VITREOUS OPACIFICATION

Opacification, or clouding, of the vitreous gel can happen for a number of reasons or disease states. Most commonly, mild opacification occurs as a simple function of ageing. However a number of conditions can also lead to the clouding of the vitreous gel. These are most commonly seen as the result of bleeding into the vitreous gel in patients with diabetes or sickle cell disease, or following trauma.

Additional causes for opacification of the vitreous gel include inflammatory cells causing the vitreous gel to become white and cloudy. This can be seen in patients who have ocular inflammatory diseases known as Uveitis. Most commonly, when there is significant vitreous inflammation, there is a systemic underlying disease causing it. In emerging economies, this is most commonly seen as the result of an infection inside of the eye known as Toxoplasmosis. In the developed world, the most common cause for vitreous opacification from an inflammatory basis is due to a systemic inflammatory disease.

With recurrent cases of vitreous inflammation, it is essential that further investigations be performed. Internally, the treatment for the vitreous opacification depends on the underlying cause. Appropriate management directed at that underlying cause will generally lead to a proper resolution.

CAUSE

Vitreous opacification is the process by which the vitreous body of the eye goes from being clear to cloudy. Since the opacification of the vitreous body blocks light from reaching the retina, it may cause mild to severe vision loss. The three root causes for this condition are vitreous degeneration, systemic disease, and ocular inflammation. Deciding the treatment for vitreous opacification depends on the cause and severity of the ocular condition.

Vitreous opacification is due to the accumulation of collagen by vitreous degeneration, blood from a systemic disease (i.e. diabetes) or, white fluid from inflammation within the eye.

VITREOUS DEGENERATION

As the eyes age, the vitreous degenerates by releasing pieces of torn collagen that clump together to form floaters that can block a patient’s vision. This happens more often for patients with myopia or near sightedness. Floaters typically appear as black specs or spidery curtains to the patient and usually disappear within a year. However, the degeneration of the vitreous body can cause another condition called posterior vitreous detachment (PVD). While posterior vitreous detachment can, in some cases, cause retinal detachment and retinal tears, it also worsens the opacification of the vitreous body with the addition of more pieces of torn protein. Symptoms of this specific condition include sudden flashes of light or increase in floaters.

SYSTEMETIC DISEASE

Vitreous opacification can also occur due to vitreous hemorrhage or bleeding in the vitreous body caused by a systemic disease. Certain bodily diseases damage retinal capillaries and as a result, allow them to bleed into the vitreous body. Examples of such systemic diseases include diabetes and sickle cell disease. Additionally, vitreous hemorrhage can also occur following trauma or surgery to the eye.

INFLAMMATORY DISEASE

In some cases, it is the accumulation of white cloudy fluid, due to an infection called uveitis, that is responsible for vitreous opacification. Inflammation or infection of the uvea, which includes the iris, ciliary body, choroid layer and the vitreous body, leads to the release of white cloudy fluid into the vitreous. Uveitis is a serious condition which can lead to many complications if left untreated. Major symptoms of uveitis include the reddening of the eye, pain, floaters, and blurry vision.

Side view illustration of an eye with an opaque vitreous body.

Side view illustration of an eye with an opaque vitreous body

Side view illustration of an eye with an opaque vitreous body

PREVENTION

The most common form of vitreous opacification is the ageing process, an unfortunate natural consequence for which there is no method of prevention. Patients who are quite nearsighted are at higher risk for earlier floater formation. Should you have floaters, you must recognize that there are many different types of floaters inside of the eye. Any floaters associated with flashing light, or photopsias, a black curtain coming across the vision, or floaters which have many spots that obscure vision should be examined by your eye care surgeon to ensure that there is no evidence of retinal tears, breaks, or other underlying disease.

Once confirmed that your vitreous floaters are due to simple vitreous degeneration inside of your eye, it is important to recognize that you may continue to develop more floaters until the vitreous has been completely detached. Some patients have partial vitreous detachments with early floaters. As the vitreous fully detaches, it may continue to form more vitreous floaters or opacifications.

PROGNOSIS

For patients who develop vitreous degeneration, or clouding of the vitreous, from ageing, the prognosis is quite good because, with time, the vitreous opacification or the posterior vitreous surface tend to fall inside of the eye cavity. Accordingly, patients learn to ignore it unless they are in particularly bright environments or looking at walls that are white. It is normal that once someone has developed floaters from a posterior vitreous detachment, they may have these floaters for life. At some point, most patients learn to ignore these floaters. In patients who have developed vitreous opacification from other causes, such as bleeding or inflammation inside of the eyes or trauma, some of these can resolve once the underlying disease has been treated. For example, if a patient has a mild vitreous hemorrhage due to diabetic bleeding, once the underlying abnormal diabetic blood vessels have been treated, the majority of the vitreous blood will clear. In those patients for whom there is no resolution after one year, generally speaking, the chance for improvement is quite limited.

TREATMENTS

Whether or not vitreous opacification is treatable depends on its origin. The treatment of vitreous opacification by degeneration or aging is often unnecessary because the floaters tend to fade away within a year. If the underlying cause for vitreous opacification is a systemic disease, the direct treatment of the disease usually cures the vitreous hemorrhage. The same applies to the treatment of vitreous opacification due to uvetis. Once the uvetis is directly treated, the vitreous opacification tends to be cured as well. However, there are two more treatment options if the vitreous opacification continues to persist after a year or the floaters disrupt the patient’s lifestyle.

For patients who have severe vitreousopacification due to floaters, there is the option of using a YAG laser. A YAG laser works by producing a mini explosion near large floaters in order to shatter them into smaller pieces. And although this treatment may prove to be effective, it also carries the risk of causing retinal tears, retinal detachment or further visual distortion. This is not a commonly recommended procedure.

Moreover, for patients like pilots who need crystal clear, floater-less vision to continue their lifestyles, there is the option of a vitrectomy surgery. Using this procedure, our doctors can remove the vitreous fluid with the floaters and replace it with a clear floater-less fluid. Like the YAG laser though, the vitrectomy also has possible complications including retinal tears, distortion and bleeding.