VITREOUS HAEMORRHAGE

DEFINITION

Bleeding into the vitreous chamber or a space created by vitreous

detachment. Vitreous haemorrhage usually occurs from the retinal
vessels and may present as pre-retinal (sub-hyaloid) or an intragel
haemorrhage. The intragel haemorrhage may involve anterior, middle,
posterior or the whole vitreous body.
ETIOLOGY
1. Spontaneous vitreous haemorrhage from retinal breaks especially those associated with PVD.

2. Trauma to eye, which may be blunt or perforating (with or without retained intraocular foreign body) in nature.

3. Inflammatory diseases such as erosion of the vessels in acute chorioretinitis and periphlebitis retinae primary or
secondary to uveitis.

4. Vasculardisorderse.g.,hypertensiveretinopathy, and central retinal vein occlusion.

5. Metabolic diseases such as diabetic retinopathy.

6. Blood dyscrasias e.g., retinopathy of anaemia, leukaemias, polycythemias and sickle-cell retinopathy.

7. Bleedingdisorderse.g.,purpura,haemophiliaand scurvy.

8. Neoplasms.Vitreoushaemorrhagemayoccurfrom rupture of vessels due to acute necrosis in tumours like

retinoblastoma.

9. Idiopathic
PATHOMECHANISMS
SYMPTOMS

Sudden development of floaters occurs when the vitreous

haemorrhage is small. In massive vitreous haemorrhage, patient
develops sudden painless loss of vision.
SIGNS

Distant direct ophthalmoscopy reveals black shadows against the red

glow in small haemorrhages and no red glow in a large
haemorrhage. Direct and indirect ophthalmoscopy may show presence
of blood in the vitreous cavity. Ultrasonography with B-scan is
particularly helpful in diagnosing vitreous haemorrhage.
FATE OF VITREOUS HAEMORRHAGE
1. Complete absorption may occur without organization and the vitreous
becomes clear within 4-8 weeks.
2. Organization of haemorrhage with formation of a yellowish-white debris
occurs in persistent or recurrent bleeding.
3. Complications like vitreous liquefaction, degeneration and khaki cell glaucoma
(in aphakia) may occur.
4. Retinitis proliferans may occur which may be complicated by tractional retinal
detachment.
TREATMENT
Conservative treatment consists of bed rest, elevation of patients head and
bilateral eye patches. This will allow the blood to settle down.

Treatment of the cause. Once the blood settles down, indirect ophthalmoscopy
should be performed to locate and further manage the causative lesion such as a
retinal break, phlebitis, proliferative retinopathy, etc.

Vitrectomy by pars plana route should be considered to clear the vitreous, if the
haemorrhage is not absorbed after 3 months
PROGNOSIS

Absorption of a vitreous hemorrhage is a long process. The clinical

course will depend on the location, cause, and severity of the bleeding.
Bleeding in the vitreous body itself is absorbed particularly slowly.