top of page

Vitreous haemorrhage

  • Vitreous haemorrhage refers to bleeding into the vitreous, which is the transparent, gel-like substance that makes up most of the volume of the eye,

    • It is located between the lens and the retina (i.e. within the posterior segment). 

​

Causes

​

  • There are many causes; these can broadly be broken down as follows: ​

    • posterior vitreous detachment​ 

      • the vitreous naturally shrinks with age as part of the degenerative processes of ageing

      • as it shrinks, it pulls on the retina. this traction can then lead to a tear

      • this causes vessels to bleed

      • a break in the retina or retinal detachment may also occur

    • ​proliferative retinopathy (retinal disease in which there is new, pathological vessel growth). Causes include:​

      • ​​​diabetic retinopathy​

      • ​retinal vein occlusion

      • vasculitis

    • trauma

    • relating to systemic disease e.g. bleeding disorders, sickle cell disease

​

Symptoms

​

  • Symptoms of vitreous haemorrhage vary according to the location and size of the bleed

  • Symptoms are typically sudden in onset and painless, and may include: 

    • flashes (photopsias)

    • floaters

    • visual blurring or haze 

    • more severe / dense haemorrhage -> severe loss of vision​, visual field defects

​

Investigations​​

  • Slit lamp assessment of the fundus (back of the eye)
    • in dense vitreous haemorrhage it may not be possible to see the structures at the back of the eye
    • if this is the case, ultrasound (B-sound ultrasonography, a specific type used in ophthalmology) should be used
      • this allows assessment for an underlying retinal tear or retinal detachment​

​

Management

​​

  • Treat any underlying cause

  • Observation for a short interval - sometimes can spontaneously clear

  • Vitrectomy

    • vitreous jelly and associated haemorrhage are cut / aspirated from the eye using instruments that are introduced through ports in the sclera

    • the space left behind is then filled with fluid to maintain the pressure of the eye​

  • Intravitreal anti-VEGF injections

    • used when there is an underlying proliferative retinopathy​

​​

References

  • Gong, D., Kozak, A., Shah, V.A. and Kim, L.A. (2019). Pars Plana Vitrectomy. [online] American Academy of Ophthalmology. Available at: https://eyewiki.aao.org/Pars_Plana_Vitrectomy [Accessed 16 Nov. 2023].

  • Salmon, J. F. (2019) Kanski’s clinical ophthalmology. 9th edn. London, England: Elsevier Health Sciences.

bottom of page