Vitreous Hemorrhage

VITREOUS HEMORRHAGE    

• It is the extravasation of blood into the areas in and around the vitreous humor of the eye.
• The vitreous humor is the clear gel that fills the space between the lens and the retina of the eye.
• Most common complication after lens extraction persistent hyperplastic primary vitreous is Vitreous hemorrhage

ETIOLOGY:

1. Diabetic Retinopathy

• The most common cause found in adults is diabetic retinopathy.
• Abnormal blood vessels can form in the back of the eye of a person with diabetes.
• These new blood vessels are weaker and prone to breaking and causing hemorrhage.

2. Trauma

• Trauma is the leading cause of vitreous hemorrhage in young people, and accounts for 12-18.8% of cases in adults.

3. Retinal Tear/Detachment

• A tear in the retina can allow fluids from the eye to leak in behind the retina, which causes retinal detachment.
• When this occurs, blood from the retinal blood vessels can bleed into the vitreous.

4. Posterior Vitreous Detachment

• As one gets older, pockets of fluid can develop in the vitreous.
• When these pockets develop near the back of the eye, the vitreous can pull away from the retina and possibly tear it.

5. Other Causes

• Proliferative sickle cell retinopathy
• Macroaneurysm
• Age-related macular degeneration
• Terson syndrome
• Retinal neovascularization as a result of branch or central retinal vein occlusion

Symptoms/Diagnosis

• Blurry vision
• In a young patient presenting with recurrent vitreous hemorrhage, diagnosis is Eale’s disease
• Floaters– faint cobweb-like apparitions floating through the field of vision
• Reddish tint to vision
• Vitreous hemorrhage produces Sudden painless loss of vision
• Photopsia-brief flashes of light in the peripheral vision
• Small vitreous hemorrhage often manifests itself as “floaters”.
• A moderate case will often result in dark streaks in the vision, while dense vitreous hemorrhage can significantly inhibit vision.

Treatments

• The treatment method used depends on the cause of the hemorrhage.
• In most cases, the patient is advised to rest with their head elevated 30-45° and sometimes to put patches over the eyes to limit movement prior to treatment in order to allow the blood to settle.
• The patient is also advised to avoid taking medications that cause blood thinning (such as aspirin or similar medications).
• Retinal tears are closed by Laser treatment or cryotherapy, and detached retinas are reattached surgically.
• In cases of vitreous hemorrhage due to detached retina, long standing vitreous hemorrhage with a duration of more than 2-3 months, or cases associated with rubeosis iridis or glaucoma, a vitrectomy may be necessary to remove the standing blood in the vitreous