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.
- 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.
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.