Vitreous Hemorrhage

What is vitreous hemorrhage?

Vitreous hemorrhage is blood in the vitreous. The vitreous is the clear gel in the center of the eyeball. Normally the vitreous is clear, and light passes through it to your retina. This allows good vision.

What is the cause?

Any condition that causes bleeding in the back of the eye can allow blood to leak into the vitreous. The most common causes of vitreous hemorrhage are:

• Diabetic retinopathy: New, abnormal blood vessels can form in the back of the eyes of people with diabetes. These blood vessels are not strong and can bleed, leading to a vitreous hemorrhage.
• Trauma: Injury can cause the blood vessels in the back of the eye to bleed.
• Posterior vitreous detachment: As you get older, pockets of fluid develop within the vitreous. When a pocket of fluid forms in the back of the eye, the vitreous may pull away from the back of the eye. As this happens, the vitreous can pull on the retina. This pulling can cause tears in the retina and bleeding from blood vessels in the retina, leading to a vitreous hemorrhage.

Less common causes of vitreous hemorrhage include:

• Bleeding in the brain: Sometimes conditions that cause bleeding in the brain can be associated with bleeding in the eye.
• Blood vessel problems: Blockage in retinal veins or aneurysms in retinal arteries can lead to a vitreous hemorrhage.
• Sickle cell disease: This hereditary disease causes abnormal blood cells. Over time, it may cause abnormal blood vessels to grow in the back of the eyes.

What are the symptoms?

The two most common symptoms are blurry vision and floaters (black spots or cobwebs floating in your vision). You may notice a reddish tint to your vision. You may also notice bright flashes of light in the corners of your vision. This is caused by the vitreous gel pulling on the retina, which can sometimes lead to a retinal tear. These symptoms are painless and may come on suddenly.

How is it diagnosed?

Your healthcare provider will ask about your symptoms, examine your eyes, and do tests to identify the cause. Tests you may have are:

• an exam with a microscope to look at the front of your eye
• a dilated exam using drops to make your pupil larger to look in the back of your eye. During this exam, your healthcare provider may press on the eye to carefully examine all parts of the back of the eye.
• an ultrasound test to examine your eye if your healthcare provider does not have a clear view of the back of your eye
• blood tests to look for specific causes of bleeding in the back of the eye like diabetes.
• a CT scan to look at the bones and tissues around the eye if your eye has been injured

You may be referred to a retinal specialist.

How is it treated?

Treatment depends on the cause of the vitreous hemorrhage. Some conditions that cause vitreous hemorrhage (like diabetic eye disease) can lead to blindness. Regular eye exams and early treatment are important.

Your healthcare provider needs to be able to see through the blood to find the source of the bleeding. Your provider may ask you to sleep with your head elevated. You may need to wear patches on both eyes to limit eye movements the night before your exam. This helps the blood settle down. You may need to stop taking any medicines that make you bleed more easily (such as aspirin or other blood thinners) if your healthcare provider thinks it is safe to do so.

Once the cause of the bleeding is known, it can be treated in a number of ways, such as laser treatment, cryotherapy (freezing the side of the eye), and surgery. The vitreous hemorrhage can take months to go away even after the bleeding has stopped. In some cases, surgery called a vitrectomy may be needed to remove the blood.

How long will the effects last?

Even after the bleeding is stopped, it can take months for your body to clear the blood from the vitreous. You may keep having symptoms until all of the blood is gone.

How can I take care of myself?

• Follow your treatment plan.
• Keep all appointments for provider visits or tests.
• If you have sudden loss of vision or suddenly see flashes or floaters in your vision, contact your eye care provider right away.

How can I help prevent vitreous hemorrhage?

• If you have sudden loss of vision or suddenly see flashes or floaters in your vision, contact your eye care provider right away.
• If you have diabetes, it is very important to maintain good control of your blood sugar, your blood pressure, and your cholesterol. Keep all regularly scheduled eye appointments to check for early signs of diabetic eye disease.
• Wear eye protection at work and while playing contact sports.