VITREOUS HAEMORRHAGE

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.
Causes
Causes of vitreous haemorrhage are as follows:
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. Vascular disorders e.g., hypertensive retinopathy,
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. Bleeding disorders e.g., purpura, haemophilia and
scurvy.
8. Neoplasms. Vitreous haemorrhage may occur from
rupture of vessels due to acute necrosis in
tumours like retinoblastoma.
9. Idiopathic
Clinical features
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
1. Conservative treatment consists of bed rest,
elevation of patient’s head and bilateral eye
patches. This will allow the blood to settle down.
2. 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.
3. Vitrectomy by pars plana route should be
considered to clear the vitreous, if the
haemorrhage is not absorbed after 3 months.