using a table or counting the number of fingers;
perimetry - determination by cattle in the field of view;
biomicroscopy - detection of opacities in the vitreous body;
ophthalmoscopy - a study that allows you to assess the condition of the fundus, determine the presence of hemorrhages, with thrombosis, a characteristic picture of a “crushed tomato” is detected;
fluorescein angiography (FAG) - a study of retinal vessels, which makes it possible to identify the degree of thrombosis, the size of the affected area and the condition of the vessels;
retinal tomography displays the presence of blood clots in the vessel, allows you to diagnose retinal detachment, detect retinal hemorrhages, and inflammatory processes.

Laboratory studies include a general and biochemical blood test. Also, all patients undergo electrocardiography and blood pressure changes.

Treatment

Therapeutic measures are carried out in several stages:

restoration of blood circulation;
reduction of retinal edema;
elimination of hemorrhages with their small area;
restoration of microcirculation.

Conservative therapy

If retinal thrombosis is diagnosed in the initial stages, drug therapy has a good effect:

fibrinolytics (Fibrinolysin) dissolve thrombotic masses, are injected parabulbarno (under the eyeball) with a syringe, but their use is possible no later than 2 hours after the onset of symptoms;
hormones (Dexamethasone) reduce swelling, inflammation and pain, are injected into the area around the eye;
anticoagulants (Heparin, Warfarin) are used to prevent recurrent thrombosis;
antiplatelet agents (Aspirin) reduce blood clotting;
angioprotectors (Emoxipin) restore the structure and function of blood vessels;
antihypertensive drugs (Nefidipine) lower blood pressure;
vitamin complexes.

In the acute phase of thrombosis of the CVA of the eye, treatment is carried out in an ophthalmological hospital, then in a polyclinic, under the supervision of a doctor.

Treatment of blockage of the central retinal artery should be started in the first hours of the development of pathology, otherwise the restoration of vision will be impossible. Emergency care is to massage the eyeball, this helps to restore blood flow. Eye drops and diuretics are used to lower intraocular pressure.

Surgery

After a course of conservative therapy, laser coagulation of the retina is performed - cauterization. The purpose of this procedure is the destruction of a blood clot and the restoration of normal blood circulation. This operation is performed on an outpatient basis - no hospitalization is required. The procedure is painless, performed under local anesthesia and is highly effective. However, there are contraindications:

cataract;
retinal disinsertion;
hemorrhages in the fundus;
low transparency of the media of the eye.

After the operation, the patient should limit physical activity, avoid sudden movements, wear sunglasses, control blood pressure. Watching TV and using a computer is prohibited.

Complications and prognosis

Ischemic CVD thrombosis can be complicated by neovascular glaucoma, recurrent vitreous hemorrhage, traction retinal detachment, and a steady decrease in visual acuity. The non-ischemic form of pathology in most cases has a favorable prognosis: the condition gradually improves and vision is restored. However, after recovery there is a risk of recurrence, so people who have had retinal vein thrombosis should be observed by an ophthalmologist within 6 months. They should be examined periodically.

With thromboembolism of the retinal CAS, the prognosis depends on the timeliness of the start of treatment. Vision is restored in 2-3 months after treatment, edema decreases, hemorrhages resolve. With untimely therapy or non-compliance with the recommendations, complications may develop:

secondary glaucoma;
atrophy of the optic nerve;
hemophthalmos;
dystrophic processes in the retina;
recurrent hemorrhages;
optic neuropathy

Prevention

Thrombosis of the central retinal vein can be prevented. To do this, you need to monitor your health and undergo an annual examination. Reduces the risk of developing the disease by eliminating the pathogenetic factor:

with hypertension, you should take funds to normalize blood pressure;
in diabetes, control glucose levels: follow a diet, normalize weight and take recommended endocrine drugs;
in the presence of retinopathy, patients should visit an ophthalmologist every 6 months;
endocrinological diseases, especially thyroid pathology, also require correction, women should remember that oral contraceptives increase the risk of thrombosis - they should not be carried away;
people suffering from cardiovascular pathology should take anticoagulants: for example, Aspirin daily.

Currently, a large number of special exercises have been developed that not only prevent the deterioration of the eyes, but also increase visual acuity.

Vision training:

Open and close your eyes sharply 5 times, in turn direct your gaze to the left and right, then up and down;
blink rapidly for 2 minutes;
lightly press on the closed eyelid for a couple of seconds, repeat 10 times.

In addition to exercising, it is important to lead a healthy lifestyle. Moderate physical activity, the elimination of stress are necessary for the health of the body, including the eyes. Compliance with the diet is an important component of the prevention of thrombosis of any localization. A good effect is the use of blueberries: it can be fresh berries, frozen or pharmacy preparations.

Patients with predisposing factors should be aware that ocular thrombosis can lead to irreversible consequences that no drugs and operations can eliminate. That is why it is necessary to carry out the prevention of thrombosis constantly, lead a healthy lifestyle, and consult a doctor at the first symptoms of the disease.

Prethrombosis	there is venous congestion; veins gradually expand, change color, obvious crossings and tortuosity are formed; in the process of diagnosis, one can detect a slowdown in blood flow, darkening of the vein and petechial hemorrhages of small sizes.
2 stage	it is already characterized by obvious circulatory disorders, as a result of which the walls of the vessels of the veins are strained, provoking hemorrhages in the retina and other tissues of the eyeball; due to an increase in the permeability of the vein, transudative tissue edema is formed.
3 stage	Thrombosis develops in a complete or incomplete form, accompanied by atrophic or degenerative changes in the retina.

Additional symptoms in the form of clouding, 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 if the patient has “precursors” of the disease, which can accurately reveal the picture of visual impairment and the development of thrombosis. It is also important to clarify the presence of vascular pathologies in relatives.
Taking medications	Medications in the form of oral contraceptives and diuretics directly affect the blood coagulation system, which provokes the development of CVA thrombosis.
General condition of the patient	Thrombosis often occurs against the background of vascular diseases, which may additionally be accompanied by dizziness, headaches, high blood pressure and pain in the heart.

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

Decreased IOP	clonidine or ethacrynic acid is used to reduce edema and reduce external pressure on the vessels; to reduce swelling, you can also use Diakarb with the use of 0.25 per day for 5 days or Pilocarpine - a 2% solution, which is instilled according to the instructions and advice of a doctor.
Liquefaction of formed blood clots	here, a solution of Fibrinolysin is used, which is administered intravenously at a rate of 25 drops per minute; the solution can cause pain in the lower back or in the chest, as a result of which such treatment is stopped.
Recovery of 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 the indicators of blood clotting.

Thrombosis of a branch of the central retinal vein. Methods of treatment of thrombosis of the central vein of the retina. Evaluation of the effectiveness of treatment

Causes

Stages and types of retinal thrombosis

Stages of the thrombotic process in the retina

Clinical symptoms and diagnosis of retinal thrombosis

Diagnostics

Treatment

Therapy Methods

folk therapy

Prevention measures

Useful video about retinal thrombosis

What is this disease, what is dangerous

Causes of the disease

The main signs of the disease

Stages of the disease

Features of diagnostics

General principles of disease therapy

Consequences of thrombosis

Disease prevention

Therapeutic

Etiology and pathogenesis of a thrombus in the eyeball

Symptoms of a blood clot in the eye

Thrombosis of the eye. What's this?

Reasons for development

Stages of development

Symptoms

Diagnostics

Treatment

Conservative therapy

Surgery

Complications and prognosis

Prevention

Thrombosis of the retinal artery. How not to lose sight