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Disease

Vitreous Hemorrhage

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Vitreous Hemmorhage and Retinal Tear

Definition: Vitreous hemorrhage is a condition of intraocular (inside the eye) bleeding that usually presents with sudden vision loss, frequently with complaints of floaters or "spots" in the vision. The condition is not due to bleeding of the vitreous humor, but rather bleeding from the retinal vessels or underlying choroid (layer of capillaries beneath the retina) in most cases. Occasionally, bleeding from the iris (in the front of the eye) results in the presence of blood in the vitreous humor. 

Causes and Risk Factors: There are many potential causes of vitreous hemorrhage. Only the most common will be covered here. Proliferative diabetic retinopathy (growth of abnormal vessels) is the most common cause of spontaneous vitreous hemorrhage. A retinal tear or retinal detachment may tear a retinal vessel, thereby producing vitreous hemorrhage. This is also quite common and is the reason that patients with retinal detachment often have symptoms of floaters, typically prior to the onset of peripheral or total vision loss. Posterior vitreous separation (separation of the vitreous humor from the retina), common in the middle-aged and elderly, occasionally produces a torn retinal vessel, and therefore a vitreous hemorrhage. This condition may lead to retinal detachment. Central or branch retinal vein occlusions may produce vitreous hemorrhage, and are most common in patients with high blood pressure or diabetes. There are many other causes of vitreous hemorrhage, but these are relatively rare. 

Signs & Symptoms: Someone experiencing a vitreous hemorrhage may experience one or more of the following symptoms:

•  sudden onset of blurry vision
•  light flashes
•  floaters (spots seemingly floating across the field of vision)
•  blindness

Diagnostic Testing:

• Retinal examination
• Visual acuity
• Slit lamp examination
• Direct and indirect ophthalmoscopy
• Ultrasound (to rule out retinal detachment)
• Fluorescein Angiogram

Treatment:

Initial treatment may be observation alone. Minor hemorrhages often clot and resolve on their own over time. Unfortunately, it may take months for full visual recovery from a vitreous hemorrhage. Current research has produced drugs that can dissolve the vitreous gel inside the eye and may dramatically reduce the recovery time. These drugs are currently in the investigational stage and are awaiting FDA approval.

For more severe and debilitating vitreous hemorrhage, a vitrectomy may be performed. A vitrectomy is a surgical procedure that removes the vitreous gel and the blood from inside the eye. After the vitreous is removed, the surgeon will refill the eye with a special saline solution that closely resembles the natural vitreous fluid in the eye. Recovery from the procedure will take up to 6 weeks and complete vision recovery will take a little longer.