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When bleeding eyeballs is a "Good THING" (TM)

tomhudson (43916) writes | more than 2 years ago

Medicine 14

I guess you learn something new every day ... today I learned that apparently, as long as it doesn't get out of hand, my retina bleeding once in a while is a good thing - it means that the torsional stress is causing "gunk" (the scientificky term) to detach from the retina, so of course some blood vessels will also bleed, but as long as they eventually stop, it's a good thing ...

I guess you learn something new every day ... today I learned that apparently, as long as it doesn't get out of hand, my retina bleeding once in a while is a good thing - it means that the torsional stress is causing "gunk" (the scientificky term) to detach from the retina, so of course some blood vessels will also bleed, but as long as they eventually stop, it's a good thing ...

... the alternative being that they open the eyeball up and scrape it off. I told him that wasn't an option, and he said that if it ever gets to that point, I might want to reconsider, but that it probably won't. The good eye - 94% chance that it won't, the bad eye, obviously less, but still probably better than 50-50, "depending."

94% - I like those odds. 50/50, not so much. In the meantime, using the computer for half an hour in the morning still leaves me feeling like I've got dirt stuck under the eyelid for the rest of the day. Oh well - it's an excuse to get off it.

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retinal detachment (1)

GreatDrok (684119) | more than 2 years ago | (#39193879)

I had a double retinal detachment which resulted in debris in my eye. The left detachment was fixed by laser, but the right was so bad that they had to do a vitrectomy and cryofreeze the retina back in place which also meant they removed the debris from my eye. The end result is I now have no vitreous in one eye but actually the vision isn't too bad so as scary as it sounds, it isn't a terrible thing to have happen. It is possible that your bleeding is due to the age related process of the vitreous detaching from the retina which happens to everyone as the age, My problem was traumatic detachment which pulled chunks of the retina off. Amazing they were able to save my sight as just 20 years back I would have had a high chance of losing sight in at least one eye.

Re:retinal detachment (0)

Anonymous Coward | more than 2 years ago | (#39194351)

Retinal detachment sounds bad, but reality detachment is even uglier. As witnessed on Slashdot daily. Only with the latter, it's not the afflicted who suffer the most.

Wait a minute... (1)

mcgrew (92797) | more than 2 years ago | (#39197513)

I had a double retinal detachment which resulted in debris in my eye. The left detachment was fixed by laser, but the right was so bad that they had to do a vitrectomy and cryofreeze the retina back in place which also meant they removed the debris from my eye. The end result is I now have no vitreous in one eye but actually the vision isn't too bad so as scary as it sounds

You're confusing a torn retina with a detached retina. The laser will fix a torn retina, cryotherapy if they can't reach the tear. A vitrectomy removes the vitreous [wikipedia.org] and the clear protective covering that covers the retina, I don't remember what that's called and wikipedia gives me no clue, but the vitreous is the fluid in the eye. When they do a vitrectomy it's replaced with nitrogen gas, which is absorbed by the eye as the eye replaces the vitreous.

After mine my vision was improved, since there was no longer any junk floating around inside the eyeball.

You and I were lucky (and smart, my surgeon said most people wait until it's really bad before they go to see them), I have a friend who had to undergo a scleral buckle, which is a rubber band around the eyeball. I've "talked" to folks here at slashdlt who have also had detached retinas, and most lose quite a bit of their vision.

It isn't age related, but rather related to myopia. The more nearsighted you are the more danger you're in of a torn or detached retina, because the myopic eye isn't round, but oblong.

Re:Wait a minute... (1)

tomhudson (43916) | more than 2 years ago | (#39197983)

That makes sense, since the eye with the real problems is much more myopic to begin with. Still, I'll put up with "junk" taking a few minutes to "settle out" first thing in the morning over "opener 'er up and scrape it out", at least for now, on either eye. Still, with all the people who, like you, say it improved things, I'll keep an open mind if he recommends it.

That rubber band routine sounds really gross.

BTW - I think the term you were looking for was internal limiting membrane [tedmontgomery.com] .

The retina is composed of 10 layers, from the outside (nearest the blood vessel enriched choroid) to the inside (nearest the gelatinous vitreous humor):
1 pigmented epithelium,
2 photoreceptors; bacillary layer (outer and inner segments of cone and rod photoreceptors),
3 external (outer) limiting membrane,
4 outer nuclear (cell bodies of cones and rods),
5 outer plexiform (cone and rod axons, horizontal cell dendrites, bipolar dendrites),
6 inner nuclear (nuclei of horizontal cells, bipolar cells, amacrine cells, and Müller cells),
7 inner plexiform (axons of bipolar cells and amacrine cells, dendrites of ganglion cells),
8 ganglion cells (nuclei of ganglion cells and displaced amacrine cells),
9 nerve fiber layer (axons from ganglion cells traversing the retina to leave the eye at the optic disc),
10 internal limiting membrane (separates the retina from the vitreous).

