Vitreous detachment and vitreous opacities can occur due to aging or medical conditions. Vitreous detachment involves the separation of the vitreous gel from the retina, which commonly occurs in those over 65 years old due to liquefaction of the vitreous. Symptoms include floaters, flashes, and decreased vision. Vitreous opacities present as various structures within the vitreous that decrease its transparency. Common causes are muscae volitantes (normal vitreous residues), inflammatory conditions, aggregates from vitreous liquefaction, and conditions like asteroid hyalosis or synchysis scintillans. Treatment depends on symptoms and any complications.

1. VITREOUS DETACHMENT AND
VITREOUS OPACITIES
Nikhita Jacob,
Third year

2. ANATOMY and PHYSIOLOGY
• Transparent, gelly-like
• 4/5
• 4ml
• Anterior depression – hyaloid fossa or burger’s space
• Periphery – dense cortex
• Center – liquid
• Viscosity
• Mechanical function – shape
• Nutrients to lens and retina

3. Attachments
• Vitreous base – Ora serrata (4mm)
• Behind lens- Hyaloid fossa (firm at young age)
• Optic disc
• Macula
• Blood vessels

4. Vitreous components
• Refractive index
• Water – 98%
• Fine collagen fiblrils – cortex
• Large amount – hyaluronic acid, amino acid,
soluble proteins, salts and ascorbic acid
• Cloquet’s canal – 1-2mm wide
• With age – volume of gel
liquid content

5. Vitreous detachment
• Complete / partial
• 3 forms: -Posterior
-Anterior
-Basal
• Most common

6. Etiology
• Synchysis
• Begins posteriorly – attachment undeveloped
• Strong forces – anterior detachment and basal
detachment

8. Posterior vitreous detachment
• Separation – cortex from retina – posterior to
base
• PVD with synchysis and synersis – common above
65years
• Common with senile liquefaction - Develops a
hole – hyaloid membrane – collects between
membrane and internal limiting membrane of
retina – PVD upto base with synersis of remaining
vitreous gel
• More – aphakics and myopes

9. • Symptoms:
- Flashes
- Floaters
- Decreased visual acuity
- Cob-web like appearance
- appearance of hair-like structure
• Signs:
- Biomicroscopic examination reveals
- Synchysis
- Weiss ring or Fuch’s ring – glial tissue

11. • Diagnostic criteria:
- Requires examination of fundus
- Ultrasound examination – vitreous
hemorrhage or lens opacification

13. Detachment of vitreous base and
anterior vitreous
• Usual etiology – blunt trauma – anterior
retinal dialysis – crystalline lens dislocation

15. • Complications:
- Retinal breaks
- Vitreous hemorrhage
- Retinal hemorrhage
- Cystoid maculopathy
• Treatment:
- symtoms resolve – complete detachment
- complications – treatment

16. Vitreous opacities
• Any relatively non-transparent structure – opacity –
floaters

17. • Common conditions associated with vitreous
opacity:
-Muscae vollitantes
-Inflammatory vitreous opacity
-Vitreous aggregates and condensation with
liquefaction
-Amyloid degeneration
-Asteroid hyalosis
-Synchysis scintillans
-Red cell opacities
-Tumor cell opacities

18. Muscae vollitantes:
• Physiological – residues – hyaloid vasculature
• Fine dots and filaments
• Drifts in and out of visual field

20. Inflammatory vitreous opacities:
• Exudates – anterior/posterior uveitis
• Pars planitis
• Pan uveitis
• Endophthalmitis

21. Vitreous aggregates and condensation with
liquefaction:
• Commonest cause
• Collagen fibrils – senile, myopic, post-trauma,
post-inflammation

22. Amyloid degeneration:
• Amyloidosis
• Amyloid material – thyroid, pancreas, heart,
vitreous
• Bilateral

23. • Pathophysiology:
-originates – retinal vessel walls – cloudy
margin
• Symptoms:
-Diplopia
-Diminished vision
• Signs:
-External ophthalmoplegia
-Vitreous opacities
-Retinal hemorrhage
-Exudates

25. Asteroid hyalosis:
• Causes:
-Genetic inheritance
-Diabetes
-Hypercholestrolemia
• Pathophysiology:
-Calcium containing lipid complexes –
collagen fibrils – throughout vitreous
• Age: Elderly people
• Sex: Both

26. • Symptoms:
-Mostly asymptomatic
• Signs:
-Unilateral
-Small, white rounded bodies – vitreous
gel – ophthalmoscopy
• Treatment:
- If vision affected – vitrectomy

28. Synchysis scintillans: (cholesterolosis bulbi)
• Causes:
- Degeneration condition
- Damaged eyes – trauma, vitreous
hemorrhage or degenerative disease in past –
end stage – pathogenesis unknown
• Symptoms:
-Mostly asymptomatic

29. • Signs:
- Small, white, crystalline bodies – cholesterol
accumulation.
- Vitreous-liquid-crystals sink to bottom-
stirred up – eye movement
-Beautiful shower of golden rain –
ophthalmoscopy
• Treatment:
Not required.

31. Red cell opacities:
vireous hemorrhage – leftouts of massive
vitreous hemorrhage
Tumor cell opacities:
seen as free floating opacities –
retinoblastomas and reticulum cell sarcomas

32. Thank you