• Vitreous Hemorrhage

    Definition

    Vitreous hemorrhage is the leakage of blood into the gel-like fluid of the eye. Blood in this fluid can interfere with vision.
    Normal Anatomy of the Eye
    Copyright © Nucleus Medical Media, Inc.

    Causes

    A vitreous hemorrhage is usually caused by leakage of damaged or abnormal blood vessels in the back of the eye. The blood cells that leak into the vitreous humor reflect light that is entering the eye and distort vision.

    Risk Factors

    Medical conditions and injuries that can cause damage to the blood vessels of the eye and vitreous hemorrhage include:
    • Diabetic retinopathy—most common cause of eye blood vessel damage and new growth.
    • Retinal tear or detachment
    • Posterior vitreous detachment
    • Trauma or injury to the eye
    • Rarely, tumors or bleeding from another part of the body

    Symptoms

    Blood in the gel of the eye scatters the light which may cause:
    • Black spots, floaters, or light flashes
    • Blurriness or haziness
    • Shadows
    • Seeing red hues
    • Scotomas—changes in or distortion of visual field (blind spot)
    • Vision loss
    For some, vision problems are worse in the morning.

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. A hemorrhage may be suspected based on symptoms and risk factors.
    A vitreous hemorrhage can usually be detected with a special tool called a slit-lamp. The lamp allows the doctor to look at the back of the eye to look for blood vessel leakage or damage. If a slit-lamp is not available, bleeding may be detected with ultrasound.

    Treatment

    The vitreous blood usually resolves on its own without treatment. During this time, symptoms will be monitored for any changes.
    Treatment of the cause may be necessary. For example, a change in glucose management may help with diabetic retinopathy or surgery may be needed for a retinal detachment.
    Medications may be needed to relieve some of the bleeding. Options include:
    • Eye drops to reduce eye pressure, and/or dilate the pupils
    • Vascular endothelial growth factor inhibitors to prevent abnormal new blood vessels from forming
    A severe hemorrhage or bleeding that doesn’t stop on its own may need to be treated with surgery. Surgical options include:
    • Laser panretinal photocoagulation—Lasers are used to heat blood vessels to slow or stop abnormal new blood vessels from forming.
    • Vitrectomy—Retinal detachment or persistent vitreous hemorrhage may be treated by removal of the gel-like substance from the eye and replacement with gas or solution. Over time the eye will form new gel-like substance for the eye.

    Prevention

    To help reduce your chance of a vitreous hemorrhage:
    • Manage chronic conditions like diabetes according to your treatment plan.
    • Take safety measures to avoid injury, such as wearing protective eye wear or a seatbelt.
    • Get regular eye exams as advised by your eye doctor.
    • Seek prompt treatment for any eye problems or injuries.

    RESOURCES

    Eye Smart—American Academy of Ophthalmology http://www.geteyesmart.org

    National Eye Institute (NEI) https://nei.nih.gov

    CANADIAN RESOURCES

    Canadian Association of Optometrists https://opto.ca

    Canadian Ophthalmological Society http://www.cos-sco.ca

    References

    Berdahl JP, Mruthyunjaya P. Vitreous hemorrhage: Diagnosis and treatment. American Academy of Ophthalmology website. Available at: http://www.aao.org/eyenet/article/vitreous-hemorrhage-diagnosis-treatment-2?march-2007. Accessed November 23, 2015.

    Diabetic neuropathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 21, 2015. Accessed November 23, 2015.

    Kim DY, Joe SG, et al. Acute-onset vitreous hemorrhage of unknown origin before vitrectomy: Causes and prognosis. J Ophthalmol. 2015. [Epub ahead of print].

    Retinal detachment. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 10, 2015. Accessed November 23, 2015.

    Vitreous hemorrhage. Eye Institute website. Available at: http://www.eyeinstitute.co.nz/the-eye/eye-diseases-and-conditions/vitreous-haemorrhage.htm. Accessed November 23, 2015.

    Revision Information

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