Vitreous hemorrhage


Refers to bleeding between the iris and the retina.

It is a common cause of vision loss when new friable blood vessels in eyes with proliferative diabetic retinopathy bleed into the eyeball cavity, known as vitreous hemorrhage.

Can cause floaters and at times severe vision loss.

Can be associated with retinal tears or retinal detachment, which can lead to blindness if not repaired with laser or surgical therapy in a timely fashion.

It is the extravasation, or leakage, of blood into the areas in and around the vitreous humor of the eye.

Left untreated, vitreous hemorrhage may result in tractional retinal detachment, fibrosis, scarring, and blindness.

The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye.

The most common cause of vitreous hemorrhage found in adults is diabetic retinopathy.

In diabetic retinopathy abnormal blood vessels can form in the retina, they are weaker and prone to hemorrhage.

In ice with proliferative diabetic retinopathy treatment with either panretinal photocoagulation or anti-VEGF injections, more than 40% still develop vitreous hemorrhage.

Diabetic retinopathy accounts for 31.5-54% of all cases of vitreous hemorrhage in adults in the US.

Trauma is the leading cause of vitreous hemorrhage in young people.

Trauma accounts for 12-18.8% of cases of vitreous hemorrhage in adults.

Retinal tears can allow fluids from the eye to leak in behind the retina, causing retinal detachment, and bleeding from the retinal blood vessels into the vitreous can occur.

Retinal tear accounts for 11.4-44% of vitreous hemorrhage cases.

With advancing age fluid pockets can develop in the vitreous.

If these pockets develop near the back of the eye, the vitreous can pull away from the retina and cause a retinal tear.

Posterior vitreous detachment accounts for 3.7-11.7% of vitreous hemorrhage cases.

Less common causes of vitreous hemorrhage make up 6.4-18% of cases, and include:

Sickle cell retinopathy


Age-related macular degeneration

Retinal neovascularization as a result of branch or central retinal vein occlusion

About 7 cases in 100,000 have no known cause attributed to them.

Vitreous hemorrhage symptoms include:

Blurred vision


Reddish tint to vision

Flashes of light in the peripheral vision.

Floaters may manifest in small vitreous hemorrhages.

Moderate bleeds will often result in dark streaks in the vision, and dense vitreous hemorrhage can significantly inhibit vision.

Diagnosis is made by recognizing symptoms, an eye exam, and performing tests to identify its cause.

Treatments depend on the cause of the hemorrhage.

The goal of the treatment is to fix the cause of the hemorrhage as quickly as possible.

Retinal tears are closed by Laser treatment or cryotherapy, and detached retinas are reattached surgically.

The patient is advised to rest with the head elevated 30-45 degrees, and sometimes use patches over the eyes to limit movement prior to treatment in order to allow the blood to settle.

Patients are advised to avoid aspirin or similar medications.

It can take months to clear all of the blood from the vitreous.

In cases associated with rubeosis iridis or glaucoma, a vitrectomy may be necessary to remove the standing blood in the vitreous.

Vitrectomy surgery involves removal of vitreous gel and clearance of blood and scar tissue relieving retinal traction and is the established standard care.
Among patients whose eyes had vitreous hemorrhage from proliferative diabetic retinopathy, there was no difference in the primary outcome following initial treatment with intravenous aflibercept versus vitrectomy with panretinal photocoagulation (DRCR Retina Network).

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