Article status: Temporary high-yield summaryVitreous Haemorrhage
Vitreous haemorrhage refers to bleeding into the vitreous humour, the gel-like substance that fills the posterior chamber of the eye.
Causes
Important causes:
- Proliferative diabetic retinopathy (fragile new vessels can bleed) – most common cause
- Retinal tear / break (if the tear disrupts vessels → vitreous haemorrhage)
- Sickle cell retinopathy
- Trauma
Relationship between vitreous haemorrhage and retinal detachment:
- Vitreous haemorrhage itself does NOT cause retinal detachment
- However, the presence of vitreous haemorrhage may suggest underlying retinal tear or detachment. Because a retinal tear can cause retinal detachment and vitreous haemorrhage (if a vessel is torn too).
Therefore, the presence of vitreous haemorrhage needs immediate referral to ophthalmology to exclude underlying retinal tear / detachment.
Clinical Features
Typically presents as:
- Sudden, painless visual loss (severity depends on the density and location of haemorrhage)
- New floaters
- Flashes
- Red / brown tint to vision
Presence of a dark curtain / shadow starting in the periphery and progressing towards the centre should raise concern of concurrent retinal detachment.
Investigation and Diagnosis
Initial assessment:
- Visual acuity assessment
- Fundoscopy
- Slit lamp examination
B-scan ultrasound is particularly important if the retina cannot be visualised, as it can detect any underlying retinal detachment and tear.
Management
New vitreous haemorrhage should generally be treated as an urgent ophthalmology problem until retinal tear or retinal detachment has been excluded.
Key management principles:
- Most important early step: exclude underlying retinal tear / detachment and manage accordingly (see the Retinal Detachment article for more information)
- Identify and treat the underlying cause
- Underlying retinal tear would need laser or cryotherapy; retinal detachment would need surgical intervention (see the Retinal Detachment article for more information)
- Proliferative diabetic retinopathy would require pan-retinal photocoagulation (see the Diabetic Retinopathy article for more information)
- Management of the vitreous haemorrhage itself
- Initial treatment often involves watch and wait (conservative)
- If vitreous haemorrhage is non-clearing for >3 months, vitrectomy might be needed