EALES

Vascular inflammatory changes usually involve the venous wall causing perivascular inflammation or vasculitis, periarteritis is less common.
     The breakdown of the vascular wall leads to changes in the vascular endothelium. When the inflammation is long-term, it will lead to vascular occlusion. Circulatory congestion from capillaries to arterioles and large blood vessels, then there will be clinical manifestations.
     The disease was described by Eales in 1889, also known as recurrent vitreous hemorrhage in young people, often found in men aged 15-40. The disease is usually in both eyes but can be in 2 different stages.

1.Clinical symptoms:

     - Vision loss from slight to no vision. The patient feels like it is foggy, cloudy, sometimes seeing red blood streaks spreading. When there is too much blood, only light can be perceived.

    - Funduscopy: in the early stages, retinal blood vessels show white fibrous segments in the edematous retina, scattered hemorrhages and soft exudates. If the disease starts with inflammation in the walls of large blood vessels, it can cause edema of the entire posterior retina with many hard exudates and scattered small hemorrhages. In the late stages, there is vitreous hemorrhage. If there is a lot of vitreous blood, the pupil is dark, and the fundus cannot be examined.

2. Paraclinical examination:

    - Fluorescein angiography: when the blood vessels are newly damaged, fluorescent leakage is seen through the vessel wall in each segment, cell penetration is late. If the disease progresses for a long time, the shape of the occluded segments is seen simultaneously with areas of lack of blood flow or neovascularization.

    - In case the fundus cannot be examined, an ultrasound should be performed to assess the condition of the vitreous and retina.

    - Can test skin reaction - Mantoux is usually high (+).

  If the vitreous hemorrhage is small, the blood may resolve on its own within a few days to a few weeks. If the hemorrhage recurs many times, the disease has developed into proliferative retinopathy with neovascularization and fibrous bands from the retina into the vitreous. Neovascularization of the optic disc.
  Sometimes the fibrous bands contract, causing retinal tears and detachment.

3. Treatment:

   - Internal medicine: Help blood to dissolve quickly, drink lots of water, rest.
   - Symptomatic treatment: anti-edema drugs, stabilize blood vessels, prevent bleeding.
   - Treat the cause: if any agent is suspected, perform a definitive test such as mantoux, BW... to treat according to the cause.

   - Prevent recurrence: Laser photocoagulation of all areas of inflammation causing ischemia on fluoroscopy to prevent neovascularization. Retinal laser photocoagulation is the most effective method today.

   - In case of opacity of transparent media that cannot be treated with laser, cryotherapy is used.
  - Vitrectomy: if the blood does not dissolve after 2-3 months, there is a phenomenon of vitreous organization and formation of traction ligaments causing retinal tears and detachment, vitrectomy must be performed.