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Vitreous Wick Syndrome (Vitreous Touch Syndrome)

Practice Essentials

Vitreous wick syndrome, also known as vitreous touch syndrome, occurs after eye surgery or trauma and consists of microscopic wound breakdown accompanied by vitreous prolapse that develops into a vitreous wick. Vitreous wick syndrome may result from the following:

Routine cataract surgery with unrecognized posterior capsular rupture or zonular dehiscence with vitreous prolapse and adhesion to the surgical wound

Complicated cataract surgery with posterior capsular rupture and inadequate anterior vitrectomy with adhesion to the surgical wound

Transconjunctival scleral intravitreal injection of pharmacologic agents

Sutureless small-gauge pars plana vitrectomy

Inadequate prolapsed vitreous removal during repair of scleral or sclerocorneal lacerations

Signs and symptoms

The history may reveal the following:

Pain

Blurring of vision

Itchiness or foreign body sensation

Gush of warm fluid

Recent eye surgery

Recent eye trauma

Gross physical findings may include the following:

Mucous threadlike substance protruding from a surgical site

Irregular pupil

Corneal haze

Hypopyon

Eye redness

Eye discharge

See Presentation for more detail.

Diagnosis

Specimens may be obtained from the external and internal eye for the following studies:

Gram stain or Giemsa stain

Cultures and sensitivities

Calcofluor white (suspected fungal infection)

Findings from slit-lamp examination may include the following:

Externalized vitreous at the wound site (see image below)

Necrotic area around the vitreous wick

Vitreous strand(s) in the anterior chamber

Vitreous strands adherent to the internal aspect of the surgical wound

Peaked pupil

Displaced intraocular lens implant

Posterior capsular rupture

Anterior chamber cells and flare

Positive Seidel test result (A Seidel test is used to identify leakage of aqueous fluid from the anterior chamber. After applying topical anesthesia on the lower eyelid V-pocket, a drop of anesthetic is placed on a fluorescein sodium ophthalmic strip, which is administered on the same area. Examination using a slit lamp biomicroscope with cobalt blue filter is performed to identify pooling of dye and dilution of the dye. Dilution of the dye at the wound area signifies a positive Seidel test result.)

Corneal haze

Hypopyon

Posterior chamber cells and flare

Vitreous degeneration

Cystoid macular edema

Retinal tears or detachment

Endophthalmitis

See Workup for more detail.

Management

Principles of management for vitreous wick syndrome are as follows:

Treatment is primarily surgical but may also include medical therapy as appropriate

The surgical approach to the management depends on the presentation

The type of topical antibiotics used in treatment depends on the suspected infecting agent or the culture and sensitivity results

Postoperative medications may include topical antibiotics (broad-spectrum or targeted), nonsteroidal anti-inflammatory drug (NSAID)-containing ophthalmic drops, steroid drops, and pilocarpine ophthalmic drops

Patients should receive follow-up care 1-2 days after surgery

The use of an eye shield, especially at night, protects the globe from any untoward traumatic episodes

It is essential to determine whether the vitreous wick extends beyond the surgical wound or is merely adherent to the internal edge of the surgical wound. In the latter, the risk of infection is markedly reduced, but one must be aware of the potential long-term effects of ocular inflammation, vitreoretinal traction, and macular edema.

See Treatment and Medication for more detail.

Image library

Externalized vitreous with a peaked pupil. Image c

Externalized vitreous with a peaked pupil. Image courtesy of Manolette Roque, MD, MBA, Roque Eye Clinic.

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