Vitreous hemorrhage

What is a vitreous hemorrhage?

• Vitreous hemorrhage has variable symptoms depending on the amount of bleeding: vision of spots that are suspended in vision (floaters), blurred vision or complete and sudden loss of vision.
• It may be caused by multiple causes, such as eye traumas and even underlying conditions such as diabetic retinopathy.
• It is important to go to the ophthalmologist and undergo an examination in order to check there is no other complication associated, such as retinal detachment or glaucoma.
• In many cases, they resolve spontaneously in 2-3 months, although if the bleeding is not reabsorbed, it may require a surgery called vitrectomy.

Vitreous hemorrhages may be of different degrees. Severe bleedings may cause a sudden and complete loss of vision, while mild ones cause blurred vision or the appearance of floaters. Eye injuries, surgical interventions and vascular disorders are its most common causes.

A vitreous hemorrhage is the presence of blood within the eye cavity that is filled with vitreous humor. The vitreous humor is a jelly-like, clear substance made up mostly of water that fills up to two thirds of the eyeball total volume. In the front part of the vitreous humor, we find the crystalline lens and in the rear side, the retina.

When there’s blood within the vitreous humor, this substance loses its transparency, reason why light cannot go through it and the patient experiences vision loss.

Causes

Vitreous hemorrhages may be due to:

• An eye injury, such as direct impact on the eyeball, or damage after an eye surgical intervention.
• Traction of a retinal vessel. Spontaneously, the vitreous humor may pull from some retinal vessel, break it and cause a hemorrhage. This is known as posterior hemorrhagic vitreous detachment. In some cases, the vitreous humor does not only pull from a vessel, but also from the retina, which may cause retinal tears or retinal detachment.
• Vascular causes. Patients with diabetic retinopathy or central retinal vein occlusion experience a lack of oxygen in the retina, which stimulates the creation of abnormal vessels known as neovessels, that may break and cause these bleedings.
• Other less frequent causes are eye tumors and eye inflammations, known as uveitis.

Symptoms

The main symptom in a patient suffering a vitreous hemorrhage is a sudden loss of vision, but it all depends on the severity of hemorrhage.

• Patients suffering a dense hemorrhage, may experience a severe visual deficit, even reaching the legal blindness threshold in the affected eye.
• Patients with mild bleedings, may experience blurred vision or floaters, also known as myodesopsias.

Diagnose

In all cases when a patient experience the above-mentioned symptoms, a comprehensive eye examination will be needed. This will comprise visual acuity, eye fundus examination and, in the case of severe bleedings, an eye ultrasound will be performed in order to rule out the retinal detachment. In these cases, it is also important to monitor intraocular pressure, as blood from hemorrhage may obstruct an eye structure known as trabecular meshwork, which may hinder the drainage of aqueous humor and even lead to glaucoma.

Treatment

The treatment for vitreous hemorrhage depends on the hemorrhage cause and degree of severity.

A wait-and-see approach is usually adopted, as mildest bleedings are usually spontaneously reabsorbed in a 2 or 3-month period.

In case of patients presenting complications, such as a retinal detachment, or in the event of unabsorbed bleedings, a retinal surgery known as vitrectomy must be performed in order to eliminate such bleedings.

It is important as well to always assess whether there is an underlying cause, such as a diabetic retinopathy or vein thrombosis, as in the case of such patients, it may be necessary to apply an Argon laser treatment on the retina.