Vitreous Hemorrhage

The main chamber of the eyeball is called the vitreous cavity and is normally filled with a clear jelly called vitreous. This clear vitreous allows light to travel through to the back wall of the eye and the retina where it can be interpreted as images. Vitreous hemorrhage is a condition where bleeding into the vitreous occurs and clouds your eye’s view. Bleeding usually comes from the blood vessels that feed the retina at the back of the eye.  

Changes caused from complications of diabetes are the most common cause of vitreous hemorrhage in adults. Diabetes can cause the growth of abnormal vessels, which are weak and can break open and bleed into the vitreous. When there is a torn or detached retina, the act of the retina tearing can break blood vessels.  An injury or trauma to the eye can also cause blood vessels in the back of the eye to bleed and is the leading cause of vitreous hemorrhage in young people. Less common causes include posterior vitreous detachment, proliferative sickle cell retinopathy, macroaneurysm, age-related macular degeneration, Terson syndrome, and neovascularization from a branch or central vein occlusion.

Common symptoms include:

• blurred vision
• floaters
• reddish tint to vision
• flashes of light in the peripheral vision.

Usually only one eye is affected. Some people describe the floaters as “cobwebs” or “lace” in their vision. The floaters may appear as general haziness, a red tint, dark streaks, or as shadows. Symptoms usually affect only one eye and are usually worse in the morning or against a bright white background. A dense vitreous hemorrhage can significantly inhibit vision.

A dilated eye exam is necessary to properly diagnose a vitreous hemorrhage. In some cases, the vitreous is severely limiting the view of the retina and your doctor may not be able to see in, much like you cannot see out. In this case your doctor will need to perform an ultrasound to rule out other problems that may have caused the vision loss. A CT scan may be ordered to determine further injury around the eye if trauma was the culprit.

Observation is commonly the only treatment required for a vitreous hemorrhage. The blood usually clears on its own, within several months. The underlying cause of the bleed needs to be treated if necessary. This can be done with laser treatments, cryotherapy, and anti-VEGF injections in the office. In more severe cases, a surgery called a vitrectomy may be required to clear the vitreous and the blood from the eye and replacing it with clear saline solution. This may also be required if the cause of the hemorrhage was due to a detachment.  

Limiting the activities that require a lot of head movement and elevating your head while sleeping are ways to help keep the hemorrhage settled, and not as visible in your vision while your body naturally absorbs the excess blood. Vision usually returns to where it was before the hemorrhage occurred. Make sure to control your blood sugars, blood pressure, and stop smoking to prevent complications. If you have questions about your vision, please call us at (616) 954-2020.