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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Eye Injury, Blood Accumulation, Floaters. Normal?

I’m 21 years old and 8 months ago I got grazed in my right eye by a clump of dirt someone threw. When I went to the doctor the morning after the incident he looked into my eye with a slit lamp and said there was blood there, but that it was too dense for him to see my retina and to come back a week later to give the blood time to disperse a little. When I went back everything was fine. The blood remained, but has gotten lighter and more mobile (I guess) over the past 8 months, although I still notice light, wispy, pieces dart across my vision when looking up at a clear blue sky. I guess what I am asking is that these remnants of blood that I still see in my eye…are they ever going to fully dissolve without surgical intervention? I read somewhere that blood takes longer to dissolve in ‘younger’ eyes with a fully formed vitreous (I’m only 21). Is it normal for pieces of blood from a traumatic vitreous hemorrhage to still be present in the eye after so many months in cases like mine? Should I expect to live with this for life, or will it eventually dissolve? I wasn’t given much information on Vitreous Hemorrhages except for what I’ve read on the internet.
Fri, 9 Nov 2012
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Ophthalmologist 's  Response
When you were clunked in the eye, somewhere within the vitreous cavity you tore a blood vessel and bled into the vitreous cavity. That gel is "thick" in younger people and gets thinner as we age. For instance, in a child, a little baby, if we needed to suck out a tumor in that cavity we couldn't use just a large bore needle and stick it in there and suck it out. Nothing would happen, it's too thick. Sort of like the difference in trying to aspirate up jello versus pudding versus apple juice. The juice would suck up pretty easy with a straw but not the other two. Assuming you didn't tear anything "important" and simply have the vitreous hemorrhage, now the gel has blood in it. The blood lines up with the fibers or fibrils (little fibers) and forms those wisps sort of like cirrus clouds. Slowly the blood will dissolve. Blood goes through different stages as it dissolves or degenerates. Sort of like a bruise it will turn from RED (HEMO-globin) to BLUE (DEOXYhemoglobin), to green (VERDI-globin) to orange to yellow to gone. Same things happens in the blood inside the eye. But there's NO WHERE for the blood to go as there are no blood vessels INSIDE the vitreous to take up the blood so it sits there and clumps and slowly goes away. There may be a day when you look out and WOW it's GONE! YEA! and within a minute or so slosh it back into the center and you see the stuff again. It doesn't HURT the eye, it just blocks the view a little. And eventually it will go away. The danger with trauma is that you may have a small retinal tear out there somewhere. SO I'd suggest you see a RETINA SPECIALIST. Retina Specialists are Ophthalmologists who spent a few extra years abusing themselves learning to do the hardest part of Ophthalmology. They look at the eye differently than general ophthalmologists and see things in the Retina that they don't see. The reason isn't because the general ophthalmologist isn't smart, it's because he doesn't have the training and experience the retina guy does. If a tear is found and it is not a "dangerous" tear, it will be left alone. But some feel that any tear associated with a traumatic event should be treated. It is treated by surrounding the tear with laser spots which causes a scar from thermal injury so the retina is stuck to the wall and no fluid from the liquifying vitreous can get under the retina through the tear or hole and allow the retina to float....that's called a retinal detachment. My suggestion is you keep an "eye" on the floaters and get in to be seen if there is a change. Also as the vitreous gets more liquid, it will slosh around more and it can yank on the wall up near the front where the vitreous is tightly attached. This can cause a sensation of light flashes or photopsia. So NEW floaters or Photopsia are signals that you need to go see the retina guy. The % chance of that is relatively small, about 20% or so. That means for about 80% of these people nothing ever happens that requires treatment.
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Eye Injury, Blood Accumulation, Floaters. Normal?

When you were clunked in the eye, somewhere within the vitreous cavity you tore a blood vessel and bled into the vitreous cavity. That gel is thick in younger people and gets thinner as we age. For instance, in a child, a little baby, if we needed to suck out a tumor in that cavity we couldn t use just a large bore needle and stick it in there and suck it out. Nothing would happen, it s too thick. Sort of like the difference in trying to aspirate up jello versus pudding versus apple juice. The juice would suck up pretty easy with a straw but not the other two. Assuming you didn t tear anything important and simply have the vitreous hemorrhage, now the gel has blood in it. The blood lines up with the fibers or fibrils (little fibers) and forms those wisps sort of like cirrus clouds. Slowly the blood will dissolve. Blood goes through different stages as it dissolves or degenerates. Sort of like a bruise it will turn from RED (HEMO-globin) to BLUE (DEOXYhemoglobin), to green (VERDI-globin) to orange to yellow to gone. Same things happens in the blood inside the eye. But there s NO WHERE for the blood to go as there are no blood vessels INSIDE the vitreous to take up the blood so it sits there and clumps and slowly goes away. There may be a day when you look out and WOW it s GONE! YEA! and within a minute or so slosh it back into the center and you see the stuff again. It doesn t HURT the eye, it just blocks the view a little. And eventually it will go away. The danger with trauma is that you may have a small retinal tear out there somewhere. SO I d suggest you see a RETINA SPECIALIST. Retina Specialists are Ophthalmologists who spent a few extra years abusing themselves learning to do the hardest part of Ophthalmology. They look at the eye differently than general ophthalmologists and see things in the Retina that they don t see. The reason isn t because the general ophthalmologist isn t smart, it s because he doesn t have the training and experience the retina guy does. If a tear is found and it is not a dangerous tear, it will be left alone. But some feel that any tear associated with a traumatic event should be treated. It is treated by surrounding the tear with laser spots which causes a scar from thermal injury so the retina is stuck to the wall and no fluid from the liquifying vitreous can get under the retina through the tear or hole and allow the retina to float....that s called a retinal detachment. My suggestion is you keep an eye on the floaters and get in to be seen if there is a change. Also as the vitreous gets more liquid, it will slosh around more and it can yank on the wall up near the front where the vitreous is tightly attached. This can cause a sensation of light flashes or photopsia. So NEW floaters or Photopsia are signals that you need to go see the retina guy. The % chance of that is relatively small, about 20% or so. That means for about 80% of these people nothing ever happens that requires treatment.