What is a Vitreous Hemorrhage?
A vitreous hemorrhage is the bleeding into the vitreous body or cavity. The vitreous humor, vitreous body, vitreous cavity or posterior chamber is the posterior portion of the eye composed of a viscous jelly-like substance. It is attached to the retina in many places especially in the peripheral retina and around the optic nerve.
What Causes a Vitreous Hemorrhage?
The most common causes for a vitreous hemorrhage are a vitreous detachment with or without a retinal tear, diabetic retinopathy, and ocular trauma.
A vitreous hemorrhage can be less commonly caused by central or branch retinal vein occlusion, age-related macular degeneration, certain inflammatory ocular diseases, artery occlusion with secondary neovascularization, hypertension, retinopathy of prematurity, blood disorders, and subarachnoid hemorrhage.
Risk Factors for Having a Vitreous Hemorrhage
Vitreous hemorrhage in people who are on anticoagulation therapy can occur. There some question as to whether anticoagulation alone causes vitreous hemorrhages. It certainly can cause the hemorrhage to be more severe.
Diabetic patients who do not control their diabetes well have a higher incidence of vitreous hemorrhages.
Myopic people have a higher incidence of vitreous detachments with retinal tears and retinal detachments.
Symptoms of a Vitreous Hemorrhage
Patients can have a variety of complaints such as sudden painless loss of vision, floaters of different sizes and shapes, shadows, and sensation of something flowing into their eye or vision.
Diagnosis of a Vitreous Hemorrhage
The diagnosis can be determined with a complete dilated eye exam. If the hemorrhage is so large the eye doctor is unable to see inside the eye, a B-scan ultrasound may be used to help determine the cause of the hemorrhage.
Treatment of a Vitreous Hemorrhage
General Management of Vitreous Hemorrhage
First, the etiology of the vitreous hemorrhage needs to be determined as this will direct the proper treatment course. If there is no retinal tear or detachment present, the patients can be monitored closely. They are instructed to reduce their activity and to elevate their head when in bed. Medically unnecessary anticoagulants should be stopped.
If a retinal tear or retinal detachment is found, it needs to be repaired.
Medical Treatment of Vitreous Hemorrhages
Intravitreal injection of anti-VEGF drugs to reduce neovascularization.
Surgical Treatment of Vitreous Hemorrhages
Laser treatment may be utilized to treat neovascularization in the retina from diabetes or other vascular diseases.
Pars plana vitrectomy is indicated for non-clearing vitreous hemorrhages usually lasting a few months or longer. In some cases, the prolonged presence of red blood cells in the eye can lead severe form of glaucoma. Pars plana vitrectomy may also help with large hemorrhages for diagnostic purposes.
Vitreous Hemorrhage Outcomes
The prognosis of vitreous hemorrhage is directly related to the etiology of the hemorrhage.
People who have vitreous detachments and/retinal tears do very well. People who have serious diabetic retinopathy, macular degeneration, inflammatory disease, or ocular trauma may not have good results depending on the severity of their eye disease.