Equis ISSN 2398-2977

Vitreous: vitritis (vitreous haze)

Synonym(s): Hyalitis Vitreocapsulitis Vitreitis

Contributor(s): Graham Munroe

Introduction

  • Incidence: usually secondary to posterior uveitis.
  • Cause: inflammation   →   protein and cells invading the vitreous from the uveal tract   →   decreased translucency and discoloration.
  • Signs: clumps, veils and floating accumulations of vitreal debris, (often mobile) interfere with vision, obscure the fundus and can   →   posterior capsular cataracts   Cataract: overview  and vitreoretinal detachment .
  • Treatment: same as anterior uveitis   Uveitis: anterior - overview  with increased systemic route of administration.
  • Prognosis: guarded - poor response to treatment and resorption of inflammatory debris.

Pathogenesis

Etiology

  • Relationship of secondary vitreal changes with chorioretinal and posterior ciliary disease is poorly understood.
  • See primary diseases: uveitis   Uveitis: anterior - overview  , chorioretinitis , recurrent uveitis   Uveitis: recurrent  , bacterial anterior uveitis   Uveitis: bacterial  , immune-mediated anterior uveitis .

Predisposing factors

General

Pathophysiology

  • Primary acquired disease is rare - the avascular vitreous cannot respond to insults in the same way as other tissues.
  • Most acquired conditions are secondary to surrounding tissue diseases, particularly posterior uveitis: see uveitis   Uveitis: anterior - overview  , chorioretinitis , recurrent uveitis   Uveitis: recurrent  , bacterial anterior uveitis   Uveitis: bacterial  , immune-mediated anterior uveitis .
  • Inflammation brings protein and inflammatory cells into the vitreous from the uveal tract   →   decreased translucency and discoloration.
  • Inflammation of the posterior uvea   →   increased leakage of proteins, especially fibrin, and inflammatory cells into the vitreous.
  • Pigmented and non-pigmented ciliary body epithelium may also slough into the vitreous.
  • Clumping of inflammatory cells, products and debris may   →   vitreal floaters, filamentous structures or membranous opacities.
  • Vitritis may encourage rapid vitreal degeneration and syneresis   →   gel separation into liquid and solid protein.
  • Hemorrhage into vitreous from surrounding uveal or retinal tissues may follow trauma or uveitis - erythrocytes that do not clot   →   a diffuse red/orange haze which clears rapidly; clotted blood may take up to several months to clear.
  • Contraction of a vitreal clot may   →   retinal detachment as the vitreal filaments are attached to the retinal Muller cells.
  • Vitreal inflammation may   →   lenticular metabolic disorders and cataract formation   Cataract: overview  .

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers


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