The transparent gel-like substance in the vitreous body, if opaque bodies appear, is called vitreous opacities.

bubble_chart Etiology

Congenital residual embryonic cells or tissues in the vitreous, hemorrhage from the retina or uvea invading the vitreous, bleeding or exudates from hypertension, diabetes, or uveitis entering the vitreous, and vitreous degeneration in elderly patients with high myopia can all lead to vitreous liquefaction and opacity. Other causes such as eye trauma, long-term retention of intraocular foreign bodies, Taxillus chinensis (parasitic plant) infestation, or tumors can also result in vitreous opacity.

bubble_chart Clinical Manifestations

1. Grade I patients experience floating shadows in their vision, resembling the fluttering of mosquitoes or flies. The onset is sudden, and the condition progresses rapidly. The degree of visual impairment varies depending on the location and severity of the vitreous opacity. Grade I opacities do not affect vision and cannot be detected with an ophthalmoscope.
2. More noticeable opacities are commonly seen in degenerative myopia, uveitis, and vitreous hemorrhage. Patients perceive large and numerous dark shadows in their vision, with varying degrees of visual decline. Fundus examination may reveal floating dust-like or coarse, thread-like patches, and in severe cases, the fundus cannot be visualized, with no red reflex observed—only complete darkness.
3. Inflammatory opacities: These occur when nearby tissues become inflamed, leading to the migration of white blood cells and protein coagulation. This is a common manifestation of various retinal and choroidal inflammations, such as subcutaneous nodules and syphilitic chorioretinitis, leptospiral uveitis, and metastatic endophthalmitis involving the choroid and brain.
4. Hemorrhagic opacities: Commonly caused by trauma, surgery, various retinal vascular diseases, and blood clots.
5. Degenerative opacities: Seen in high myopia, retinal detachment, vitreous calcification, and cholesterol deposition.
6. Congenital opacities: Mostly due to residual mesodermal tissue from the embryonic period.
7. Others: Conditions such as intraocular foreign bodies, cysticercosis, and retinoblastoma can also cause vitreous opacities.

bubble_chart Diagnosis

Symptoms

1. The onset is sudden and often recurrent.
2. Smoke-like or dark cloud-like shadows appear in front of the eyes, and some may quickly lose vision, retaining only light perception.

Sign

1. Under the slit lamp, bright red blood clots or brownish old hemorrhage can be seen in the vitreous.
2. Under the ophthalmoscope, dust-like, streak-like, or lumpy opacities are observed floating, or only faint red light or no red light is visible.
3. In cases of recurrent bleeding, proliferative strands or membranes with neovascularization may be seen in the vitreous.

bubble_chart Treatment Measures

Physiological floaters do not require treatment. Pathological opacities should be treated by addressing the underlying condition. Fresh vitreous hemorrhage requires bed rest and the use of hemostatic medications. For older hemorrhages, medications that promote the absorption of opacities should be used, such as ethylmorphine hydrochloride eye drops, oral vitamin C, and tapazole; intramuscular injections of iodized oil or hyaluronidase may also be administered. In severe cases where general treatment is ineffective, vitrectomy may be performed.