Vitreous haemorrhage
Bleeding into the gel of the eye blurs or blocks vision suddenly. In adults it usually comes from diabetic new vessels or a retinal tear.
What it is
Blood in the vitreous cavity, which causes sudden floaters, haze or loss of vision without pain. It is a sign of another disease: most often proliferative diabetic retinopathy, a retinal tear during vitreous detachment, a vein occlusion or trauma. The key question is whether a retinal detachment lies behind it.
See it in 3D
Who gets it
Proliferative diabetic retinopathy is the most frequent cause in adults; trauma predominates in young people and children.
Causes
- Proliferative diabetic retinopathy
- Retinal tear with posterior vitreous detachment
- Retinal vein occlusion with new vessels
- Trauma
- Neovascular macular degeneration
- Subarachnoid haemorrhage (Terson syndrome)
- Abusive head trauma in infants
Risk factors
- Diabetes with proliferative retinopathy
- Sickle cell disease
- High myopia
- Trauma
Pathophysiology
Fragile new vessels growing on the retina bleed when the vitreous pulls on them, or a normal vessel tears when the vitreous detaches. The blood fills the gel and blocks light; it clears slowly over weeks to months.
Symptoms and signs
- Sudden shower of dark floaters or cobwebs
- Hazy or reddish vision
- Sudden painless loss of vision in severe cases
Diagnosis
- Clinical
- Reduced red reflex and poor view of the fundus; dilated examination of the other eye often shows the cause (for example diabetic retinopathy).
- Tests
- Glucose or HbA1c, blood pressure, blood count and clotting tests according to the cause.
- Imaging
- Ocular ultrasound when the fundus cannot be seen, to rule out retinal detachment and tumours.
Differential diagnosis
- Posterior vitreous detachment without bleeding
- Retinal detachment
- Vitritis (inflammation)
- Dense cataract
Goal of treatment
Find and treat the cause, exclude retinal detachment, and clear the blood if it does not resolve.
Treatment
- Conservative
- Rest with the head raised so the blood settles, and regular ultrasound until the retina can be seen.
- Procedure
- Laser to the retina or anti-VEGF injections for proliferative diabetic retinopathy.
- Surgical
- Vitrectomy for blood that does not clear, for retinal detachment or for some diabetic cases.
- Medical
- Control of glucose, blood pressure and lipids; antithrombotic drugs are reviewed with the treating doctor, not stopped by the patient.
Complications
- Tractional or rhegmatogenous retinal detachment
- Neovascular glaucoma
- Ghost-cell glaucoma
Prognosis
Depends on the cause; many haemorrhages clear and vision recovers when the cause is treated.
Prevention
- Diabetic retinal screening and timely laser
- Eye protection
Test yourself
Think of the answer, then tap the question to see it.
What is the most common cause of vitreous haemorrhage in adults?
Proliferative diabetic retinopathy.
Which imaging is used when the fundus cannot be seen?
Ocular ultrasound, to rule out retinal detachment.
What does vitreous haemorrhage with subarachnoid haemorrhage suggest?
Terson syndrome.
Why it happens
Connections
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Vitreous Hemorrhage (StatPearls Publishing (NCBI Bookshelf), 2023).
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Representative model, for educational purposes only.