Re:Wait a minute... (1)

mcgrew (92797) | more than 2 years ago | (#39214559)

I doubt he'll recommend a vitrectomy for floaters, mine didn't. I wouldn't go through that again for anything but keeping away from blindness.

Re:Wait a minute... (1)

GreatDrok (684119) | more than 2 years ago | (#39199899)

My eyes both had multiple tears and one part was pulled away entirely. The condition I had is called Posterior Vitreous Detachment and I realised I was in trouble after a quick google of my symptoms. Straight to the hospital (thank goodness for socialised medicine) and I was treated immediately. The surgeon said if I had waited any length of time the retinas would both have completely pulled away and blinded me. There was quite a lot of bleeding which I could see in my field of view, literally streams moving around in my eye, not to mention a large chunk of floater which was tissue pulled from around the optic nerve. I had the laser treatment which sorted the left eye stopping the bleeding and holding the tears in place but it wasn't enough for the right which continued to pull away so they opted to do the vitrectomy which is as you describe where they completely empty the eye of the jelly and then cryofroze the retina back. There were some interesting days while my body replaced the vitreous with water and I could see it sloshing about upside down. Eventually, the eye was full and I thought that was that but then the scaring happened which distorted my vision by pulling the retina out of shape soI had to go back in for another surgery which was a membranectomy. Over the last four years the retina has smoothed back out and the extensive distortion had gone but I am still left with less than optimal and uncorrectable vision in my right eye which can never be as clear as my left.

Grateful to have any vision at all though and it is related to myopia but only mild and it happens just after a 36 hour flight from Europe so I may have been very dehydrated and that could have triggered it since its odd that for PVD to happen to both eyes at the same time.

Re:Wait a minute... (1)

tomhudson (43916) | more than 2 years ago | (#39200197)

Ouch! I guess I should count myself lucky.

Straight to the hospital (thank goodness for socialised medicine) ... it happens just after a 36 hour flight from Europe

So, which hospital, since we're both talking about Kanuckistan? I was seen at the Lakeshore, then the specialist clinic, then referred to the Jewish General.

Re:Wait a minute... (1)

GreatDrok (684119) | more than 2 years ago | (#39202021)

Kiwistan as it happens (New Zealand) hence the crazy long flight from Europe due to an 11 hour stop over in Dubai. The hospital was a specialist eye hospital and they did seriously good work, especially the membranectomy where the surgeon actually waited for a new machine to come in which had 10x the resolution so he was able to remove the scar tissue.

Re:Wait a minute... (1)

tomhudson (43916) | more than 2 years ago | (#39202943)

Kiwistan - nice!

Still, I wouldn't want to go through what happened to you. My sympathies.

Re:Wait a minute... (1)

GreatDrok (684119) | more than 2 years ago | (#39203389)

Thanks! It was a little scary but more irritating, especially when my vision got all distorted and I had horrendous double imaging which made even reading difficult. After the membranectomy it improved slowly and only now four years on is the distortion mild enough to not notice any more.

You're in trouble (1)

mcgrew (92797) | more than 2 years ago | (#39197605)

And I'd find a new retina specialist. They don't open the eyeball andd scrape it off; I've had a vitrectomy [slashdot.org] . The "gunk" is a natural transparent shield that protects the retina, and the vitrectomy removes it as a side effect of reattaching a detached retina.

One or two drops of blood floating around isn't cause for much concern, but if you see a black snake or black snow, get to the emergency room or your eye doctor immediately.

When your retina bleeds, it's been torn and you should seek immediate medical attention. There are a couple of treatments for it, none of them fun. They can weld it back together with a laser, or put a metal probe supercooled by liquid nitrogen on your eyeball. That's painful as hell, especially if it's on a major nerve.

Torn retinas that aren't fixed usually detach, and a detached retina can make you 100% blind in the affected eye if not taken care of. The sooner the surgery is performed, the better. But my own surgeon said he could do a vitrectomy for the large number of floaters in the eye but was against it, it is a dangerous surgery. He had to when my retina finally did detach.

If you do have to undergo it (not fun, not fun at all) you have a choice of a local or general anesthetic and I made the mistake of letting the anesthesiologist talk me into a local. Your head is bolted to the table and they stick needles in your eyeball to do the surgery through. The retina is smoothed back, the vitreous removed from your eye and replaced by a nitrogen bubble. It takes a week or two for the eye to absorb the nitrogen and replace the vitreous, and until the bubble is gone you have to hold your head down for all but ten minutes of each hour, and sleep on your stomach.

It isn't fun at all.

Re:You're in trouble (1)

tomhudson (43916) | more than 2 years ago | (#39199841)

It's been a LOT worse than it is now. Originally, the left eye was completely opaque due to all the bleeding.

