Vitreous Hemorrhage

 

🩸 Vitreous Hemorrhage

Bleeding into the vitreous cavity — the clear, gel-like substance that fills the eye behind the lens and in front of the retina.

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🔍 Definition

Vitreous hemorrhage is the presence of blood within the vitreous humor, caused by bleeding from retinal vessels, neovascularization, trauma, or other retinal pathologies.

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🔬 Anatomy Recap

• The vitreous body is avascular (no blood vessels).

• Hemorrhage usually results from blood entering from adjacent structures, especially the retina, optic disc, or ciliary body.

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🧠 Causes

👁️‍🗨️ Common Causes:

Category	Examples
Retinal Neovascularization	➤ Diabetic Retinopathy (most common)
➤ Retinal vein occlusion
➤ Sickle cell retinopathy
Trauma	➤ Blunt or penetrating trauma
➤ Post-surgical (cataract, vitrectomy)
Posterior Vitreous Detachment (PVD)	➤ May tear a retinal vessel
Retinal Tears/Detachment	➤ Associated with bleeding
Others	➤ Terson's syndrome (subarachnoid hemorrhage)
➤ Blood dyscrasias (e.g., leukemia)
➤ Coagulopathies

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👁️ Clinical Features

Symptom	Description
Sudden painless vision loss	Partial or complete, depending on amount of blood
Floaters	"Cobwebs" or black dots
Photopsia	Flashes of light if retinal tear/detachment
Red hue or shadows	Seen in dense hemorrhages
Visual obscuration	“Looking through smoke” or “red fog”

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🩺 Examination & Diagnosis

🔦 Clinical Exam:

• Visual acuity: may be drastically reduced

• Pupillary reflex: RAPD if retinal detachment present

• Red reflex: Reduced or absent

• Fundoscopy:

  • Mild: Visible fundus with blood strands

  • Moderate-Severe: Fundus obscured

🧪 Investigations:

1. B-scan Ultrasonography (if fundus not visible)

   • Rules out retinal detachment, foreign body, mass

2. OCT / OCT-A

   • Post-clearance, used to assess retina, macula, neovascularization

3. Fluorescein Angiography

   • Helpful once hemorrhage clears

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🛠️ Management

🤍 Conservative (Initial Approach)

• Bed rest with head elevated

• Avoid anticoagulants/NSAIDs if safe

• Monitor with serial ultrasounds

• Spontaneous resolution in 2–6 weeks if small bleed

🔬 Medical Treatment

• Manage underlying cause:

  • Diabetes (tight glycemic control)

  • Hypertension

  • Retinal ischemia → anti-VEGF injections (e.g., bevacizumab)

🧑‍⚕️ Surgical Intervention

Pars Plana Vitrectomy (PPV) if:

• Non-clearing hemorrhage > 3 months

• Dense hemorrhage with retinal detachment

• Recurrent hemorrhage

• Tractional retinal detachment

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🚩 Complications

• Retinal detachment

• Proliferative vitreoretinopathy (PVR)

• Persistent floaters

• Re-bleeding

• Vision loss if not treated

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📝 Key Summary

Feature	Details
Common cause	Diabetic retinopathy
Symptoms	Sudden, painless vision loss + floaters
Diagnosis	Clinical + B-scan US
Treatment	Observation → Vitrectomy
Urgency	Depends on severity and cause