Robert Maloney Doctor, I have flies in front of my eyes!” Currently, complaints of this type remain the most common at an appointment with an ophthalmologist.
In an extensive clinical study conducted by a British doctor, among the surveyed patients of ophthalmic offices, about 80% of people experience discomfort associated with this phenomenon. With severe discomfort, this can cause a depressive state and a significant decrease in the quality of life.
So why do they appear, what is dangerous and most importantly – how to treat them?
The cause in the vitreous body — ST) is a gel-like substance that fills 2/3 of the entire volume inside the eye, unable to regenerate. When it is lost, the space is replaced by intraocular fluid. The vitreous body maintains a constant shape of the eye and participates in the refraction of incoming light on the light — receiving shell of the eye-the retina. According to the composition of ST, 98% is water, 2% is glycosaminoglycans, collagen proteins and other structural substances. Between the fibers, the space is filled with hyaluronic acid molecules, which do not allow collagen to condense, thanks to this, the vitreous body retains its transparency.
Risk factors — high myopia, metabolic disorders of the body (diabetes mellitus, atherosclerosis), high blood pressure, head and eye injuries in the anamnesis, ophthalmic surgery, physical exhaustion, etc.
Types of opacities.
1) Idiopathic floating opacities are primary opacities. Under the influence of various factors, the structure of hyaluronic acid changes, which leads to its reduction. Collagen fibers are no longer separated by anything, they connect with each other and, thickening, lose their transparency. The most common cause is age-related changes-usually 40-60 years. Opacities become especially noticeable on a bright background, periodically falling into the field of view and moving according to the movements of the eye. They can appear in both eyes, but not synchronously. Floating opacities of the vitreous body of small size are not a pathology, but large spots, falling into the field of vision, cast a shadow on the retina and cause significant visual discomfort.
2) Secondary opacities are not associated with changes in the structure of the vitreous body. These are always opaque molecules from the outside.
Detachment or rupture of the retina-can cause the appearance of similar complaints-floating flies, spots in front of the eyes. The feeling of curtains, flashes and lightning, and decreased visual acuity are additional symptoms. This pathology is very serious, can threaten complete and irreversible loss of vision. Any delay is dangerous! Therefore, if a complex of symptoms occurs, an emergency visit to an ophthalmologist is necessary.
Hemorrhage into the vitreous body — hemophthalmus. It occurs spontaneously, against the background of already existing changes in the fundus due to diabetes mellitus or arterial hypertension. Also, 18% of all hemorrhages are caused by blunt trauma to the eye or a penetrating wound.
When the retinal vessels are ruptured, blood elements enter the eye cavity. The vitreous body loses its transparency within a few minutes. Depending on the intensity of the bleeding, the loss of vision may be partial or complete. If the hemorrhage is mild, then it manifests itself in a slight turbidity of vision. In the future, the blood clots and can form a path from the retina to the vitreous body. This weight, having a strong pulling effect, can later cause a rupture or detachment of the retina. Therefore, early treatment of hemophthalmos will ensure rapid resorption of blood clots and prevention of further complications.
Inflammation of the vitreous body. Caused by infection such as Toxoplasma or tsitomegalovirusnoy infection. Due to the presence of inflammatory elements in the vitreous body, there are dense strands that will reduce visual acuity. The inflammatory process covers not only the transparent structure, but also neighboring areas (retina, vascular membrane of the eye), so often in addition to “flies” in front of the eyes, patients feel pain, loss of entire areas of the visual field.
Ocular migraine. The patient at the same time suffers from attacks of visual impairment, the process may be accompanied by a headache, it may occur without it. In this pathology, there is no organic damage to the eyes. The risk group includes young patients, mostly women with high levels of stress and physical activity. Symptoms from the organs of vision: “flies” in front of the eyes, lightning, flashes of light, flickering dots. Usually, after such symptoms, a recovery period occurs within a few hours and vision returns.
Diagnostics.
When should I see a doctor?
If the number of opacities increases, other visual symptoms are noted — lightning and flashes in front of the eyes, loss of lateral vision, eye pain — this is all a sign of a serious pathology.
If you already have a history of injuries or surgery on the eyes, the appearance of opacities may indicate a deterioration in the condition and the presence of complications.
In all these cases, an examination by an ophthalmologist is necessary!
At the reception.
The reception begins with the collection of anamnesis: the doctor will specify the time of occurrence of symptoms, the speed of their development, the degree of discomfort, whether there were injuries or operations before this. It is necessary to tell the doctor about the chronic existing diseases. The results of the tests can also help to find the cause of the turbidity.
The objective examination.
It is necessary to conduct a full examination of the patient’s visual organ. To do this, check the visual acuity according to special tables, inspect the fields of vision, evaluate the movement of the eyeballs. With the help of a special microscope, an external examination of the eyes is carried out, and intraocular pressure is also measured. The most important part of the examination is the examination of the fundus in the conditions of the dilated pupil. To do this, a remedy is instilled, the effect of which persists for 3-4 hours after the examination. With the help of special lenses, the condition of the vitreous body and retina is examined.
Additional research methods necessary to clarify the diagnosis are usually prescribed by the doctor after the examination, based on the data obtained. For example, with inflammation, a microbiological examination may be required, with hemophthalmos or detachment, ultrasound eyes are prescribed. If you have an ocular migraine, you need to consult a neurologist.
Treatment.
Treatment of age-related changes in the vitreous body does not require conservative intervention. Usually, patients get used to small floating opacities, and they do not cause significant discomfort. Treatment of secondary opacities is based on the exclusion of the pathological conditions that caused these symptoms.
If treatment is still required, in the arsenal of modern doctors there are methods of both conservative and surgical treatment.
1) Conservative treatment
Pharmacological vitreolysis is the liquefaction and dissolution of dense haze with the help of special medications. The method is promising, but poorly studied, its application is not so widespread.
2) Surgical treatment
AG-laser vitreolysis. Treatment of opacities in the vitreous body has become possible only recently, thanks to the improvement of the technical features of laser installations. When laser exposure occurs spot removal of turbidity. Due to the small size of the opacity and the location in the posterior part, the accuracy and experience of the surgeon is important in this method. Therefore, this method is associated with risks of complications and it is not recommended to resort to it with small sizes of opacities. The literature describes cases of laser treatment for extensive hemorrhages. The efficiency at the same time reached 70%, which is a high result.
Vitrectomy. The most radical method of treatment. It consists in removing the vitreous body with opacities. In this case, the volume of the removed substance is completely filled with a transparent saline solution. This method allows you to achieve the highest clinical results. One of the disadvantages of the method is its invasiveness (i.e., the need to perform eye punctures), which increases the risk of postoperative complications, the most common of which are lens opacity, retinal detachment and intraocular inflammation. Vitrectomy is considered the last recommended method, in the case when opacities in the vitreous body significantly reduce visual acuity.
Numerous studies and articles state that more than 70% of patients with floating opacities recognize it as a nuisance rather than a condition requiring treatment. Over time, the flies that appear due to age-related changes cease to be noticeable.
If these symptoms occur, it is necessary to exclude dangerous conditions and in the future you can make a decision based on the impact of turbidity on the quality of life of the patient.
Take care of your eyes and be healthy!