Over time, with lots of laser photocoagulation (which isn't just to "snip the bleeders", but also to reduce the permeability of the retina to perfusion of O2 so that it doesn't promote new vascularization [nih.gov] ), the bleeding is now occasional, and pretty much limited to a "stalk" of fibrous tissue in the center (which they avoid lasering because that's where your sharpest vision is, and hitting that will really ruin your day).

The stalk, until it completely breaks down and is absorbed, will continue to exert some torsion on the tissues, so it will occasionally bleed - but nowhere near as badly as it did. So, I'll get lines of black as a "tubule" (for want of a better word - a blood vessel that has since stopped being a blood vessel, but left behind the epithelial cells that composed its outer surface) fills with blood, and when the blood flow stops, it will gradually fade as the blood gets absorbed by the vitreous and then removed from the eye as part of the natural ebb and flow ... or it settles out as "gunk".

Like everything else, it's all about risk management and playing the odds.

My problem is that the fibrous stalk is right on the fovea, so it's smack dab in the middle of my field of vision, which makes it a real PITA to work on a computer, as it not only interferes with the vision in that eye, but the other eye then gets over-strained. If the same problem were off to one side, I'd just ignore it.

As to whether this guy is good ... this hospital is the designated treatment center for optical critical cases, and they don't take ANY other cases. I saw one patient trying to get on the waiting list, and (since I'm friendly with all the women working the desk) we talked about it after ... the rule is simple - nobody who can get routine treatment elsewhere gets on the list. Not even if they're wiling to wait a year, 2 years, 3 years.

This particular doctor is the guy who teaches the specialists, so every visit, every patient gets seen by several doctors; yesterday was a "light" day (Monday is heavier) - so there was only the usual eye exam to see if there had been any vision loss since the last visit, q&a on changes to medications, etc., tests for internal eye pressure, stuff like that, then several doctors examining both retinas in detail using the slit lamp [wikipedia.org] along with a lens thingee stuck to the eyeball, then the bright light and magnifying lenses and all that stuff, and an explanation as to what they've found so far, what's good, what's bad, and what's next.

Since the cause of the bleeding was advanced proliferative diabetic retinopathy, and not degeneration of the retinal tissue itself, but bleeding of delicate blood vessels that "had n business being there in the first place" and as such, were not well-supported against torsional effects from such things as looking in different directions, it's actually better for the vessels to snap and bleed, than for them to maintain structural integrity and continue to exert torsion on the retina (and possibly tear it) - that, if I understand correctly, is part of the "every time it bleeds, it's that much less likely to bleed in the future" conundrum. A blood vessel that is no longer fixed to the retina will eventually deteriorate and become part of the "debris" floating around, and hopefully eventually continue deteriorating to the point that it can be eliminated by the eye's natural processes.

For non-detail work (like watching TV) it's not really an issue - one good eye is enough, and the other one sees enough outside the central field that a big enough screen is okay, and the commercial breaks every 10 minutes gives an automatic "time out". Computer work - not so good. Even with rest breaks, there's still too much eyestrain, and it's also harder/impossible to do anything meaningful when you can't "get in the zone" for a good chunk of uninterrupted time - not to mention that using larger fonts means less code visible, so a lot more hunting around to find anything. It's not like in the "bad old days" when 40 columns was overkill for asm listings.

I've tried other work-arounds, like replacing some numerical values with constants to make it easier to scan quickly, but it's simply not enough to make up for what's lost. Life's a b*tch, I guess.

Just writing this post is a PITE (pain in the eye), because, unlike writing a story or article, I'm composing it as I write, instead of thinking about it ahead of time and then just committing it to text as a separate, shorter step involving less computer time. So I'm going to have to find some way to make a living either (a) writing, (b) stand-up comic, or (c) politician ... oops, b and c are redundant :-)

Re:You're in trouble (1)

mcgrew (92797) | more than 2 years ago | (#39214665)

It sounds like you're in pretty good hands, and have had some tears lasered. (They should change the spelling of "tear" to "tare", when you're talking about eyes "tear" hinders communication)

lens thingee stuck to the eyeball

If it looks like an ink pen, maybe with a wire going to a small box, that's the instrument they determine ocular pressure with.

Re:You're in trouble (1)

tomhudson (43916) | more than 2 years ago | (#39215845)

No - they use a wireless pen with a pressure sensor probe to determine intra-ocular pressure. This is different.

The lens on the eyeball is a contact lens, along with a cap so that it keeps the eye fully open, and it presses up against the receiver in the slit lamp. This way they get a really magnified, detailed view of the retina - it's pretty much the same setup as when they want to laser the retina, lubricating goop and all, just not as long or occasionally painful, and with a different lens and holder to accommodate the .laser beam.

Kind of gross, but you get used to anything after a few dozen times, I guess.

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