Common vitreous cases
(click on the cases or conditions for cases and description)

Vitreous pathology rarely presents as the main case in the examination, more commonly the pathology is either 
an incidental finding or an associated feature. Common signs in vitreous are: asteroid hyalosis, posterior vitreous 
detachment, cells in the vitreous and red blood cells. Only two conditions are described here: asteroid hyalosis 
and posterior vitreous detachment.

The most common reason for failing to spot physical sign(s) in the vitreous is incomplete examination. 
For example:

  • during the slit-lamp examination, the candidate may fail to observe the anterior vitreous in his/her 

  • eagerness to look  for physical signs in the anterior segment 
  • during the fundal examination (with 78 or 90D) the attention is drawn to the retinal pathology and 

  • therefore forget to examine the vitreous (vitreous pathology is especially important in macular hole
    in which you need to look for operculum and also in vasculitis/chorioretinal scar for vitreous cells). 
The following describe how to examine the anterior vitreous using a slit-lamp:
Rotate the slit to 45 degrees and tilt it up at the minimum angle of separation from the viewing pathway. 
Observe the vitreous for cells and any opacities. Ask the patient to look up and down and then at your
ear to observe any settled opacities which may thus be stirred up (especially posterior vitreous

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Asteroid hyalosis

Asteroid hyalosis seen through the slit-lamp.

Asteroid hyalosis as seen with an indirect 

The vitreous contains white or yellow refractile deposits dispersed through out the vitreous. The deposits are 
immobile despite movement of the eyes (because they are made up of calcium salts firmly attached to the vitreous
fibrils). The retina view is obscured.

Further examination:

  • look for a second pathology as asteroid hyalosis rarely form the only physical sign

1. What are the differences between asteroid hyalosis and synchysis scintillans?

2. Does asteroid hyalosis reduce the visual acuity of the patient?

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Synchysis scintillans
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Posterior vitreous detachment

Posterior vitreous detachment is a common sign in the examination especially in the elderly. The examiner usually 
does not expect you to comment on it. However, there are certain conditions in which you are expected to look for 
its presence:
  • macular hole: look for the presence of posterior vitreous detachment in the opposite eye; its presence means

  • that macular hole is unlikely to develop.
  • previous retinal detachment surgery: the presence of vitreous detachment means that the patient had an 

  • external procedure and its absence usually suggests vitreoretinal surgery.
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