Vitreous haemorrhage

• Vitreous haemorrhage:

  • Vitreous haemorrhage is a bleed into the gel-like filling (vitreous humour) in the globe of the eye. 
  • Occurs when damage to the retinal blood vessels has occurred - usually vessels formed due to neovascularisation
  • These vessels are new brittle vessels prone to leaking or breaking in the event of a retinal tear or retinal detachment
  • Often suggestive of other underlying pathology
• Most common causes:

  • Proliferative diabetic retinopathy
  • Posterior vitreous detachment
  • Retinal breaks
  • Retinal detachment or trauma
• Conditions that cause neovascularisation:

  • Diabetic retinopathy
  • Wet age-related macular degeneration
  • Sickle cell retinopathy
• Typical symptoms:

  • Blurred vision - the vitreous is a transparent gel and if the vitreous humour is clouded or filled with blood the vision will be impaired
  • Floaters - often described as a gush of floaters (actually seeing the vitreous haemorrhage)
• Clinical findings:

  • Severe = hazy fundal view and absent red reflex
  • Mild = partially obscured fundal view
  • Chronic = appears as a yellow lesion - due to haemoglobin breakdown
  • May be sign of retinal tear = tobacco dust in the vitreous. This is released by retinal pigment epithelial cells
• Management options:

  • Observation - haemorrhage without a retinal tear or detachment often resolves by itself within a couple of weeks. Should avoid heavy lifting.
  • Laser therapy - for patients with proliferative vasculopathies (e.g. diabetic) and retinal tears
  • Surgical - posterior vitreous detachment, retinal detachment, or haemorrhage that is lasting several months