VITREOUS CELLS
Leucocytes
Iridocyclitis
Signs
- •
Retrolental cells ( Fig. 11.1 ) seen in association with aqueous cells.
Fig. 11.1
Intermediate uveitis
Definition
- •
A common, chronic, frequently bilateral but often asymmetric condition that typically affects young adults. It may be idiopathic or associated with underlying systemic disease ( Table 11.1 ).
Table 11.1
Systemic associations of intermediate uveitis
- •
Sarcoidosis
- •
Multiple sclerosis
- •
Whipple disease
- •
Lyme disease
- •
Cat-scratch fever
- •
Waldenström macroglobulinaemia
- •
Signs
- •
Vitreous cells (vitritis) vary in severity from mild to very severe ( Fig. 11.2 ).
Fig. 11.2
Look for
- •
Mild anterior uveitis.
- •
Inferior peripheral snowbanking (pars planitis – Fig. 11.3 ).
Fig. 11.3
- •
Vitreous cotton balls.
- •
Peripheral periphlebitis.
- •
Chronic cystoid macular oedema.
Fuchs syndrome
Fuchs syndrome is frequently associated with vitritis that must not be mistaken for intermediate uveitis.
Posterior and panuveitis
Signs
- •
Cells are most dense at the site of the inflammatory focus ( Fig. 11.4 ).
Fig. 11.4
- •
Severe vitritis may impair visualisation of the fundus ( Fig. 11.5 ).
Fig. 11.5
Infectious endophthalmitis
Classification
- a.
Acute-onset postsurgical and post-traumatic .
- b.
Delayed-onset chronic postoperative .
- c.
Delayed-onset acute associated with a filtering bleb .
- d.
Endogenous .
Erythrocytes
Acute posterior vitreous detachment
Presentation
- •
Unilateral, sudden shower of minute red-coloured or dark spots frequently associated with photopsia.
Look for
- •
Source of bleeding is either a tractional retinal tear ( Fig. 11.6 ) or less frequently avulsion of a peripheral blood vessel unassociated with a tear.
Fig. 11.6
Proliferative retinopathies
New vessel formation associated with the following conditions may cause vitreous haemorrhage.
- a.
Diabetes ( Fig. 11.7 ).
Fig. 11.7
- b.
Following retinal vein occlusion .
- c.
Sickle cell disease .
- d.
Eales disease .
- e.
Vasculitis .
Miscellaneous retinal disorders
- a.
Macroaneurysm ( Fig. 11.8 ).
Fig. 11.8
- b.
Telangiectasia .
- c.
Capillary haemangioma .
Trauma
- a.
Blunt trauma which may be associated with dialysis formation ( Fig. 11.9 ).
Fig. 11.9
- b.
Penetrating .
- c.
Iatrogenic during surgery for retinal detachment.
Systemic causes
- a.
Bleeding disorders .
- b.
Terson syndrome (subarachnoid haemorrhage + vitreous haemorrhage).
Pigment cells
Signs
- •
Pigment cells (‘tobacco dust’) in the anterior vitreous ( Fig. 11.10 ) consisting of macrophages containing retinal pigment epithelial cells.
Fig. 11.10
Causes
- •
Acute retinal tear associated with acute posterior vitreous detachment (see Fig. 11.6 ).
- •
Rhegmatogenous retinal detachment.
- •
Excessive retinal cryotherapy.
- •
Proliferative vitreoretinopathy.
- •
Trauma.
Tumour cells
Endophytic retinoblastoma
Signs
- •
A friable lesion may seed tumour cells into the vitreous ( Fig. 11.11 ).
