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A-Z Glossary

Table of Contents

Vitreous Hemorrhage

Courtney Dryer, OD
Written byCourtney Dryer, OD
Courtney Dryer, OD
Courtney Dryer, ODOptometristCharlotte, NC

Bio

Dr. Courtney Dryer earned her doctorate from Southern College of Optometry, Memphis, Tennessee in 2011. She opened her own practice Autarchic Spec Shop in 2013 in Charlotte, NC. She has had the privilege of writing for numerous optometric publications and serving in various industry capacities. In 2015, Vision Monday named her a rising star and one of the most influential women in optometry. Her optometric passions include practice management, specialty contact lenses, and dry eye management.

  • Last updated January 13, 2023

What is a Vitreous Hemorrhage?

A vitreous hemorrhage is a bleed in the vitreous which is caused by a disruption to retinal blood vessels, the growth of abnormal, new blood vessels or the extension of bleeding from the retina.  A serious vitreous hemorrhage is estimated to affect 7 per 100,000 people per year. A vitreous hemorrhage results in rapid clot formation and is followed by slow clearance at approximately 1% per day. 

Key Takeaways

  • Vitreous hemorrhage is caused by a disruption to current blood vessels or the growth of abnormal vessels.
  • Vitreous hemorrhages occur quickly but clear slowly.
  • Treatment is directed at the cause, typically diabetic retinopathy.
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Understanding Vitreous Hemorrhage

Blood into the vitreous cavity is usually caused by two mechanisms: the rupture of normal blood vessels by mechanical force and a hemorrhage from pathologic ocular structures such as tumors or neovascularization.

Prevention should be directed at controlling risk factors for systemic vascular disease such as diabetes, hypertension, and smoking. Frequent dilated fundus exams can reveal retinopathy in high-risk populations and proper opportunistic therapeutic intervention.  Proper eye protection should be worn during activities likely to cause eye trauma (e.g. hammering or grinding metal, using firearms, playing sports with high-speed balls such as racquetball). 

Risk Factors for Vitreous Hemorrhage

The most common causes of a vitreous hemorrhage include proliferative diabetic retinopathy, vitreous detachment with or without retinal breaks, age-related macular degeneration, and trauma. People younger than 40 with vitreous hemorrhage often have a history of recent ocular trauma whereas older, non-diabetic populations have suffered an acute PVD and/or retinal tear.

Less common causes include vascular occlusive disease, retinal arterial macroaneurysm, hemoglobinopathies, age-related macular degeneration, intraocular tumors, and others. It can be difficult for an eye doctor to find the underlying cause of a vitreous hemorrhage. Anticoagulants and antiplatelet agents do not likely cause a spontaneous vitreous hemorrhage, but they may enhance bleeding from ocular pathology.

Symptoms of Vitreous Hemorrhage

  • Painless, but substantial vision loss
  • Red hue to vision
  • New onset of floaters, shadows, or cobwebs
  • Worsened symptoms in the morning if blood settles on macula during night

Diagnosing Vitreous Hemorrhage

Evidence of vitreous hemorrhage is often seen on physical exam and inferred through the patient’s  history. Systemic past medical and ocular history can help lead a doctor to diagnosis.

Vitreous Treatment

Treatment is directed at the cause for the vitreous hemorrhage, such as laser photocoagulation for proliferative diabetic retinopathy or for retinal breaks. Sometimes the hemorrhage does not resolve, and vitrectomy surgery is necessary and beneficial for improving the patient’s visual acuity.

Bibliography

  1. Goff MJ, McDonald HR, Johnson RN, Ai E, Jumper JM, Fu AD. Causes and treatment of vitreous hemorrhage. Compr Ophthalmol Update. 2006 May-Jun;7(3):97-111. PMID: 16882398.
  2. Spraul CW, Grossniklaus HE. Vitreous Hemorrhage. Surv Ophthalmol. 1997 Jul-Aug;42(1):3-39. doi: 10.1016/s0039-6257(97)84041-6. PMID: 9265701.

Related Terms

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Episclera

is a fibroelastic structure consisting of two layers joined together loosely. It is the white of the eye

Dermatochalasis

describes the presence of loose and redundant eyelid skin. It is most often caused by aging

Chemosis

is the swelling of the conjunctiva, which is the clear membrane over the eyelids and the surface of the eye

Pupillometer

is a device that measures the distance between the pupils. The device is used when you order new eyeglasses

Spatial Frequency

describes the rate that a stimulus changes across space. It is usually measured with black and white line gratings

Macula Lutea

also known as the macula, refers to the small area in the back of the eye that is responsible for central vision

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