Vitreous prolapse is an eye condition involving the displacement of the eye’s internal gel-like substance from its normal position in the back of the eye. This occurs when the clear, gelatinous material leaks forward into the front chamber of the eye. The condition is a complication that typically follows an injury or surgical procedure that breaches the eye’s internal structure.
Understanding the Vitreous and Prolapse
The vitreous humor is a transparent, gel-like substance that fills the large space between the lens and the retina, making up about 80% of the eye’s total volume. Composed primarily of water, collagen, and salts, this material is contained within the vitreous cavity. Its main functions are to help the eyeball maintain its spherical shape, support the lens, and keep the retina pressed against the back wall of the eye.
Vitreous prolapse describes the mechanical action where this gel is pushed or leaks into the anterior segment of the eye. This displacement is often caused by a break in the posterior capsule, the thin membrane separating the vitreous from the lens. When the vitreous moves forward, it can interfere with anterior chamber structures, potentially creating issues like traction on the retina.
Primary Causes and Risk Factors
Vitreous prolapse occurs almost exclusively following an event that breaches the natural barriers within the eye. The most common context is during intraocular surgery, particularly complicated cataract surgery. If the posterior lens capsule ruptures during the procedure, the opening allows the vitreous gel to move forward into the anterior chamber.
This event is more likely when a patient has pre-existing conditions that weaken the eye’s internal support structures. Risk factors include pseudoexfoliation, which causes weakened zonules—the fibers that hold the lens in place—or a history of ocular trauma. Anatomical issues like lens subluxation or a dense cataract that complicates the surgical view also increase the likelihood of a capsular break. Penetrating eye trauma can also directly cause a breach in the eye wall, leading to vitreous displacement.
Recognizing the Signs
Patients who experience vitreous prolapse may notice a sudden onset of symptoms. The most common symptom is blurred vision. Other symptoms include the appearance of new floaters, or discomfort and irritation in the eye.
During an eye examination, a physician looks for specific clinical signs that confirm the presence of prolapsed vitreous. The most telling sign is the visibility of vitreous strands or gel in the anterior chamber. The pupil may also exhibit a distinctive “peaked” or irregular shape where the vitreous gel is pulling on the iris. Diagnostic tools, such as specialized dyes that stain the vitreous, can help confirm the location and extent of the prolapse.
Treatment Options and Expected Outcomes
Immediate management of vitreous prolapse is necessary to prevent long-term complications. The standard treatment is an anterior vitrectomy, a surgical procedure involving the mechanical removal of the prolapsed vitreous material. The goal is to clear the visual axis and eliminate any strands of vitreous pulling on the iris or other anterior structures, thereby preventing traction on the retina.
The vitrectomy is performed using a specialized cutting and suction device to excise the misplaced gel. Surgeons often prefer a pars plana approach, where the instrument enters the eye through the pars plana, a section behind the iris. This technique helps pull the vitreous back toward the posterior segment, minimizing retinal traction.
If the prolapse is not managed effectively, there is a risk of secondary complications affecting long-term vision. These risks include cystoid macular edema (swelling in the central retina) or retinal detachment, which can lead to permanent vision loss. Prompt surgical cleanup generally leads to favorable outcomes, resulting in improved visual acuity and symptom resolution.