Diagnostics
For a clear diagnosis of a thrombosis in the eye, the ophthalmologist usually performs a reflection of the retina (also called ophthalmoscopy). For this purpose, the ophthalmologist shines a light into the affected eye and can thus detect changes in the retina. The main characteristic of thrombosis in the eye is the streaky or punctiform bleeding in various areas of the retina.
Treatment/Therapy
In the case of thrombosis in the eye, the first step is to treat it with blood-thinning therapy (also known as hemodilution). This is particularly effective if it is started within a few hours after the event. This method of treatment is intended to improve the blood supply to the retina in the long term, thus reducing or even completely eliminating the resulting visual deterioration.
The therapy with the blood-thinning medication should last about four to five weeks. In addition, therapy with VEGF antibodies (such as ranibizumab) is conceivable. VEGF (vascular endothelial growth factor) is a messenger substance that is formed for the formation and growth of new vessels.
Treatment with antibodies against VEGF is therefore intended to inhibit the effect of this messenger substance and thus counteract the proliferation of vessels in the retina. This drug has to be administered by means of an injection into the eye. Another drug for the treatment of ocular vein thrombosis is an implant, which also has to be injected into the eye, where it releases cortisone constantly over several months.
This is intended to suppress the inflammation of the retina and has a positive effect on the healing process. If vascular growths are already present, they can be obliterated by laser coagulation, thus preventing new bleeding into the retina with further complications.Finally, there is also a surgical procedure for the treatment of ocular vein thrombosis. This is radial opticoneurotomy (RON), in which small incisions are made in the area of the optic nerve head to improve the blood supply to the retina in the long term.
However, the operation is relatively complex and only suitable for occlusions of the central vein. Probably the most commonly used drugs for the treatment of thrombosis in the eye are drugs for blood thinning (also: haemodilution). The primary purpose of these substances is to dissolve the thrombus that has formed, thus restoring blood flow to the retina.
There are also two drug therapies where the drug has to be injected into the eye due to its solubility properties. Firstly, thrombosis in the eye can be additionally treated with antibodies. These are directed against VEGF (vascular endothelial growth factor).
This is a messenger substance that is crucial for the formation of new vessels. The administration of this drug is intended to counteract the random proliferation of new vessels in the retina, as this can be accompanied by permanent visual impairment. The second drug that is administered by injection is an implant that remains in the eye and continuously releases cortisone over several months.
This counteracts an inflammatory reaction and thus supports the healing process of the damaged retina. Drugs that have to be injected into the eye usually have solubility properties that make this necessary. This is an injection into the vitreous body (also: intravitreal injection).
This procedure is usually performed on an outpatient basis and can be performed both in hospital and in specialized ophthalmologic practices. The eye is first dilated with the help of drops so that it is less sensitive to light and glare. In this state, the pupil can no longer contract well and allows the doctor to look better into the eye.
This is followed by local anesthesia using eye drops. To avoid possible blinking during the injection, the eyelid is usually held open by an instrument called an eyelid lock. Due to the local anesthesia, this is usually not or hardly noticeable.
The actual medication is then finally injected into the white of the eye with a syringe. The person affected only feels a slight pressure. After the procedure, patients should not drive a car or ride a bicycle and should wear dark glasses for a few hours if necessary, as they are more sensitive to light. After a few hours, however, all changes will have disappeared and no further follow-up treatment will be necessary.
